4.4 PERICARDIAL TAMPONADE

Question 1

Anatomy

Answer 1

Refer back to pericarditis for anatomy

Question 2

Pathophysiology

Answer 2

(1) Accumulation of fluid in the pericardium preventing venous return and ventricular filling
(2) Etiology
(a) Trauma: blunt or penetrating
(b) Pericarditis
(c) Neoplasm
(d) Uremia
(e) Radiation therapy
(f) AMI
(g) Infection
(h) Hypothyroidism
(i) Idiopathic in up to 48%

Question 3

Symptoms/Physical Findings

Answer 3

(1) Becks Triad: muffled heart sounds, Jugular venous distension, Hypotension unresponsive to fluid challenge.
(2) Tachycardia
(3) Chest pain
(4) Tachypnea
(5) Hypotension
(6) Pulsus Paradoxus: > 10 mmHg fall in SBP during inspiration

Question 4

Differential Diagnosis

Answer 4

(1) Pericarditis
(2) Tension PTX
(3) AMI
(4) Myocarditis
(5) Dissecting Aortic aneurysm

Question 5

Labs/Studies/EKG

Answer 5

(1) EKG: sinus tachycardia
(2) Telemetry may see electrical alternans (alternating amplitude in the
precordial leads, meaning that every other QRS complex has reduced
amplitude alternating with increased amplitude)
(3) Echocardiogram: gold standard
(4) CXR may reveal cardiomegaly (enlarged cardiac silhouette)

Question 6

Treatment

Answer 6

(1) IV fluid bolus to help correct hypotension
(2) Pericardiocentesis is required treatment for life threatening Tamponade
(a) Para-xiphoid approach with continuous EKG monitoring
(b) 18-gauge, 10 cm spinal needle attached to stopcock and 20 ml syringe
(c) Direct needle to lift tip of scapula
(d) Aspirate as needle is advanced
(e) Complications of procedure include RV and coronary artery perforation,
dysrhythmias

Question 7

Initial Care

Answer 7

(1) IV, O2, monitor
(2) Higher level of care vs pericardiocentesis based on hemodynamic stability
(3) MEDEVAC ASAP

Question 8

Complications

Answer 8

(1) RV puncture/tear
(2) PTX
(3) Arrhythmias
(4) Cardiac arrest
(5) Death