What are the two ways to treat a tension pneumothorax?

The correct approach to treating a tension pneumothorax involves both "burping" and needle decompression. Needle decompression is typically the first action taken in an emergency scenario to rapidly relieve the pressure build-up in the pleural space. This is performed by inserting a large-bore needle into the second intercostal space, typically in the midclavicular line, to allow trapped air to escape and re-establish normal pressure in the thoracic cavity.

Burping refers to a procedure where the operator gently decompresses the thoracic cavity by opening a sealed chest tube to allow excess air to escape, further effectively managing the pressure. This additional process can help maintain a functional pleural space in cases where a chest tube has already been placed but air continues to accumulate.

Both techniques are critical in emergency situations to prevent cardiovascular collapse and improve oxygenation. Other options, such as fluid resuscitation and monitoring, do not directly address the immediate life-threatening aspect of a tension pneumothorax.