A 35-year-old man is brought to the emergency department after being stabbed in the left chest. He is alert, pale, and sweating.
Vital signs:
- BP: 82/60 mmHg
- HR: 135/min
- RR: 28/min
- SpO₂: 94% on high-flow oxygen
Examination findings:
- Distended neck veins
- Muffled heart sounds
- Trachea midline
- Breath sounds equal bilaterally
What is the most appropriate immediate management?
A
Immediate needle decompression of the left chest at the 2nd intercostal space mid-clavicular line
B
Emergency resuscitative thoracotomy in the emergency department
C
Urgent pericardiocentesis using the subxiphoid approach
D
Immediate left chest drain insertion at the 5th intercostal space mid-axillary line
E
Urgent CT chest with contrast to identify the injury