A 43 year old gentleman presents to the emergency department via ambulance with significant shortness of breath.
On clinical exam, he is in respiratory distress, and his blood pressure is 80/40 with a heart rate of 114. The JVP is quite elevated on exam, and there is significant pedal edema. Heart sounds are difficult to appreciate on auscultation, and there are crackles bilaterally on lung auscultation.
You perform a quick bedside ultrasound which reveals the following images:
These images represent a significant pericardial effusion causing cardiac tamponade. Although tamponade is a clinical diagnosis, bedside ultrasonography can aid in the diagnosis (Grade 1C recommendation, Society of Critical Care Medicine 2016).
In these images, both the presence of a significant pericardial effusion as well as right ventricular collapse in diastole support the diagnosis of cardiac tamponade.
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