Which of the following is NOT included among the ten signs of tension pneumothorax?

• A. Air hunger
• B. Hypotension
• C. Neck vein distention
• D. Fever

Answer: (D)

Tension pneumothorax causes a rapid cascade of changes from the pressure build-up in the chest: ventilation is impaired, venous return to the heart is reduced, and the mediastinum shifts. This leads to air hunger from poor gas exchange, hypotension from decreased preload, and neck vein distention from obstructed venous return. Fever does not arise from this acute mechanical process; it signals infection or inflammation rather than the sudden intrathoracic pressure effects. So fever is not a sign you’d expect in tension pneumothorax.