| Summary: | Tension pneumothorax is one of the commonest life-threatening condition seen in multiple injury or polytrauma trauma victims. Chest tube insertion has been the mainstay treatment for tension pneumothorax since early 1970s until today. Despite being a common procedure performed by an emergency resident, the incidence of complications related to the procedure remains significantly high. Iatrogenic complications are particularly more common in patients that are critically ill, obese or with a flail chest. This report will be discussing on an ectopic chest tube insertion during management of a case of traumatic tension pneumothorax in an obese patient with flail chest. Further discussions are on various recent updates on chest tube insertion procedures in an emergency setting. It is vital to understand that prior to chest tube insertion, it is important to acknowledge a possibility of complicated procedure by stratifying the risk of individual patients. Hence, this may reduce the risk of iatrogenic complications. © The Author(s) 2020.
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