A 28-year-old male is brought to your trauma center after a motor vehicle collision. He presents with chest pain, difficulty breathing, and signs of shock. On examination, you note muffled heart sounds, distended neck veins, and hypotension. What is the most likely diagnosis?
Tension pneumothorax
Myocardial contusion
Cardiac tamponade
Aortic dissection
The correct diagnosis is cardiac tamponade, which is suggested by Beck's triad of muffled heart sounds, jugular venous distension, and hypotension. These findings indicate fluid accumulation in the pericardial sac, impairing cardiac output. Tension pneumothorax also presents with hypoxia and hypotension but is characterized by decreased breath sounds and tracheal deviation. Myocardial contusion may cause arrhythmias and chest pain but does not typically present with Beck's triad. Aortic dissection can cause severe chest pain and hemodynamic instability but involves a tearing pain radiating to the back and a widened mediastinum on chest x-ray.
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