Mr. AD

39-year-old male was admitted to the emergency room with dypsnea and chest pain 5 hours after having a stone thrown to the chest. At presentation, he was alert, tachypnea with heart rate 128 beats/min, and in pain. On general examination, he was hypotensive, blood pressure of 80/50 mmHg, with peripheral hypoperfusion. There was bruise mark on the chest. Cardiovascular examination showed distended jugular venous pressured, muffled heart sound, and pulsus paradoxus.

Echocardiography was performed to determine the ideal entry site (subxiphoid). Next, we prepared the CVC kit triple lumen 7 Fr x 16 cm and other equipment with aseptic technique. CVC kit triple lumen was rinsed with heparinised solution. The patient was placed in the supine position with the head of the bed elevated at 30 degrees. We cleansed the skin with an antiseptic solution and the patient was fully draped with exposure of only the subxiphoid. Lidocaine was injected. Under echocardiography guidance, we inserted a 16 G needle into the subxiphoid area toward the patient’s left shoulder while aspirating the syringe until the pericardial fluid was obtained. We then extracted 100 ml of bloody pericardial fluid. J wire was then passed through the needle into the pericardial space. The introducer and dilator were inserted over the guidewire and catheter was inserted after the removal of the dilator. The catheter was then fixed to the skin and pericardial drainage continued by connecting its end to infusion set and then to the urine bag with a goal of drainage was 150 ml/day. After the procedure, he was clinically improved, no complications were seen. Echocardiography evaluation showed a reduction in effusion size with a resolution of tamponade. Three days after the procedure, the drainage volume of bloody pericardial fluid was 10 ml. Echocardiogram evaluation showed minimal pericardial effusion with no signs of tamponade. He was then discharged from the hospital 5 days after admission.

This is a case of cardiac tamponade as an uncommon and fatal complication of blunt chest trauma that was diagnosed clinically. Echocardiography was used as an imaging modality to confirm clinical suspicion and as a guide for treatment. The definitive treatment of cardiac tamponade is to reduce the intrapericardial pressure by pericardiocentesis. Pericardiocentesis serves as a procedure for therapeutic and diagnostic. Subxiphoid approach of pericardiocentesis is considered the safest method. Here, we demonstrate a good outcome of emergency pericardiocentesis in cardiac tamponade that was done by CVC kit triple lumen using Seldinger technique in a rural area with limited resources.