Call Your Mother, but not When Driving

Johnny is anxious to head out to lunch and finds the stories of his anatomy professor exasperating. Johnny loses it when the anatomist, Carlos, tells him that he lost his car and that is how he got his name.  Johnny is desperate for a bagel and dashes out of the classroom, jumps in his car and begins aggressive driving. Unfortunately, he finds himself sitting behind a truck with four wheels and flies. Yes, a garbage truck. No amount of honking makes the truck go faster. Then Johnny sees his chance to pass, he swerves over the double yellow line, cranks up the engine, all while ordering a bagel from Call Your Mother. You know what happens next: he smashes head on into an oncoming car. Johnny had not bothered to put on his seat belt and is rammed hard against the stirring wheel. He begins to experience hypotension, notices jugular venous distension, and when he tries to feel for his chest heart-sounds they are muffled. At least he remains sufficiently conscious to call an ambulance and tells the EMT that he is suffering from cardiac tamponade. He takes care to tell the bagel attendant to “hold the mayo” before passing out. What is the best location to introduce a needle to drain out fluid causing the tamponade?

Pericaridal space is best reached by inserting a needle at which location?