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Pediatrics · Paediatric emergencies: cardiac tamponade
Sample itemA 6-year-old with a tuberculous pericardial effusion becomes restless with BP 70/50 mmHg, heart rate 160 per minute, muffled heart sounds, distended neck veins and pulsus paradoxus. What is the immediate treatment?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Urgent pericardiocentesis
Hypotension, muffled heart sounds, raised venous pressure and pulsus paradoxus indicate cardiac tamponade, which is a cause of obstructive shock. Urgent pericardiocentesis, ideally under echocardiographic guidance, is life-saving.
Option by option
A. Intravenous furosemide
Diuretics reduce preload and worsen tamponade physiology.
B. Antitubercular drugs alone
Antitubercular drugs act slowly and will not relieve an acute life-threatening effusion.
C. Urgent pericardiocentesis (correct)
Correct. Draining the pericardial fluid relieves the obstruction to cardiac filling.
D. Digoxin loading
Digoxin does not relieve the mechanical compression and is not indicated.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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