Question

A 22-year-old man is involved in a high-speed road traffic collision. He is restless and dyspnoeic. Observations: respiratory rate 36/min, pulse 140 bpm, BP 80/50 mmHg, oxygen saturation 85% on high-flow oxygen. Trachea is deviated to the left, there is absent breath sounds on the right and distended neck veins. What is the most appropriate immediate management?

Accepted Answer

Perform immediate needle decompression of the right chest in the appropriate site followed by chest drain insertion

Answer

Order an urgent CT scan of the chest before any intervention

Answer

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

Answer

Give high-dose intravenous Morphine for pain relief and observe

Answer

Arrange urgent echocardiography to exclude tamponade before treatment

Practice question