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1. You are assessing a patient who was involved in a motor
vehicle collision. He is conscious and alert, but complains
of severe chest pain and difficulty breathing. His skin is
pale and diaphoretic, and his pulse is weak and rapid. You
suspect he has a tension pneumothorax. What is the most
appropriate intervention in the primary assessment?
A) Apply high-flow oxygen via non-rebreather mask
B) Perform needle decompression in the second intercostal
space
C) Insert a chest tube in the fifth intercostal space
D) Transport the patient immediately to the nearest trauma
center
* B) Perform needle decompression in the second
intercostal space
Rationale: A tension pneumothorax is a life-threatening
condition that requires immediate intervention to relieve
the pressure in the pleural cavity and restore adequate
ventilation. Needle decompression is performed by
inserting a large-bore needle in the second intercostal space
at the midclavicular line on the affected side. This allows
air to escape from the pleural space and prevents further
compression of the lung and mediastinal structures.
Applying oxygen, inserting a chest tube, and transporting
the patient are important steps, but they are not as urgent as
needle decompression.
2. You are assessing a patient who was stabbed in the
abdomen. He is conscious but restless, and has a large
amount of blood soaking his clothes. His skin is cool and
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