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Cardiac tamponade is a life threatening injury following trauma where life can be saved with appropriate and timely intervention. Several studies have been published about management of cardiac tamponade comparing pericardiocentisis vs open surgery. In absence of cardiothoracic surgeon, pericardiocentisis remains the only option for treatment for cardiac tamponade. We present here a successful case of cardiac tamponade managed solely by pericardiocentisis under echo guidance.
A 37 year old man involved in motor vehicular accident was brought to emergency services by local EMS services. On presentation he was restless and agitated, tachypneic with vital sign in extremis. Bedside ultrasound shows no free fluid in abdomen and positive sliding sign in lungs however echo shows pericardial fluid collection with diastolic ventricular collapse. Pericardiocentesis were performed successfully under ultrasound guidance and catheter was anchored for future aspiration. Vital improved following pericardiocentisis, but patient required intubation due to type 1 respiratory failure due to lung contusion. He was subsequently transferred to centre with cardiothoracic unit. Patient was subsequently discharged well on day 15.
While studies have shown superiority of open heart surgery compared to pericardiocentesis, but in centers without cardiothoracic surgery, option to surgery is not available. As such pericardiocentesis might be the only option available, and sometimes may be the only treatment needed without proceeding to surgical repair as seen in this case. Medical literature is scarce regarding comparison of pericardiocentisis as sole management for cardiac tamponade vs open heart surgery in trauma. More study needed to compare between this two methods to find out if pericardiocentisis alone could be successful in managing traumatic cardiac tamponade.
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