Penetrating Thoracic Trauma

Which of the following chest injuries would you most likely be able to identify from the primary survey of a patient (with careful assessment of the ABCDEs) alone?

As described, you have identified a single stab wound with no exit point. The stab wound is left, anterior chest in the mid-clavicular line, just below the nipple line.

Which of the following anatomical structures could be injured as a result of this stabbing? (Please select all that apply)

Among others, one of the differentials for this patient would be a cardiac tamponade. Textbooks describe Beck’s triad as a collection of 3 clinical signs associated with cardiac tamponade. These include:

1. Hypotension
2. Muffled heart sounds
3. Distended neck veins (raised jugular venous pressure).

In clinical practice, and especially in pre-hospital emergency medicine, Beck’s triad is of limited utility.

Which of the following factors might explain why Beck’s triad is not a reliable tool for diagnosing cardiac tamponade in the pre-hospital environment? (Please select all that apply)