Emergency critical care AI Flashcards
What is the significance of inspiratory dyspnoea?
Inspiratory dyspnoea suggests upper airway obstruction.
What does expiratory dyspnoea indicate?
Expiratory dyspnoea suggests lower airway obstruction, such as feline asthma.
What pattern of dyspnoea suggests parenchymal disease?
A slow, laboured pattern of dyspnoea suggests parenchymal disease.
What pattern of dyspnoea suggests pleural space disease?
A rapid, shallow pattern of dyspnoea suggests pleural space disease.
How should normal lung sounds be?
Normal lungs sounds should be barely audible, but slightly louder cranioventrally.
What does the presence of crackles during auscultation suggest?
Crackles indicate fluid in the airways, e.g. bronchitis, pneumonia, or pulmonary edema.
What do wheezes during auscultation indicate?
Wheezes indicate airway narrowing, with expiratory wheezes suggesting intrathoracic airway disease like feline asthma.
What does the absence of lung sounds suggest?
The absence of lung sounds suggests pleural space disease.
What does stertor or stridor suggest during auscultation?
Stertor (rostral to larynx) or stridor (larynx or caudal) suggest upper airway obstruction.
What does percussion provide valuable information about?
when suspicious of pleural space disease.
What causes mucous membrane cyanosis?
Mucous membrane cyanosis is caused by the presence of deoxygenated haemoglobin in the blood (>11g/dl) and indicates severe hypoxaemia.
What is pulse oximetry used for?
Pulse oximetry is used to measure the saturation of arterial haemoglobin with oxygen.
What is the significance of SaO2 measurement in pulse oximetry?
The percentage of haemoglobin saturated with oxygen is determined from SaO2 readings in pulse oximetry.
Where can the probe for pulse oximetry be placed?
The probe can be placed on the lip, unpigmented digital pads, or unpigmented areas of skin.
What is the value of SaO2 at arterial oxygen concentrations as low as 60mmHg?
Even at arterial oxygen concentrations of 60mmHg, the SaO2 will be high (>90%) due to the sigmoid shape of the oxygen dissociation curve.
What technique can provide extremely helpful information about arterial oxygenation?
Arterial blood gas analysis can provide extremely helpful information about arterial oxygenation.
Which artery is generally the most accessible for arterial blood gas analysis?
The dorsal metatarsal artery is generally the most accessible for arterial blood gas analysis.
What is the normal PaO2 when the animal is breathing room air?
The normal PaO2 is 80-100mmHg when the animal is breathing room air.
How is the alveolar oxygen concentration calculated?
The alveolar oxygen concentration (PAO2) is calculated using the equation: PAO2 = FiO2(Patms-PH2O) - 1.2 (PaCO2).
What is the simplified equation for calculating PAO2 at sea level with an animal breathing room air?
The simplified equation is PAO2 = 150 - 1.2 (PaCO2).
What does the alveolar-arterial gradient (PAO2 - PaO2) measure?
The alveolar-arterial gradient measures the difference between the alveolar oxygen concentration and the arterial oxygen concentration.
What is considered normal for the alveolar-arterial gradient?
A normal alveolar-arterial gradient is less than 25mmHg.
When is the PaO2:FiO2 ratio more appropriate to use?
The PaO2:FiO2 ratio is more appropriate to use when an animal is receiving supplemental oxygen.
How should the animal be restrained during the Trans-Tracheal Wash procedure?
The animal should be restrained in sternal recumbency or whilst sitting.
.
.
How should the neck be clipped for the Trans-Tracheal Wash procedure?
The neck should be clipped in the ventral midline (cranial third of the neck).
What type of local anesthesia is used during the Trans-Tracheal Wash procedure?
2% lignocaine is used as a local anesthetic.
What is the purpose of stabilizing the trachea during the Trans-Tracheal Wash procedure?
The trachea is stabilized to allow for the advancement of a through-the-needle catheter.
What should be done after advancing the needle of the catheter into the tracheal lumen during the Trans-Tracheal Wash procedure?
The needle should be removed and sterile saline (0.9%) is instilled in aliquots.
What is the purpose of induction of coughing during the Trans-Tracheal Wash procedure?
Induction of coughing helps with the retrieval of fluid.
What type of samples are collected during the Trans-Tracheal Wash procedure?
Samples are collected in EDTA for cytology and plain tubes for culture.
What should be done after removing the catheter during the Trans-Tracheal Wash procedure?
Digital pressure should be applied over the area for 1-2 minutes.
How is the trans-laryngeal approach modified for small dogs during the Trans-Tracheal Wash procedure?
The trans-laryngeal approach is used in small dogs, advancing between the cricoid and thyroid cartilages.
When should diagnostic thoracocentesis be performed?
Diagnostic thoracocentesis should be performed in any patient with suspected pleural space disease.
What size of needle is adequate for most patients during thoracocentesis?
A 19g butterfly needle with 3-way tap and syringe attached is adequate for most patients.
How should the needle be inserted during thoracocentesis if air is suspected?
The needle should be inserted over the dorsal 1/3 of the chest.
