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This is a very unusual case.

A 74 yr old presented with constipation, he had a back- ground history of emphysema, and was otherwise well and on no medication.

He had been seen in the emergency department 1 week prior with a similar complaint of constipation, nausea and vomiting and had been discharged with laxatives.

Whilst being examined, he became unresponsive and went into cardiac arrest, and was in PEA on the monitor.

He had CPR commenced and the usual arrest protocol for PEA was commenced.

He was transferred to the resus  room with ongoing CPR via our Lucas device. Bedside ultrasound in resus showed a large pericardial effusion with an echodense collection in the pericardial space which was thought to be likely organized clot.

Due to the organized clot causing tamponade, it was decided that this would not be able to be drained with a pericardial drain or pericardiocentesis, and after consultation with cardiology and cardiothoracic teams, the patient went on to have a thoracotomy in the emergency department performed by the cardiothoracic surgeon.

The heart was delivered from the pericardial sac, and there was found to be a rupture of his left ventricle.

This was sewn up, however there was only a flicker of cardiac activity, and it was decided that further intervention in theatre would be futile, and the patient was pronounced deceased.

See the subxiphoid image of the bedside ultrasound below.

Dr Steve Korbel MBBS, BSc(med), FACEM, CCPU

St George Hospital, Sydney, NSW


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