A 72-year-old woman is brought to the Emergency Department by her daughter because of significant...

This patient has classic signs of cardiac tamponade (Beck's triad: hypotension, muffled heartsounds, elevated JVP, plus pulsus paradoxus). However, she also has advanced metastatic cancer, functional decline, and has stopped active treatment. In this context, a goals-of-care discussion is the most appropriate next step to determine her wishes regarding interventions like pericardiocentesis.

Toronto Notes 2023 – Palliative Care:

“End-of-life care should prioritize quality of life and patient preferences. In patients with terminal illness and life-threatening conditions (e.g., tamponade), initiate a conversation about goals before aggressive intervention.”

MCCQE1 Objectives – Internal Medicine > Palliative and End-of-Life Care:

“Candidates must assess prognosis, patient values, and initiate appropriate end-of-life discussions before invasive treatment.”

Although pericardiocentesis (A) may relieve symptoms, it should follow consent based on the patient’s goals. ICU (E), fluids (B), or transfusion (D) are not appropriate without this discussion.