A 22-year-old male presents to the emergency department after a high-speed motor vehicle collision. He is alert but anxious, with rapid shallow breathing, and exhibits paradoxical chest wall movement. On auscultation, breath sounds are absent on the left side, and tracheal deviation is noted toward the right. Which of the following is the most appropriate initial intervention?
Obtain a chest X-ray to confirm the diagnosis
Immediate needle decompression on the affected side
The presentation is suggestive of a tension pneumothorax, characterized by absent breath sounds on the affected side, paradoxical chest wall movement, and tracheal deviation away from the affected side. Immediate needle decompression on the affected side is the correct intervention to prevent cardiovascular collapse. Although a chest X-ray is an important diagnostic tool, it is not the initial intervention in a hemodynamically unstable patient. Administering oxygen and placing the patient on a continuous positive airway pressure (CPAP) could potentially worsen the tension pneumothorax without prior decompression. Intubation without addressing the pneumothorax can also increase intrathoracic pressure and worsen the patient's hemodynamic status.
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Respiratory Emergencies
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