A patient presented with a steering wheel injury to the right side of chest with breathlessness and shock. How will you differentiate tension pneumothorax and cardiac tamponade?
(A) Pulse pressure (B) JVP (C) Breath sound (D) Hea sounds
(C) Ans: C. Breath sound(Ref Harrison 19/e p1573, 1719, 18/e p1972)Raised JVP, pulse pressure and muffled hea sounds along with pulsus paradoxus are seen in both cardiac tamponade and tension pneumothorax.These are differentiated by auscultation for breath sounds, which are normal in cardiac tamponade but absent in tension pneumothorax patients.Pericardial Tamponade:The three principal features of tamponade (Beck's triad) are hypotension, soft or absent hea sounds, and jugular venous distention with a prominent x-descent but an absent y-descent.