Nasogastric tube as an improvised chest drain for tension pneumothorax in a resource-limited rural clinic: bridging a 4-hour transfer time in the absence of a standard intercostal drain.

BACKGROUND: Tension pneumothorax is a life-threatening emergency requiring immediate decompression followed by definitive pleural drainage to prevent rapid cardiopulmonary collapse. Management becomes particularly challenging in resource-limited settings where standard intercostal chest drains are unavailable. CASE PRESENTATION: A 21-year-old woman presented with recurrent tension pneumothorax at a rural clinic in Bhutan after initial needle decompression. Because a standard intercostal chest drain was unavailable and transfer to the nearest referral hospital required approximately four hours, an improvised chest drain using an 18-Fr nasogastric tube connected to an underwater seal was inserted. The patient improved clinically and radiographically, allowing safe transfer for definitive management. DISCUSSION: This case demonstrates that prompt clinical decision-making and the use of an improvised nasogastric tube connected to an underwater seal can provide an effective temporary bridge when standard pleural drainage equipment is unavailable in remote settings. CONCLUSION: Judicious use of readily available devices may provide a lifesaving bridge for recurrent tension pneumothorax when standard equipment is unavailable, allowing safe transfer for definitive management. CLINICAL TRIAL NUMBER: Not applicable.