Point of care ultrasound (POCUS) in the Emergency Department is a powerful diagnostics tool. The heart is a complex organ and its assessment is intimately intertwined with the nuances of acute and critical care management. Cardiac tamponade is a life threatening condition, and early recognition with timely intervention are crucial.

I was fortunate to learn from echocardiologist Dr Lizzy Guimaraes under the AIU-NUS critical care echo program, with hands-on sessions and logging of cases. I signed up almost right out of med school because sonography is operator dependent — the more you sound under watchful guidance, the larger your library of normals, abnormals and optimisation techniques, and the more efficient and accurate your acquisition and interpretation.

If a patient in cardiac tamponade has arrested / is peri-arrest and timely cardiology support is not available, resuscitative POCUS-guided pericardiocentesis is part of the ED’s workflow. The classic Beck’s triad of hypotension, elevated JVP and muffled heart sounds are straightforward diagnostic clues. None of these were present in our patient, however. He walked into the ED, was triaged to the P3 area (lowest acuity) on arrival, and had been planned for discharge initially until a probe was placed on his chest. He eventually required early drainage of 1.4L of pericardial fluid.

When a patient is not clearly in distress / peri-arrest, how can we better assess for cardiac tamponade / impending tamponade in the ED to improve early intervention and prevention of collapse? I covered these in my presentation at ICEM 2026, learning lots in the process. Grateful to my senior consultant who asked me to sound this case, and the on-call cardiologist (off-site overnight) who reviewed my images and clips in 2D and M-Mode remotely to corroborate interpretation and management.