Question

A 25-year-old man presents to the Emergency Department after a gunshot wound to the chest. He is awake and following commands. His vital signs are T 97.5ºF, BP 89/50 mm Hg, HR 120 beats/minute, RR 35 breaths/minute, and oxygen saturation 87% on a nonrebreather facemask. Jugular venous distension is present, and he has diminished breath sounds on the left. Which of the following is the next best step in management?

A) Focused assessment with sonography for trauma examination
B) Needle decompression of the chest
C) Pericardiocentesis
D) Upright chest X-ray

Answer 1

The next best step in management for a 25-year-old man with a gunshot wound to the chest and signs of tension pneumothorax is needle decompression of the chest.

Step-by-step explanation:

The next best step in management for a 25-year-old man with a gunshot wound to the chest and signs of tension pneumothorax, such as jugular venous distension and diminished breath sounds on the left, would be needle decompression of the chest (option B).

Tension pneumothorax occurs when air accumulates in the pleural space and causes a shift of the mediastinum, compromising cardiac output and lung function. Needle decompression involves inserting a large-bore needle into the second intercostal space in the midclavicular line to release the air.

Other options, such as chest tube placement (option A) or upright chest X-ray (option D), may be necessary later in the management, but immediate needle decompression is crucial in this life-threatening emergency.