Traumatic acute pericardial tamponade.

Pericardial tamponade should always be suspected in the clinical setting of any penetrating wound to the thorax or upper abdomen. The most reliable diagnostic criterion is the triad of hypotension, tachycardia and an elevated central venous pressure. Pericardiocentesis should be performed as a temporizing measure until definitive surgical therapy can be carried out. If the patient suddenly decompensates or arrests in the emergency department, immediate thoractomy with evacuation of the pericardial clot and open chest cardiac massage should be performed. Four case reports are presented. The pathophysiology and treatment are reviewed in detail.