A 58-year-old woman with a large pericardial effusion develops cardiac tamponade. Emergency pericardiocentesis is performed via the subxiphoid route. The needle is inserted just left of the xiphoid process and directed toward:

• A The left shoulder ✓
• B The umbilicus
• C The right shoulder
• D The right iliac fossa

Explanation

In the subxiphoid approach the needle enters at the left xiphisternal angle and is advanced at about 45 degrees toward the tip of the left scapula or left shoulder, which aligns it with the long axis of the heart while staying clear of the pleura and lung. Direction toward the right shoulder or abdomen would miss the pericardial sac and risk visceral injury.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.