Question

A patient is brought to the casualty following a road traffic accident. On examination, the patient is conscious, BP is 90/60 mm Hg, respiratory rate is 40 breaths per minute, and pulse rate is 120 bpm. The X ray is shown below. What is the next step in management?

• A. Pericardiocentesis
• B. Thoracotomy
• C. Pleurodesis
• D. Chest tube insertion

Answer 1

The Correct Option is A

In this clinical scenario, we are presented with a patient who has experienced a road traffic accident. The patient is conscious but exhibits signs of hemodynamic instability, including hypotension with a blood pressure of 90/60 mm Hg, tachypnea with a respiratory rate of 40 breaths per minute, and tachycardia with a pulse rate of 120 bpm.

The management of a trauma patient involves prioritizing life-threatening conditions, as outlined by the Advanced Trauma Life Support (ATLS) protocol. The key points to consider in this case are:

• Hypotension (low blood pressure) suggests potential internal bleeding or cardiac tamponade.
• Tachypnea and tachycardia are compensatory mechanisms for either hypoxemia or hemodynamic instability.

Given these findings and without additional specific information from the X-ray, a logical deduction must be made. In trauma settings, the conditions causing abrupt hemodynamic compromise and requiring urgent intervention typically include tension pneumothorax, massive hemothorax, and cardiac tamponade.

Cardiac tamponade is a condition where fluid accumulates in the pericardial space, compressing the heart and hindering its ability to pump blood, leading to hypotension and shock. The classic signs of cardiac tamponade include:

• Hypotension
• Tachycardia
• Tachypnea

The most immediate life-saving procedure to relieve cardiac tamponade is pericardiocentesis.

Conclusion: Based on the patient’s unstable blood pressure, increased respiratory rate, and rapid pulse, coupled with the context of recent trauma, cardiac tamponade is a likely concern. Therefore, the next step in management for this patient should be Pericardiocentesis.