What is the benefit of using ultrasonography during thoracocentesis?
Ultrasonography is very useful for rapid detection and localization of fluid.
What should be done if fluid is obtained during thoracocentesis?
Samples should be submitted for cytology (EDTA and smear), biochemistry (plain tube), and culture (plain tube).
How can therapeutic thoracocentesis be performed in large dogs?
In large dogs, an intravenous catheter with additional fenestrations can be used for removal of large volumes of fluid.
What can be used as an alternative catheter for therapeutic thoracocentesis in the absence of a pericardiocentesis kit?
A 6Fr dog urinary catheter can be fed through a 3-inch 12g or 14g intravenous catheter.
What can help to reduce the ‘stinging’ associated with injection of lignocaine during thoracocentesis?
Buffering the lignocaine with 1 part 8.4% sodium bicarbonate to 9 parts lignocaine can help to reduce the ‘stinging’.
What is the purpose of using a centesis valve during thoracocentesis?
A centesis valve allows fluid to be drawn through one way in a syringe.
What is the target range for the PaO2:FiO2 ratio?
The target range for the PaO2:FiO2 ratio is 400-500.
What is the example range of PaO2 for a dog on nasal oxygen with an FiO2 of 0.40?
The example range of PaO2 for a dog on nasal oxygen with an FiO2 of 0.40 is 160-200mmHg.
What are some techniques for administering oxygen therapy?
Some techniques for administering oxygen therapy include flow-by mask, oxygen cage, nasal prongs, and nasal catheter.
What can you increase the Fio2 to when using nasal catheters?
One nasal catheter increases FiO2 to about 40%, and 2 can increase it to 80%.
When are tracheotomy tubes rarely required?
Tracheotomy tubes are rarely required for bypassing laryngeal obstructions like paralysis, abscesses, and tumors.
What is recommended for intubation if laryngeal obstructions cannot be bypassed with a small diameter tube?
In such cases, it is recommended to have a range of intravenous catheters for placing directly into the trachea and attaching to oxygen supplies/anaesthetic circuits.
What is the method for placing a tracheotomy tube?
The method for placing a tracheotomy tube involves making a longitudinal skin incision caudal to the larynx, extending it through the sternohyoid muscles, and making an incision between the 3rd and 4th or 4th and 5th tracheal ring.
What should be preserved while making the incision for a tracheotomy tube?
While making the incision for a tracheotomy tube, the recurrent laryngeal nerves should be preserved on both sides.
How is the tracheotomy tube placed in position?
The tracheotomy tube is placed by pulling up and apart of the nylon loops on either side of the tracheal incision.
What is the recommended care for a tracheotomy tube?
The tube needs constant observation to avoid occlusion, needs to be nebulized or have sterile water passed into it every 4 hours, and the tube and wound should be cleaned frequently every 2 hours.
How can excessive mucus be suctioned if a tracheotomy tube is in place?
A soft urethral catheter can be used to allow suctioning of the trachea and large airways if excessive mucus is present.
How can a nasal catheter be placed?
To place a nasal catheter, local anesthesia is instilled into one or both nostrils, the tube is marked at the level of the medial canthus, and it is inserted into the ventral meatus after lubrication.
What is the recommended position for a nasal catheter in dogs?
In dogs, the nasal catheter is aimed at the opposite canine tooth by pushing the nasal planum dorsally and placing the catheter in the ventral meatus.
How is the nasal catheter fixed in place?
Once the nasal catheter is in place, it is fixed with butterfly tapes, nylon suture, or tissue glue.
What are thoracic drains used for?
Thoracic drains are used to remove large volumes of fluid rapidly or allow for repeated drainage of fluid.
What is the advantage of using a 3 way tap with thoracic drains?
Using a 3 way tap with thoracic drains allows for fluid to be emptied in a different direction without adjusting anything.
What technique is used to place thoracic drains inserted using a stylet or guidewire?
Thoracic drains inserted using a stylet or guidewire are placed using the Seldinger technique.
Where should the drain tip ideally be positioned within the chest?
The drain tip should ideally be positioned at the 2nd intercostal space within the chest.
What dressing should be used to secure the tube against the chest?
A flexible net dressing such as Surgifix should be used to secure the tube against the chest.
What must all animals with a chest drain in place wear?
All animals with a chest drain in place must wear a Buster collar.
What should be done before placing a Stylet Chest Drain?
The animal should be anesthetized if possible before placing a Stylet Chest Drain.
What should be done prior to general anesthesia for a Stylet Chest Drain procedure?
Needle thoracocentesis can be performed first either as a diagnostic technique or to improve ventilatory capacity.
How should the animal be positioned for chest drain placement?
The animal should be placed in lateral recumbency with the side for chest drain placement uppermost.
What area of the chest wall should be prepared for a Stylet Chest Drain procedure?
The prepared area is from just caudal to the shoulder blade to the end of the last rib and from the horizontal vertebral processes dorsally to the sternum in the midline.
How can the position of the 8th - 12th ribs be marked for a Stylet Chest Drain procedure?
