Which of the following is NOT a sign of tension pneumothorax?

In the context of tension pneumothorax, increased breath sounds on both sides are not typically observed. Tension pneumothorax occurs when air enters the pleural space and cannot escape, leading to increased pressure that collapses the lung on the affected side and shifts mediastinal structures.

In the presence of tension pneumothorax, you would expect to see difficulty breathing due to compromised lung function, and tracheal deviation towards the unaffected side, which indicates a shift in anatomical structures caused by increased pressure. Decreased breath sounds on the affected side would also occur because the lung is unable to expand properly. However, increased breath sounds on both sides would suggest that airflow is normal in both lungs, which contradicts the pathology of tension pneumothorax, where one side is severely compromised. Thus, the presence of increased breath sounds bilaterally does not align with the clinical signs associated with this condition.