Patients with cardiac tamponade following trauma require an urgent thoracotomy. If this is not immediately available, pericardiocentesis might be considered as a temporising measure, however it will not address the cause of bleeding and the patient will rapidly destabilise again.
Pericardial effusion without signs of tamponade and vital signs stable
There are several approaches. Ultrasound guidance is recommended in all cases
The needle is advanced in plane with the operator aspirating the syringe until blood is obtained.
The traditionally taught approach
Ultrasound is placed in the subxiphoid position
The needle is inserted between the xiphoid process and left subcostal margin at 45 degrees, aiming up towards the tip of the scapula
Ultrasound is placed in the apical position
Insert needle at the apex (5th intercostal space, midclavicular line) aiming towards the right shoulder
Advantage of avoiding the liver and lung but can lacerate the internal mammary artery
Ultrasound is placed in the parasternal long view position
Insert needle adjacent to the probe perpendicular to skin in the 4th or 5th intercostal space just lateral to the sternum