A 25-year-old man with COPD on home BiPAP presents with acute onset dyspnea and hypotension (BP 88/52). Vital signs show HR 128/min, RR 28/min, SpO2 78% on supplemental oxygen, and temperature 37.2°C. Physical examination reveals absent breath sounds on the right, distended neck veins, and leftward tracheal deviation. Chest X-ray shows right-sided pneumothorax. He denies chest pain. Which of the following is the best next step in management?
- A)Immediate needle decompressionGABARITO
- B)High resolution chest CT before intervention
- C)Urgent bronchoscopy
- D)Thoracentesis for pleural fluid analysis
- E)Intravenous loop diuretics
Explicação
Immediate needle decompression is correct. This patient has a tension pneumothorax causing obstructive shock, evidenced by unilateral absent breath sounds, hypotension, jugular venous distension, and tracheal deviation. Treatment must precede confirmatory imag... Ver explicação completa e trilha adaptativa →