Pericardiocentesis should be performed emergently on patients with signs and symptoms of cardiac tamponade regardless of coagulopathy. Pericardial tamponade occurs when fluid builds in the pericardial sac causing collapse of the right ventricle. Relative contraindications include coagulopathy, previous thoracoabdominal surgery, pacemakers, prosthetic heart valves and inability to visualize the effusion with ultrasound.
Pericardial Effusion – The Oreo Cookie Sign: Pericardial effusion: Lateral radiograph of the chest demonstrating the pericardial fat (yellow line) and epicardial fat (red line) with opaque density separating them, indicating pericardial effusion. See oreo cookie for comparison.