A focused cardiac ultrasound study is indicated in the setting of undifferentiated hypotension to assess for the presence or absence of the following entities ¹:

• pericardial effusion
• left ventricular systolic dysfunction
• right ventricular dysfunction
• intravascular hypovolemia

Point of care ultrasonography is sensitive for the presence of pericardial fluid, and when present, several features are suggestive of tamponade physiology, including ²:

• right ventricular diastolic collapse
• right atrial systolic inversion
• plethoric, invariant inferior vena cava

Pericardial tamponade is, however, ultimately a clinical diagnosis. This patient was hypotensive on arrival with JVD on physical exam and echocardiographic evidence of tamponade physiology. Emergency pericardiocentesis was performed, 50mL of fluid removed with subsequent improvement in BP and mental status, and surgery consulted for a pericardial window.