A 56 year-old female presents with respiratory distress and…

A 56 year-old female presents with respiratory distress and septic shock.  After intubation, mechanical ventilation, central line placement, and 2 liters normal saline infused, her CVP 12 mmHg, BP 78/52 mmHg, ScvO265%.  What is the appropriate next step:

A trauma patient develops severe difficulty breathing, diste…

A trauma patient develops severe difficulty breathing, distended neck veins, and diminished breath sounds on the right, cyanosis, and deviation of the trachea to the left. Vital signs are blood pressure, 60/40; respirations, 36/min; and pulse, 130/min. Which of the following is the most appropriate next step?