Emergency and Toxicologycommon
A 27-year-old man is brought in 20 minutes after his motorcycle struck a tree at speed. He is agitated, with a respiratory rate of 38/min, oxygen saturation 84% on high-flow oxygen, pulse 138/min and blood pressure 76/40 mmHg. His trachea is deviated to the left, the veins in his neck are distended despite the low blood pressure, the right side of the chest is hyper-resonant to percussion and breath sounds are absent on that side. The abdomen is soft.
Which one of the following is the most appropriate immediate management?