<prompt> Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is :Pulmonary LacerationCardiac tamponadeHemothoraxSplenic rupture  <response>: Ans. is b ie Cardiac Tamponade Ref. Harrison, 17e pi490 16e, p 1415, 15e, p 1367Road traffic accident can lead to all 4 condition but only cardiac tamponade can present the given sign symptom.Cardiac Tamponade - It is accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to the ventricles.Etiology : 3 most common cause are :Neoplastic dsIdiopathic pericarditisUremia other causes include : TraumaCardiac operation TuberculosisThe three principal feature of tamponade are elevation of intra cardiac pressures, limitation of ventricular filling and reduction of cardiac output.Clinical symptoms of tamponadeFalling arterial pressure - Pallor, rapid pulseRising venous pressure - Engorged neck veinsFaint heart soundsPulsus Paradoxus is an important clue to tamponade 