Where should the needle decompressor be inserted for a tension pneumothorax?

In the case of a tension pneumothorax, the priority is to relieve pressure build-up in the pleural space to restore normal respiratory function. The recommended sites for needle decompression are both the second intercostal space at the midclavicular line and the fourth intercostal space at the anterior axillary line.

Inserting the needle in the second intercostal space at the midclavicular line is particularly effective because this area provides easy access to the pleural space, and it is away from major blood vessels. This insertion point is often emphasized in TCCC protocols due to its anatomical suitability for quick decompression.

The fourth intercostal space at the anterior axillary line is also an acceptable site for needle decompression. This location provides another effective entry point to access the pleural cavity, although it is less commonly used than the second intercostal space. Both sites are correct, making the option of A and C together valid.

Therefore, the correct answer encompasses both sites, acknowledging that both can be utilized for decompressing tension pneumothorax based on the situation and the provider's training.