What is the definitive treatment for cardiac tamponade?

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Relieving the pressure on the heart by removing the excess pericardial fluid is the definitive treatment for cardiac tamponade. This decompression is achieved with pericardiocentesis, an urgent procedure that drains fluid and restores normal diastolic filling, quickly improving cardiac output. In unstable patients, perform the drainage at the bedside with real-time imaging guidance (often ultrasound) to maximize safety and effectiveness. After successful drainage, hemodynamics typically improve and signs of tamponade—such as hypotension and pulsus paradoxus—resolve. If tamponade recurs or the underlying problem will continuously produce fluid (for example malignancy or purulent effusion), a surgical pericardial window or pericardiectomy may be needed for long-term control, but the immediate life-saving step is pericardiocentesis.