Quiet morning shift. What do you do?

You are working a quiet morning shift when a patient is brought in after a motor vehicle crash. The patient is hypotensive, and the FAST exam reveals a pericardial effusion. You know that time is of the essence, so you rapidly assess the options and wonder whether a needle pericardiocentesis is the best option?

Case Conclusion:
The patient was triaged directly to the resuscitation unit and the trauma surgery service was immediately available at bedside. Further review of the FAST exam revealed right ventricular collapse, and the initial blood pressure of 80/40 mm Hg was consistent with pericardial tamponade. Two large-bore peripheral IVs were placed, and an ECG revealed sinus tachycardia. A bedside pericardiocentesis was performed under ultrasound guidance and 25 mL of blood was aspirated. Repeat blood pressure was 100/60 mm Hg. Chest and pelvic x-rays were within normal limits. The patient was then emergently transported to the operating room for further management. A thoracotomy was performed and noted a 2.5-mm rupture of the right anterior ventricular wall. The defect was repaired, and the patient had an uneventful recovery.

Would you have done it different? Tell us how you would have handled this case.

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