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?

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.