What is the first intervention for penetrating chest trauma with absent breath sounds on the right and BP of 90/60 mmHg?

In the scenario described, the first intervention for a patient with penetrating chest trauma, absent breath sounds on one side, and hypotension (blood pressure of 90/60 mmHg) is a needle thoracostomy. This intervention addresses the probable presence of a tension pneumothorax, which can occur with penetrating injuries. The absence of breath sounds indicates that there is likely a significant disruption in lung function, possibly due to air trapped in the pleural space.

Needle thoracostomy is performed by inserting a large-bore needle (usually 14-gauge) into the pleural space at the 5th intercostal space in the anterior axillary line, allowing trapped air to escape and relieving pressure on the lung. This intervention can rapidly improve ventilation and oxygenation, and is crucial before progressing to other treatments.

Other interventions, while important, are not the immediate priority in this situation. For instance, chest compressions are critical in cases of cardiac arrest, but they are not indicated solely based on the hypotensive state. Endotracheal intubation may be necessary for airway protection, but it does not address the immediate issue of tension pneumothorax. Administration of IV fluids may be necessary for hypotension but