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Pericardiocentesis decision — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsPericardiocentesis decisionSCE Acute Medicine

A 54-year-old man is assessed on the acute medical unit. He has malignancy, hypotension and echo-confirmed tamponade with right ventricular diastolic collapse. Fluids give minimal improvement. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Arrange urgent echo-guided pericardiocentesis

Arrange urgent echo-guided pericardiocentesis is the best answer because unstable cardiac tamponade requires urgent drainage under imaging guidance where possible. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Temporising fluids do not replace definitive pericardial drainage.

Reference: ESC pericardial disease guideline