Malignant Pericardial Effusion causing Cardiac Tamponade on Echocardiogram (S4c) Hypotensive + respiratory distress. At first glance you might think "RV looks weird". Its actually an effusion crushing the RV so you can't see it. This is cardiac tamponade! Patient arrests. Bedside pericardiocentesis β ROSC. Repeat echo shows improved filling! After window, found to have tumor infiltration of pericardium Dr. Michael I. Prats @PratsEM #Malignant #Pericardial #Effusion #Cardiac #Tamponade #clinical #ultrasound #s4c #echocardiogram #POCUS #cardiology