ENARE Practice Questions - ENARE - Exame Nacional De Residências (Brazil) Exam

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A 32-year-old construction worker arrives at the trauma bay after sustaining a penetrating stab wound to the right hemithorax. On initial evaluation, he is in severe respiratory distress, cyanotic, and agitated. Vital signs reveal blood pressure of 72/40 mmHg, heart rate of 142 bpm, and respiratory rate of 36 bpm. Physical examination demonstrates absent breath sounds and hyperresonance on the right hemithorax, with distended jugular veins and tracheal deviation to the left. What is the immediate priority intervention?

Urgent chest computed tomography (CT) scan to quantify the size of the pneumothorax. Immediate needle decompression in the 4th/5th intercostal space anterior to the mid-axillary line, followed by tube thoracostomy. Endotracheal intubation with high positive end-expiratory pressure (PEEP). Immediate pericardiocentesis under subxiphoid ultrasound guidance.

Correct Answer:

Immediate needle decompression in the 4th/5th intercostal space anterior to the mid-axillary line, followed by tube thoracostomy.

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