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.
- Morgenstern J. (2015). An approach to undifferentiated hypotension. First10EM. Retrieved from https://first10em.com/undifferentiated-hypotension/
- Pickens, A. (2018). EM in 5: Shock. EMDocs. Retrieved from http://www.emdocs.net/em-in-5-shock/
- Richards JB & Wilcox SR. (2014). Diagnosis and management of shock in the emergency department. EB Medicine, 16(3), 1-24. Retrieved from https://www.cmua.nl/Cmua/Inwerken_files/0314%20Shock.pdf