Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is :

Ans. is 'b' ie Cardiac Tamponade (Ref. Harrison, 17/e pi490 (16/e, p 1415, 15/e, p 1367))Road traffic accident can lead to all 4 condition but only cardiac tamponade can present the given sign & symptom.Cardiac Tamponade - It is accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to the ventricles.Etiology : 3 most common cause are :Neoplastic ds*Idiopathic pericarditis*Uremia** other causes include : TraumaCardiac operation TuberculosisThe three principal feature of tamponade are elevation of intra cardiac pressures, limitation of ventricular filling and reduction of cardiac output.Clinical symptoms of tamponadeFalling arterial pressure - Pallor, rapid pulseRising venous pressure - Engorged neck veinsFaint heart soundsPulsus Paradoxus > is an important clue to tamponade