Unforeseen

A 63-year-old man presents with worsening dyspnea for one day. Further questioning reveals that he has been 'feeling ill' since four days ago.

Eight days earlier, he fell off of a ladder and fractured two ribs on his right side. X-rays at the emergency department showed no evidence of pneumothorax, and he was subsequently sent home on analgesics.

An urgent ECG is found to be normal.

Select Relevant Investigations
Portable chest X-ray

Performed

The films show healing rib fractures with no consolidation, pneumothorax or hemothorax.
FAST scan

Performed

You remember that FAST scanning is indicated for the evaluation of acute trauma.
Portable echocardiography

Performed

A moderate to severe pericardial effusion is seen with a fluid rim of approximately 2cm around the entire pericardium.
CT Thorax

Performed

You realize that the patient is hemodynamically unstable, and thus unsuitable for CT imaging right now.

Select Relevant Management
IV vasopressors
IV fluids stat
Intercostal tube placement
Ultrasound-guided drainage