Treatment

The following is recommended:

• Fluid resuscitation to increase pre-load
• Is the patient stable? For urgent cases, surgical exploration in theatre. Look for co-existing injuries (especially pneumothorax) on a portable CXR first
• Thoracotomy within 10 minutes of cardiac arrest

Correctly performed pericardiocentesis is likely to fail because the blood within the pericardium is clotted. The procedure will also delay thoracotomy. We (the authors) advise against pericardiocentesis unless there is really no one capable of opening the chest. ATLS [2] advises pericardiocentesis only as a temporising measure, pending thoracotomy.

Learning Bite:

• Cardiac tamponade as a result of blunt injury is exceptionally rare
• eFAST is highly sensitive
• Thoracotomy, not pericardiocentesis, is recommended