مريض بعد جراحة قلب مفتوح بست ساعات. نزف أنبوب الصدر كان ١٥٠ مل/ساعة ثم توقف فجأة. الضغط نزل إلى ٨٢/٦٠، والنبض ١٢٨، والأوردة الوداجية منتفخة، وأصوات القلب مكتومة. ما المضاعفة الأرجح؟

Six hours after open-heart surgery, chest-tube drainage was 150 mL/h then stopped abruptly. BP has fallen to 82/60, HR 128, neck veins are distended and heart sounds muffled. What is the most likely complication?

1. A simple left pneumothorax
2. Hypovolaemic shock from post-operative dehydration
3. Improved bleeding because the tube no longer drains blood
4. Cardiac tamponade from blood collecting around the heart

Answer: D) Cardiac tamponade from blood collecting around the heart. A sudden stop in drainage with hypotension, raised JVP and muffled sounds means the tube is blocked and blood is collecting around the heart. This is an emergency needing immediate reporting and usually re-exploration or drainage.