Eventually, increasing pressure on the heart forces the septum to bend in towards the left ventricle, leading to a decrease in stroke volume. This causes the development of obstructive shock, which if left untreated may lead to cardiac arrest (often presenting as pulseless electrical activity). The decrease in stroke volume can also ultimately lead to a decrease in cardiac output, which could be signaled by tachycardia and hypotension. Diagnosis
The three classic signs, known as Becks triad, are low blood pressure, jugular-venous distension, and muffled heart sounds. Other signs may include pulsus paradoxus (a drop of at least 10 mmHg in arterial blood pressure with inspiration), and ST segment changes on the electrocardiogram, which may also show low voltage QRS complexes. Medical imaging
Tamponade can often be diagnosed radiographically. Echocardiography, which is the diagnostic test of choice, often demonstrates an enlarged pericardium or collapsed ventricles. A large cardiac tamponade will show as an enlarged globular-shaped heart on chest x-ray. During inspiration, the negative pressure in the thoracic cavity will cause increased pressure into the right ventricle. This increased pressure in the right ventricle will cause the interventricular septum to bulge towards the left ventricle, leading to decreased filling of the left ventricle. At the same time, right ventricle volume is markedly diminished and sometimes it can collapse. Differential diagnosis
Initial diagnosis of cardiac tamponade can be challenging, as there is a broad differential diagnosis. The differential includes possible diagnoses based on symptoms, time course, mechanism of injury, patient history.
Pathophysiology
Crush injury is damage to the body as a result of being crushed by an object. Crush syndrome is a systemic result of skeletal muscle injury and breakdown and subsequent release of cell contents. The severity of crush syndrome is dependent on the duration and magnitude of the crush injury as well as the bulk of muscle affected. It can result from both short duration, high-magnitude injuries (such as being crushed by a building) or from low magnitude, long-duration injuries such as coma or drug induced immobility. Treatment
Early fluid resuscitation reduces the risk of kidney failure, reduces the severity of hyperkalaemia and may improve outcomes in isolated crush injury.For casualties with isolated crush injury who are haemodynamically stable, large volume crystalloid fluid resuscitation reduces the severity of and reduces the risk of acute kidney injury. See also
Crush syndrome

References
Further reading
Rajasekaran S. (2005). "Ganga hospital open injury severity score - A score to prognosticate limb salvage and outcome measures in Type IIIb open tibial fractures". Indian J Orthop. 39 (1): 4–13. Archived from the original on 2016-09-16. Retrieved 2016-09-06. == External links ==