A patient involved in a high-speed motor vehicle collision presents with hypotension, distended neck veins, and decreased breath sounds on the left side. Which of the following interventions is the highest priority?
Ensure airway patency and perform chest decompression.
Initiate rapid intravenous fluid resuscitation to correct hypotension.
Administer high-flow oxygen via a non-rebreather mask.
The patient's presentation with hypotension, distended neck veins, and unilateral decreased breath sounds is the classic triad for a tension pneumothorax, which is a life-threatening emergency requiring immediate intervention. According to trauma resuscitation principles (ABCDE), addressing airway and breathing threats is the first priority. This involves ensuring airway patency and performing immediate needle decompression of the chest to relieve the tension and restore normal cardiorespiratory function. Rapid fluid resuscitation is contraindicated as it may worsen a potential underlying hemorrhage (permissive hypotension is preferred), and high-flow oxygen, while important, is secondary to decompressing the chest. Arranging a surgical consult is a crucial step for definitive care but is not the most immediate life-saving intervention.
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