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DDx for JVD + hypotension + clear lungs:
RV infarction
massive PE
tension PTX (clear lung)
pericardial tamponade
Assuming your physical exam diagnoses tension PTX, you only need two simple tests to make the diagnosis amongst the other possibilities:
1. EKG: RV infarction will almost always show a concurrent inferior MI;
2. bedside U/S: tamponade patients have effusion, PE patients have RV distension