[greg c]

bdonham has it nailed, I would guess pericardiocentesis is the word you are going for. I have done it ten times or so, usually at code arrest settings in the hospital. Not technically difficult, but anytime you blindly are sticking sharp pointy things into people, you'd better hope your anatomic landmarks are reliable. I would imagine that this could be a problem in a trauma setting.

Of note, deciding whether you truly have tamponade can be tricky, especially in the prehospital setting where U/S and other diagnostic modalities are not available...

For example: you stick a needle into someone who is actively dying on you. (I do this from an entry point at the xiphoid process, aiming toward the middle third of the (Left) clavicle, at a very shallow angle to the skin, actively aspirating as I go. I'll add that in practice some guys do it differently) Let's say as you advance the needle you begin to get a brisk bloody return- how do you know if you've got a bloody pericardial effusion versus a needle that's just entered a heart chamber? Sure there's all these textbook ideas of hooking up an EKG lead to the needle and watching the EKG spike when you hit myocardium but I guarantee you this will not be possible in the chaotic theater of an arrest situation. You might say that the patient should get better- in fact, s/he should get WAY better if an acute tamponade is the case. I guess if you're lucky enough that tamponade is your ONLY problem that may happen. However, in the real world things usually aren't so clean, eh?

I will add that a check for pulsus paradoxus may be helpful in your clinical exam, and requires only a blood pressure cuff and a stethoscope. I would also add that almost no one does it correctly, and that in a loud environment it is likely worthless. And that it is not a very sensitive nor specific test. I won't waste time typing a description you can likely find on the internet, but if you read about it and still have questions I'll be happy to give my input.

Hope this helps.

-G