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Forensic Medicine · Injuries and wounds: cardiac tamponade
Sample itemA man with a stab wound to the left parasternal chest arrives with blood pressure 70/40, distended neck veins and muffled heart sounds. What is the best immediate step?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Emergency pericardial decompression
Hypotension, raised venous pressure and muffled sounds form Beck's triad of tamponade. The blood in the pericardium must be released by pericardiocentesis or surgical decompression, since fluids only temporise. Scanning wastes time in an unstable patient.
Option by option
A. Insertion of an intercostal drain
A chest drain treats blood or air in the pleura and does not relieve tamponade.
B. CT of the chest before intervention
Imaging delays treatment in an unstable patient.
C. Emergency pericardial decompression (correct)
Correct. Relieving the pericardial blood is lifesaving in tamponade.
D. A large fluid bolus alone
Fluids may support pressure briefly but do not remove the cause.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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