Though emergent pericardiocentesis is a relatively rare procedure in the ED, it is a critical intervention in patients with effusion and life-threatening instability/PEA arrest.
Ultrasound-guided pericardiocentesis is preferred over the traditional "blind" approach, as it allows the provider to choose an optimal position and is associated with fewer complications.
A few pearls when using ultrasound for emergent pericardiocentesis:
Consider placing an NGT for abdominal decompression.
Don't mistake the epicardial fat pad for an effusion; fat pads don't change size and usually move in concert with the ventricle.
The apical 4-chamber view tends to be the most common probe position, as the largest collection of fluid is usually around the apex.
If you are unsure about your needle location, inject 5-ml of agitated saline to confirm you are in the pericardial space.
References
L'Italien AJ. Critical cardiovascular skills and procedures in the emergency department. Emerg Med Clin N Am 2013; 31:151-206.
Tirado A, Wu T, Noble VE, et al. Ultrasound-guided procedures in the emergency department - Diagnostic and therapeutic asset. Emerg Med Clin N Am 2013; 31:117-149.
