This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
A patient presents to the ER after a A with multiple rib injuries. He is conscious, speaking single words.RR= 40/ minute, BP= 90/40mm Hg. What is the next immediate step in management? 
Select and explain. 
A. Intubate the patient, B. Urgent fluid infusion, C. Chest X- ray, D. Needle inseion in 2nd ICS
D: Needle inseion in 2nd ICS
Answer: D: Needle inseion in 2nd ICS 
Explanation: Answer- D. Needle inseion in 2nd ICSThis is a case of pneumothorax. Although the new ATLS update is 5th intercostal space in mid axillary line but in this question we will go with a time tested method of needle in the 2nd ICS.