First Things First (assess for & treat the following):

• Is pt hemodynamically stable?
  • Vital signs, including bilateral pulses, BP & pulsus paradoxus
  • Pulse oximetry or ABG
  • Consider invasive monitoring (PA catheter, arterial line) to help establish the diagnosis as well as direct therapy.
• Ensure adequate volume resuscitation.
• Does pt have pulmonary edema?
  • If yes, then a pericardial etiology is unlikely.
• Does pt have a predisposing condition for tamponade or other pericardial disease?
  • Recent cardiac surgery or trauma, neoplastic disease, recent viral infection or TB, uremia, history of mantle irradiation
• Consider aortic dissection causing tamponade.
• Consider acute MI & PE in any pt w/ chest pain.