Cardiac tamponade is a lifethreatening condition due to abnormal collection of fluid in the pericardial sac causing hemodynamic instability. In trauma it is blood that gets collected in the sac, most commonly due to penetrating chest injuries or less commonly, blunt chest trauma. If this is not diagnosed and intervened timely, this can be rapidly fatal. We are reporting a case of 35 years old male who was involved in a road traffic accident (RTA). He sustained steering wheel injury on his chest and was taken to multiple hospitals where he was managed only conservatively due to missed diagnosis, before presenting to our ED (Emergency Department). He was here diagnosed with cardiac tamponade with obstructive shock and was urgently taken to operation theatre (OT) for pericardial decompression and was saved.

Keywords: Cardiac Tamponade; Thoracic Injury; Hypotension; Obstructive Shock; Beck’s Triad; Muffled Heart Sounds; Pulsus Paradoxus; Electrical Alternans; Kussmaul Sign; Road Traffic Accident (RTA); Controlled Fluid Resuscitation; Thoracotomy; Sternotomy; Pericardiectomy; Pericardiotomy; FAST Scan.