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Cardiac Tamponade in Trauma — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaCardiac Tamponade in TraumaFRCA Final

A 35-year-old man sustains a stab wound to the left fifth intercostal space, 2 cm lateral to the sternal edge. On arrival he is conscious but has a blood pressure of 75/50 mmHg, a heart rate of 135 beats min−1, distended neck veins and quiet heart sounds. He then develops narrow-complex pulseless electrical activity in the resuscitation room. Bilateral thoracostomies produce no significant release of air or blood. What is the most likely diagnosis and the next immediate intervention?

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Correct answer: A — Cardiac tamponade — immediate resuscitative thoracotomy and pericardiotomy

The answer is A. A precordial stab wound followed by hypotension, raised jugular venous pressure, quiet heart sounds and narrow-complex PEA strongly indicates haemopericardium causing cardiac tamponade. Following witnessed traumatic cardiac arrest, immediate resuscitative thoracotomy with pericardiotomy is required to evacuate blood and clot, relieve tamponade and permit control of the cardiac wound. Traumatic haemopericardium commonly contains clot, so pericardiocentesis is unreliable and is reserved as a temporary measure when surgery is unavailable. Tension pneumothorax and massive haemothorax are less likely because bilateral thoracostomies released neither significant air nor blood. Flail chest does not explain obstructive shock with distended neck veins. Traumatic aortic injury is more typical of major deceleration trauma and endovascular repair is not an immediate treatment for traumatic cardiac arrest.

Reference: NHS England, Clinical Guidelines for Use in a Major Incident, version 2, penetrating knife injury and thoracic rapid-access incision sections, 2020. https://www.england.nhs.uk/wp-content/uploads/2018/12/B0128-clinical-guidelines-for-use-in-a-major-incident-v2-2020.pdf?sJUUAJ4Tml7=w9gofd0qiWyJkT1