Patient with raised JVP and CVP of 16 mm of H2O and persistent hypotension | Crack PGIMER 22 MAY 2016

Following a major trauma a patient presented 3 days later with raised JVP and CVP of 16 mm of H2O and persistent hypotension. The possible causes could be

A. Tension pneumothorax 
B. Cardiac tamponade 
C. Head injury
D. Splenic trauma 
E. Air embolism

The Answer is. (A) Tension pneumothorax ;(B) Cardiac tamponade

• As, the patient having persistent hypotension with raised JVP following history of trauma the possibilities are

(a) Tension pneumothorax                                (b) Cardiac tamponade

• Important features

In cardiac tamponade  incr. JVP ; Narrow pulse pressure, hypotension, .paradoxical low voltage in ECG, etc.
Tension pneumothorax Respiratory distress, mediastinal shifting, reduced air entry: present with weak or absent breath sounds, incr JVP, hypotension

• In head injury, splenic trauma, air-embolism, JVP is not raised.