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  • • Inadequate perfusion

    • Compression of the heart or great veins


  • • Pericardial tamponade

    • Tension pneumothorax

    • Abdominal compartment syndrome

    • Diaphragmatic rupture with abdominal viscera in chest

Symptoms and Signs

  • • Distended neck veins

    • Postural hypotension

    • Oliguria

    • Sweating

    • Mental status changes

    Kussmaul sign: Distention of neck veins with deep inspiration is pathognomonic of pericardial tamponade

    Paradoxic pulse: A fall of > 10 mm Hg with inspiration supports diagnosis

    • Equalization of heart chamber pressures with pulmonary artery catheter placement

  • • Mechanism of injury often raises suspicion

    • Decision must sometimes be made for intervention without full confirmation of diagnosis, eg, thrombectomy or pericardial aspiration for penetrating chest injuries and loss of signs of life

  • • Physical exam/trauma work-up



  • • See section on particular etiology

Treatment Monitoring

  • • Blood pressure

    • ECG


  • • Varies with etiology and severity


American College of Surgeons: ATLS: Advanced Trauma Life Support Student Manual. American College of Surgeons, 2004.

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