If initial needle thoracostomy fails to relieve a tension pneumothorax, what is the next step?

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Relief of intrathoracic pressure from tension pneumothorax is initially achieved with a quick needle decompression, but that is temporary. If that decompression does not relieve the tension, the next step is definitive drainage with a chest tube (tube thoracostomy) to evacuate the air continuously and re-expand the lung. A chest tube provides a much larger, longer-lasting pathway for air to escape, which is necessary when the relief from a needle is incomplete or fails. IV fluids don’t address the underlying air in the chest and won’t resolve the pneumothorax. Pericardiocentesis targets cardiac tamponade, not a pneumothorax, so it isn’t appropriate here.