Needle DecompressionYou’re working an overnight shift in the community hospital emergency department. A 42-year-old male farmer fell 20 feet from the barn loft and presents holding his left wrist. He is tachycardic, tachypneic, slightly hypotensive, and appears to be in moderate distress. On your primary survey, you note decreased breath sounds on the left. On your extended FAST exam you detect no lung sliding on the left. You reach for the 14 gauge angiocatheter as you visualize the 2nd intercostal space in the midclavicular line, when your colleague, an EP with recent frontline experience from the war in Afghanistan, gives you a better idea.

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