Rosh Emergency Medicine Practice Test

What is the next most important intervention for managing a patient with a thoracic injury after a rollover accident?

1. Pericardiocentesis

2. Right-sided chest thoracotomy

3. Right-sided needle decompression

4. Right-sided tube thoracostomy

The correct answer is: Right-sided tube thoracostomy

In the context of managing a patient with a thoracic injury following a rollover accident, the priority often lies in addressing potential complications related to pneumothorax or hemothorax. A tube thoracostomy, commonly referred to as chest tube placement, is the most important intervention after initial assessment and stabilization because it allows for the immediate evacuation of air (in the case of a pneumothorax) or blood (in the case of a hemothorax) from the pleural space. This intervention is critical for restoring normal respiratory mechanics and preventing respiratory distress. Given the high risk of chest trauma in rollover accidents, where blunt force trauma to the chest may lead to significant intrathoracic injuries, the placement of a tube thoracostomy is vital. It not only helps relieve pressure caused by air or fluid buildup but also promotes lung re-expansion, improving oxygenation and ventilation. Other potential interventions, while relevant in specific scenarios, do not address the immediate concerns as effectively as tube thoracostomy does in this situation. For example, pericardiocentesis is indicated primarily in cases of cardiac tamponade, which may not be the immediate concern in the context of isolated thoracic trauma. Similarly, a thor