Get Answer: Year Presents Emergency Question Guide

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Original Question

A 36-year-old man presents to the emergency department by ambulance after a fall from a high ladder. He reports chest pain, shortness of breath and abdominal pain. Vital signs include a temperature of 98.6°F, pulse of 110 beats/min, respiratory rate of 24 breaths/min, blood pressure of 118/72 mmg and oxygen saturation of 92% on 100% oxygen by face mask. Physical examination demonstrates an anxious patient who appears to be in pain. His airway is patent. Cardiac examination demonstrates normal heart sounds with rapid rate and regular rhythm. Breath sounds are present bilaterally and a gurgling noise is also heard over the left chest. Peripheral pulses are present. Ecchymosis is noted on the left chest and the left upper quadrant of the abdomen. There is tenderness over the left chest and diffuse abdominal tenderness, but no rebound tenderness. The abdomen is soft and appears mildly distended. A portable chest x-ray is obtained (see below). What is the next best step in management? (A) Needle decompression (B) Operative management (C) Pericardiocentesis (D) Repeat chest x-ray in 6 hours (E) Tube thoracostomy

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