A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management?
A. The patient likely is suffering from hypovolemic shock and should respond quickly to fluid resuscitation B. Beck’s triad will likely be an obvious indication of compressive cardiogenic shock due to pericardial tamponade C. Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade D. The placement of bilateral chest tubes will likely resolve the problem
Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade-shock from cardiac compression occurs when external pressure on the heart impairs ventricular filling. because ventricular filling is a function of venous return and myocardial compliance, any process that places pressure on the heart can cause compressive cardiogenic shock. included among these are pericardial tamponade, tension pneumothorax, mediastinal hematoma, and positive pressure from mechanical ventilation. any patient with hypotension after a wound in proximity of the heart should be considered to have compressive cardiogenic shock until proven otherwise. the classical clinical findings of pericardial tamponade include becks triad of hypotension, neck vein distention and muffled heart sounds. pulses paradoxus may be noted (this involves a decrease rather than the normal increase of systolic blood pressure with inspiration; values 10mmhg are significant). these findings, however, may be obscured in a noisy emergency room environment by positive pressure ventilation or by associated injuries. placement of a cvp catheter confirms the elevation of right-sided filling pressure. if a pulmonary artery catheter has been placed, findings consistent with tamponade or other forms of cardiac compression are a trend toward equalization of chamber pressures as hypotension progresses. in the patient at risk, echocardiography is an extremely sensitive and noninvasive approach to demonstrate pericardial fluid and the need for operation. pericardial tamponade must be relieved urgently and cardiac injuries require emergent sternotomy. chest tube placement would not be appropriate as the sole treatment in this patient.