Synopsis
Recognise haemodynamic pericardial compression, use echo without delaying source control and choose percutaneous versus surgical drainage safely.
- Tamponade is a haemodynamic diagnosis: intrapericardial pressure impairs filling and output; effusion size alone does not define it.
- Rapid haemopericardium can cause arrest with a small volume, while slowly accumulating malignant fluid may be very large before collapse.
- Tachycardia and raised JVP are common; Beck's triad is insensitive and may be altered by hypovolaemia or ventilation.
Key red flags
Hypotension, confusion, oliguria, mottling, rising lactate and syncope indicate failing output and demand immediate drainage.
Investigation priorities
Confirm fluid and haemodynamic effects and plan the safest access.
Management branches
Shock, rapidly worsening perfusion or peri-arrest state with suspected effusion.
- Call resuscitation, interventional cardiology and cardiothoracic/critical-care help; monitor, obtain IV/IO access and perform immediate focused echo during ongoing ABCDE care.
- Avoid induction/positive-pressure ventilation if possible until decompressed; if unavoidable, use expert haemodynamic planning with vasopressor and drainage readiness.