Red flags
- PEA arrest imminent
- Rapid deterioration
- Pulsus paradoxus >20 mmHg
First steps
- ABCDE
- IV fluid 500 mL bolus as bridge
- Avoid PEEP, vasodilators, diuretics
- Urgent bedside echo
Key investigations
- Bedside echo (diastolic RV collapse, effusion)
- ECG (low voltage, electrical alternans)
- CXR (globular heart)
Differentials
- Cardiogenic shock
- Tension pneumothorax
- Massive PE
Initial management
- Pericardiocentesis (echo-guided subxiphoid)
- Send fluid for cell count, culture, cytology, TB
- Treat cause: malignancy, uraemia, TB, post-MI, trauma
- Surgical pericardial window if recurrent
Referral
- Cardiology + cardiothoracic surgery
- Oncology if malignant
AI clinical assessment
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