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EasyEmergency MedicineTension pneumothoraxus-abemus-usmle-step-2

A 24-year-old with suspected pneumothorax after sudden pleuritic pain; CXR shows large right-sided pneumothorax with 3 cm apical pleural line and mediastinal shift, BP 86/58, JVD, trachea deviated left. Best immediate management?

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