MEDizzy - A 25-year-old woman arrives in the ER following an

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Trauma II

A 25-year-old woman arrives in the ER following an automobile accident. She is acutely dyspneic with a respiratory rate of 60 breaths per minute. Breath sounds are markedly diminished on the right side. Which of the following is the best first step in the management of this patient?

ExplanationC. Tension pneumothorax is a life-threatening problem requiring immediate treatment. A lung wound that behaves as a ball or flap valve allows escaped air to build up pressure in the intrapleural space. This causes collapse of the ipsilateral lung and shifting of the mediastinum and trachea to the contralateral side, in addition to compression of the vena cava and contralateral lung. Sudden death may ensue because of a decrease in cardiac output, hypoxemia, and ventricular arrhythmias. To accomplish rapid decompression of the pleural space, a large-gauge needle should be passed into the intrapleural cavity through the second intercostal space at the midclavicular line just above the third rib. This may be attached temporarily to an underwater seal with subsequent insertion of a chest tube after the life-threatening urgency has been relieved. Tension pneumothorax produces characteristic x-ray findings of ipsilateral lung collapse, mediastinal and tracheal shift, and compression of the contralateral lung. Occasionally, adhesions prevent complete lung collapse, but the tension pneumothorax is evident because of the mediastinal displacement.