Thats what I chose too, but the patient isn't in acute distress so we don't need to drain fluid right away. I read a couple of articles, all said the same thing, if patient is hemodynamically unstable then you do the paracentesis. this patient has had the symptoms for 4 days so you can wait until diagnosis confirmed and do the pericardiocentesis under image guidance etc. step2 Medbullets also says you can manage conservatively but mostly the goal is to get fluid out. So I'm just remembering to poke the needle if the patient sick as shit, but if the patient seems stable than you should get the echo. +