What is a common sign of tension pneumothorax in a trauma patient?

Tracheal deviation is a key indicator of tension pneumothorax in a trauma patient. This occurs due to the accumulation of air in the pleural space, which increases intrathoracic pressure and can cause the mediastinum (which includes the trachea) to shift away from the affected side. In a tension pneumothorax, the pressure buildup can cause the trachea to deviate laterally, typically away from the side of the pneumothorax. This physical examination finding is critical as it helps clinicians identify the need for immediate intervention, such as needle decompression, to relieve the pressure and restore normal respiratory function.

Other symptoms like hypotension can occur but are not specific to tension pneumothorax and can be present in various shock states. Severe headache is more often associated with other conditions like intracranial issues rather than tension pneumothorax. Fever generally indicates an infectious process rather than a traumatic respiratory emergency. Therefore, tracheal deviation is the most definitive sign among the options provided that correlates directly with the presence of tension pneumothorax.