What initial investigations should I perform in a patient suspected of having cardiac tamponade before referring to secondary care?

Initial investigations for suspected cardiac tamponade before referral to secondary care include:

• Clinical assessment: Evaluate vital signs including pulse, blood pressure, and oxygen saturation to assess haemodynamic stability.
• 12-lead ECG: Perform a resting 12-lead electrocardiogram to detect electrical alternans, low voltage QRS complexes, or other abnormalities suggestive of tamponade or pericardial disease.
• Chest X-ray: Consider a chest radiograph to identify an enlarged cardiac silhouette or other thoracic pathology.
• Point-of-care ultrasonography (if available): Use bedside echocardiography to assess for pericardial effusion and signs of cardiac tamponade such as right atrial or right ventricular diastolic collapse.

These investigations help confirm the diagnosis and assess severity, guiding urgent referral to secondary care for definitive management.