A young motorist suffered injuries in a major road traffic accident. He was diagnosed to have fracture of left femur and left humerus. He was also having fractures of multiple ribs anteriorly on both the sides. On examination the blood pressure was 80/60 mm Hg. and hea rate was 140/minute. The patient was agitated, restless, and tachypenic. Jugular veins were distended. Air entry was adequate in both the lung fields. Hea sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt. On priority basis, the immediate intervention would be :
Answer is B (Urgent pericardial tap) `If manifestations of pericardial tamponade appear pericardiocentesis must be carried out at once; since relief of intrapericardial pressure may be life saving' This patient is a case of acute tamponade as seen after cardiac trauma as suggested by the classical findings of : Falling aerial pressure Increased venous pressure and Faint hea sounds In case of tamponade pericardiocentesis (pericardial tap) should be carried out at once, as the release of intrapericardial pressure is life saving. Rapid blood transfusion though essential will be effective only once pericardial tap decompresses the pericardium and enables the hea to pump normally. Intercostal tube drainage is not indicated as air entry is adequate in both lung fileds. Fixation of femur and repair of femoral aery is not the immediate priority. Weak femoral pulsation may be a manifestation of falling aerial pressure due to cardiac tamponade and need to be explored only if patient fails to improve after pericardial tap and blood transfusion.
Rapid blood transfusion.
Urgent pericardial tap
Intercostal tube drainage on both the sides.
Fixation of left femur & repair of femoral aery