<prompt> A 25 yr old man came to emergency depament after A. On CXR, multiple ribs fractures were visible. On physical examination, blood pressure was 8060 mmHg and hea rate 150min. Patient was restless, and tachypneic with jugular veins distended. On auscultation, air entry equal on both sides, hea sounds very soft or inaudible. What is the immediate step of management?Needle inseion in 5th ICSEcho guided PericardiocentesisIntercostal tube drainage on both sidesIV fluids for Hypotension  <response>: The above clinical presentation is suggestive of Cardiac Tamponade. The presence of Becks triad Hypotension ,Soft or absent hea sounds and Jugular venous distention ours the diagnosis of Cardiac Tamponade TOC for Cardiac Tamponade: - ECHO guided Pericardiocentesis Tension pneumothorax is ruled out as there isequal air entry on both sides Cardiac Tamponade 1. Exaggerated septal detion 2. Pulsus Paradoxus: SBP , Hence an example of obstructive shock3. BECKS TRIAD: - MUFFLED S1S2 HYPOTENSION Congested neck veins: Non pulsatile JVP 4. Pulsus Paradoxus Electrical Alternans Cardiac TamponadeIf electrical Alternans is given alone in a MCQ, answer as Pericardial Effusion5. Kussmaul sign absent6. Electrical alternans present7. Money bag appearance8. TOC: - Echo guided Pericardiocentesis Xiphisternal approach 