21st February 2025

A 45-year-old man presents to A&E with a 1-week history of shortness of breath and fevers at home.

A 45-year-old man presents to A&E with a 1-week history of shortness of breath and fevers at home. Over the last 4 hours, his breathlessness has deteriorated significantly.

He is brought by ambulance to A&E and his initial observations show a heart rate of 115 bpm, blood pressure 92/50 mmHg, oxygen saturations 88% on 15L oxygen, respiratory rate 28/minute and temperature 37.6°C. Examination of the chest reveals absent air entry and reduced chest expansion on the right, with hyperresonance to percussion. There is tracheal deviation to the left. 

What is the most appropriate next step in management?