This patient sustained significant blunt trauma to the chest, presents to the Emergency Department with hypotension, tachycardia, a large chest ecchymosis, and palpable sternal crepitus. The ultrasound image provided shows a subxiphoid view of the heart with a large pericardial effusion. In the setting of trauma, this should be assumed to be a hemopericardium. This patient has cardiac tamponade, which is considered a type of obstructive shock (Choice C). Treatment includes IV hydration to increase preload, bedside pericardiocentesis, and ultimately, a surgical cardiac window performed by cardiothoracic surgery. The other shock types (Choices A, B, D) do not describe this patient’s presentation. Please see the chart below for further description of the different shock types and therapies.
Cite this article as: Joseph Ciano, USA, "Question Of The Day #54," in International Emergency Medicine Education Project, September 10, 2021, https://iem-student.org/2021/09/10/question-of-the-day-54/, date accessed: August 9, 2022
Joey Ciano, DO, MPH is an Emergency Medicine Physician from New York, USA. He completed his Emergency Medicine Residency in Brooklyn, NY and a Fellowship in Global Emergency Medicine in the Northwell-LIJ Health System. He is interested in building the educational infrastructure of EM in countries where EM is not yet recognized as a field and in countries that are in the early stages of this process. He has partnered with international NGOs in EM educational projects and works as a visiting EM faculty member in West Bengal, India. He is excited to collaborate with the other authors of the iEM Education Project to contribute to world of FOAM-ed.
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