03-24-2007, 10:35 AM
A 35-year-old woman is brought to the ED after receiving a stab wound to the right side of the chest at the third intercostal space in the midclavicular line. She is acutely dyspneic but can say her name. Her vital signs are as follows: blood pressure, 80/40 mm Hg; heart rate, 130 bpm; and respiratory rate, 60 breaths/min. Breath sounds are markedly diminished on the right side of the chest, neck veins are flat, and there is tracheal deviation to the left. Which of the following is the most appropriate first step in managing this patient™s injury?
1. Order immediate radiography of the chest
2. Obtain an arterial blood gas measurement
3. Administer a bolus dose of lactated Ringer™s solution, intravenously
4. Intubate the patient
5. Perform needle decompression of the right pleural space
1. Order immediate radiography of the chest
2. Obtain an arterial blood gas measurement
3. Administer a bolus dose of lactated Ringer™s solution, intravenously
4. Intubate the patient
5. Perform needle decompression of the right pleural space