Traumatic pericardial tamponade: relearning old lessons

Traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more common, early diagnosis of tamponade is important so that life saving treatment can be started. The classical features of tamponade may be modified by hypovolaemia and the presence of associated injuries; acute tamponade may also be precipitated by rapid administration of large volumes of fluid. Pericardiocentesis, while sometimes life saving, is dangerous and of limited value. Echocardiography is limited by availability and operator dependence. A high degree of clinical suspicion in patients with chest injuries, together with close monitoring and reevaluation, particularly during volume replacement, is essential. Four cases are described which presented to the accident and emergency department of Glasgow Royal Infirmary, in three of which there was a significant delay in the diagnosis.