According to ATLS protocol, in a patient with suspected cardiac tamponade following penetrating chest trauma, which finding on examination constitutes Beck's triad, and what is the initial emergency intervention?

• A Bradycardia, hypertension, irregular respiration; emergency pericardiocentesis
• B Hypotension, muffled heart sounds, raised JVP; emergency pericardiocentesis or thoracotomy ✓
• C Tachycardia, hypotension, decreased breath sounds; needle decompression
• D Distended neck veins, tracheal deviation, absent breath sounds; chest tube insertion

Explanation

Beck's triad of cardiac tamponade = hypotension (decreased cardiac output), muffled/distant heart sounds (pericardial fluid damping), and raised JVP (impaired venous return). In penetrating trauma with suspected tamponade causing hemodynamic instability, pericardiocentesis (subxiphoid approach, Seldinger technique) provides temporary relief, while emergency resuscitative thoracotomy or surgical pericardial window is the definitive treatment. Needle decompression in the second intercostal space mid-clavicular line is for tension pneumothorax, not tamponade.

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

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Written and medically reviewed by the StethoPrep medical team.