PAEA Surgery End Of Rotation (EOR) Practice Exam

Where should the needle be inserted during a needle decompression?

1. Between the 4th and 5th rib

2. Between the 2nd and 3rd rib

3. Above the 3rd rib, midclavicular line

4. Under the 5th rib, anterior axillary line

The correct answer is: Above the 3rd rib, midclavicular line

During a needle decompression, particularly for cases such as tension pneumothorax, the most efficient and effective entry point is above the 3rd rib at the midclavicular line. This approach is critical due to the anatomical considerations of avoiding injury to the underlying structures. The intercostal vessels and nerves are located just below the ribs, so inserting a needle above the 3rd rib minimizes the risk of damaging these vessels and nerves. The midclavicular line is a standard reference point that helps ensure proper placement and effectiveness of the decompression. In cases of pneumothorax, this site allows for the rapid release of trapped air in the pleural space and can quickly relieve respiratory distress, making it a critical skill in emergency scenarios. Choosing other sites might not only be less effective in relieving the pressure but could also pose a higher risk of complications, such as vascular injury or inadequate decompression.