Pericarditis, Pericardial Tamponade, Tuberculosis.

A 38 year-old man (Ethiopian refugee) with untreated HIV and past history of TB, presents to the emergency department (ED) with anterior chest pain, shortness of breath, and hypotension. He was seen 3 days prior by a walk-in clinic and referred to the ED with chest pain and ECG showing pericarditis but did not attend the ED until symptoms were severe. In the ED, the patient quickly progresses to profound shock and has a PEA arrest. POCUS will show a large pericardial effusion and tamponade. Team members are to initiate CPR, manage the arrest, and treat the effusion using bedside pericardiocentesis in order to obtain the return of spontaneous circulation (ROSC).

Goals and Objectives

Educational Goal: To diagnose and manage a case of pericardial tamponade causing PEA arrest.

Objectives (Medical and CRM):

CRM

1. Demonstrate effective communication with the healthcare team
2. Maintain situational awareness during a rarely performed procedure

Medical

1. Work through the causes of shortness of breath in a young HIV positive patient
2. Recognize the clinical features of pericarditis and pericardial tamponade
3. Manage a PEA arrest that is triggered by pericardial tamponade according to ACLS guidelines and consider modifications to ACLS pertinent to this situation