Afghanistan Specialization Entry Exam

Practice session

A 40-year-old male with metastatic lung adenocarcinoma presents with progressive dyspnea, fatigue, and dizziness. On physical examination, his blood pressure is 82/58 mmHg, heart rate is 124 bpm, jugular veins are engorged and distended up to the angle of the jaw, and heart sounds are distant and muffled (Beck's triad). Pulsus paradoxus is measured at 22 mmHg (an inspiratory drop in systolic blood pressure > 10 mmHg). ECG demonstrates low-voltage QRS complexes and electrical alternans. What is the definitive emergency bedside procedure to relieve this life-threatening obstructive shock?

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