A 26-year-old man has a stab wound just left of the sternal border. He is haemodynamically stable and the eFAST shows a moderate pericardial effusion without tamponade physiology. What is the most appropriate next step?

• A Admit for observation and repeat eFAST in six hours
• B CT chest with contrast and discharge if no active bleed is seen
• C Pericardiocentesis under ultrasound guidance in the emergency department and discharge if dry
• D Subxiphoid pericardial window in the operating theatre ✓

Explanation

Any penetrating wound in the box region with demonstrated pericardial blood mandates operative evaluation, because clotted haemopericardium may be missed and deterioration is sudden. A subxiphoid pericardial window under anaesthesia allows direct inspection of the pericardial cavity and proceeds to sternotomy if blood is found. Serial imaging risks death from sudden tamponade, emergency department pericardiocentesis evacuates clot poorly and is a temporising measure, and CT cannot exclude a sealed cardiac laceration.

Reference: ATLS Advanced Trauma Life Support Student Course Manual, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.