MEDizzy - A 21-year-old woman sustains a stab wound to the middle of

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Trauma II

A 21-year-old woman sustains a stab wound to the middle of the chest. Upon arrival to the ER she has equal breath sounds, blood pressure of 85/46 mm Hg, distended neck veins, and pulsus paradoxus. Which of the following is the most appropriate management of this patient?

ExplanationD. The clinical presentation is consistent with cardiac tamponade. In most cases of trauma-related cardiac tamponade, patients need surgical exploration to relieve the tamponade and repair the wound in the heart that caused it. It is advisable to perform pericardiocentesis or subxiphoid pericardial drainage under local anesthesia before anesthetic induction in these unstable patients. Cardiac tamponade is a reversible cause of shock that occurs when fluid or blood accumulates between the pericardium and the heart. If the pericardial fluid develops under significant pressure, filling of the heart cannot occur during diastole, and the amount of blood ejected during systole decreases. Cardiac tamponade is mainly seen in patients with penetrating trauma in proximity to the sternum. The diagnosis should be considered in patients with pulsus paradoxus, which is a greater than 10-mm Hg fall in arterial systolic blood pressure with inspiration. Echocardiography is the preferred diagnostic tool for identification of fluid or blood in the pericardium.