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