This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Trauma, Subject name: Surgery
An 18-year-old man is brought to the emergency department with a stab wound just to the right of the sternum in the sixth intercostal space. His blood pressure is 80 mm Hg. Faint heart sounds and pulsus paradoxus are noted. Auscultation of the right chest reveals decreased breath sounds. The initial management of this patient should be which of the following? 
Select and explain. 
A. Aspiration of the right chest cavity, B. Aspiration of the pericardium, C. Echocardiogram, D. Pericardial window
A: Aspiration of the right chest cavity
Answer: A: Aspiration of the right chest cavity 
Explanation: In a patient presenting with a chest wound in shock, the priorities are airway, breathing, and circulation. Thus, aspiration of the right chest to rule out a tension pneumothorax should be performed first. Aspiration of the pericardium does not definitively rule out cardiac injury; a pericardial window provides both diagnosis and decompression. An echocardiogram is not indicated in an unstable patient.