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To Dr.Asif Huda Ansari
Re : cause of  hypotension

Thank you for the questions and the case.   I recognize that you  may not 
have benefit of an autopsy, which would have been very helpful in this  case.    
Several causes of hypotension can be considered, and one  has already been 
cited to be some sort of spinal cord  injury.     
 
Both PERICARDIAL TAMPONADE and CARDIAC HERNIATION would be rather common  
injuries in the kind of case which you described.    Cardiac  herniation could 
occur following a blunt tear in the pericardium, either on the  right or the 
left.    As you will recall it was this injury which  caused the death of 
Princess Diana, and she too had two losses of her peripheral  pulse prior to arriving 
at the hospital, and the herniation was discovered only  after the clamshell 
incision and no heart was discovered in the pericardial  sac.   Sometimes the 
initial chest x-ray might be suggestive of an  abnormal position of the heart. 
  
 
In the case you described, I would have been tempted to do an EC  thoracotomy 
after the arrest in the CT scan, and not external cardiac  massage.   
 
Kenneth Mattox, MD
Houston



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