Cardiogenic Versus Obstructive Shock as a Consequence of Road Traffic Accidents: A Case Report on Approach.

BACKGROUND AND

INTRODUCTION

Cardiac tamponade is a medical/traumatic emergency characterized by the increased intrapericardial pressure from the accumulation of excessive fluid (either exudate, transudate, or blood) in the pericardium. Emergency sonography is a vital part of the rapid assessment of cases with traffic accidents and chest traumas, as pericardial injuries are among the hidden affected organs. Here, we present a case of successful resuscitation of cardiac tamponade.

CASE PRESENTATION: An 18-year-old male presented as a case of a traffic accident within 30 min with hemodynamic instability from bradycardia, hypotension, decreased Glasgow Coma Scale, and distended jugular venous pressure. Bilateral air entry was present, with the aid of E-FAST, tension pneumothorax was excluded, and cardiac tamponade was diagnosed. Immediately, needle pericardiocentesis was done under the supervision of a senior traumatologist, followed by rapid improvement. A central venous line was inserted in the pericardium for continuous drainage. A total of 810 mL of blood and serosanguineous fluid were drained. The patient was discharged home after 4 days of intensive care stay and 1 day in the ward.

DISCUSSION: Beck's triad, along with bradycardia, indicates cardiac tamponade until proven otherwise. Any case presenting with features of hypotension, especially following trauma to the chest, should have tamponade excluded by using E-FAST. Needle pericardiocentesis is a life-saving procedure that can provide immediate relief through aspiration of the pressure.