Question

A 35-year-old man is brought to the emergency department after a high-speed motor vehicle collision. He is hypotensive and has decreased air entry on the right side with tracheal deviation to the left and distended neck veins. What is the most appropriate immediate management?

Accepted Answer

Perform needle decompression in the 2nd intercostal space mid-clavicular line (or 4th/5th intercostal anterior axillary line) on the right, followed by definitive chest drain

Answer

Order a CT scan of the chest before intervention

Answer

Insert a large-bore chest drain in the 5th intercostal space mid-axillary line without prior decompression

Answer

Give high-flow oxygen and observe

Answer

Arrange urgent thoracotomy without decompression

Practice question

A 35-year-old man is brought to the emergency department after a high-speed motor vehicle collision. He is hypotensive and has decreased air entry on the right side with tracheal deviation to the left and distended neck veins. What is the most appropriate immediate management?