A 17-year-old male is stabbed in the anterior chest with an ice pick. He quickly becomes hypotensive, tachycardic and obtunded. His breath sounds are equal, his neck veins are distended, and his chest x-ray is normal. What condition is most likely?
- Simple pneumothorax
- Tension pneumothorax
- Pericardial Tamponade
- aortic laceration distal to the origin of the left common carotid artery
- inferior vena cava laceration
Answer: C
Pericardial Tamponade
This is the typical clinical presentation of tamponade (hypotension, JVD). He was stabbed and probably has a mediastinal bleed (so, I think the mediastinum would be widened on his chest film — but the "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.
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