A 22-year-old man sustains a stab wound to the left chest in the 'cardiac box' region. He presents with muffled heart sounds, hypotension, and raised JVP. BP is 70/50 mmHg despite 1L fluid bolus. What is the IMMEDIATE management?

• A Emergency echocardiography to confirm tamponade
• B Bilateral chest tubes to rule out tension pneumothorax
• C CT angiography of the chest for vascular mapping
• D Emergency thoracotomy or pericardiocentesis as a temporising measure ✓

Explanation

Beck's triad (muffled heart sounds, hypotension, raised JVP/distended neck veins) after penetrating chest trauma indicates cardiac tamponade. This is a surgical emergency. In an immediately life-threatening situation without access to theatre, pericardiocentesis (needle aspiration of pericardial blood) is a temporising measure. Definitive treatment is emergency thoracotomy with pericardiotomy and cardiac repair. Imaging should not delay treatment in haemodynamic compromise.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.