The position of the 8th - 12th ribs can be marked outside the sterile field.
Where should the chest drain be inserted for a Stylet Chest Drain procedure?
The chest drain should be inserted through the skin at around the 10th intercostal space, but enter the thorax around the 8th intercostal space.
Why is the chest drain placed ventrally and dorsally?
The chest drain is placed ventrally to collect fluid and dorsally to collect air.
How should the chest drain be measured for placement?
The chest drain should be measured so that the cranial end will lie level with the 2nd or 3rd rib and all holes are within the chest.
What should be done while inserting the chest drain into the thoracic cavity?
The chest drain should be tapped into the thoracic cavity using the heel of the dominant hand and supported firmly 1-2 cm above the chest wall.
What are the learning objectives of this module?
Understand how to perform a major body system assessment, recall the importance of perfusion and ventilation in emergency medicine, consider options for vascular access in critical patients, reflect on options for analgesia in emergencies, identify different respiratory patterns, understand the clinical findings and causes of dyspnea, consider options for oxygenation, understand the basics of thoracic point of care ultrasound, understand the effect pleural air or effusion has on ventilation, recall potential ways to drain pleural effusions, understand how to place both Stylet and Seldinger chest drains, and reflect on hands-off management of dyspneic cats.
Why is staying calm essential in emergency situations?
Staying calm is essential as it allows for a logical approach to triaging and stabilizing emergency patients effectively.
What are the key principles in emergency medicine for an emergency patient?
Ventilation (getting oxygen into the patient and removing carbon dioxide) and perfusion (moving oxygen to the tissues and removing carbon dioxide).
What does anaerobic metabolism result in?
Anaerobic metabolism is less efficient and produces metabolites such as lactate, which leads to metabolic acidosis.
What is the meaning of the term ‘triage’?
Triage comes from the French word meaning ‘to sort.’
What are the two ways in which ‘triage’ is applicable in veterinary emergencies?
Triage allows clinicians to prioritize which animal requires the most urgent attention and which of an individual animal’s problems needs the most urgent treatment.
What should the initial triage assessment include?
A capsule history (age, sex, nature and duration of presenting problem, any ongoing medical problems) and a limited physical examination.
What are the key components to assess during the initial triage assessment?
Airway, breathing, circulation, mucous membrane color/CRT, brief urinary and neurological assessment.
What is the purpose of obtaining vascular access in emergency presentations?
Vascular access allows for fluid and drug therapy.
When should vascular access be obtained in emergency presentations?
Vascular access should be obtained early and if possible as part of the triage procedure.
What should be considered when placing peripheral catheters?
The position of the catheter is important, for example, with fascial or forelimb trauma, saphenous catheters may be helpful.
How is the needle held during insertion in a ‘pistol grip’?
With the handle in the palm of the hand.
What motion is used while inserting the needle into the bone?
A slight twisting motion.
What should the needle feel like once it is in position?
Firmly seated.
What is recommended maximum flow rate for the needle?
11ml/min
How often should a new needle be placed at a different site?
After 72 hours.
What are some complications of needle insertion?
Infection, damage to growth plates, fat embolization.
What type of opioids are initially used for emergency analgesia?
Potent short acting opioids, like pethidine.
How long does 5mg/kg i/m pethidine provide good analgesia?
Approximately 2 hours.
Which full agonist opioid can be continued after pethidine?
Methadone or morphine.
Is methadone or morphine preferred for inducing less vomiting?
Methadone.
How long should methadone not be used for?
Longer than 24 hours.
In which animals can buprenorphine provide good analgesia?
Cats.
What is the recommended dose of buprenorphine for cats?
0.01-0.02mg/kg q6-8hours.
Which route can buprenorphine be given in difficult animals?
Sublingually.
What can be helpful after chest drain placement to improve patient comfort?
Combinations of lidocaine and bupivacaine.
What is the term for combining different analgesic agents to improve pain relief?
Multimodal analgesia.
What is the drug loading dose for morphine?
0.5mg/kg i/m.
What is the CRI dosage range for lidocaine?
0.5-1mg/kg/hour.
What is the CRI dosage range for ketamine?
0.1-0.25mg/kg/hour.
What should be assessed, stabilized, and monitored in respiratory emergencies?
The respiratory system.
Why is relief of respiratory distress a true emergency?
Because it can be life-threatening.
What body position do dyspnoeic animals often adopt to maximize tidal volume?
Neck extended and elbows abducted.
What is the correct position for the chest drain tip?
At 2nd or 3rd rib
How can correct positioning of the chest drain be verified?
Radiographically
What should be done to prevent air entry and allow connection to rubber tubing?
Place a gate clamp
What is the purpose of a Heimlich valve?
Allow drainage of air
What is the consequence if the Heimlich valve chamber becomes flooded with fluid?
It no longer works
How is the chest drain secured?
Using a box suture and a Chinese finger trap suture
How is the chest drain removed?
By placing firm pressure over the subcutaneous tunnel and pulling it out briskly
What should be done after the chest drain is removed?
Maintain pressure for 2-3 minutes and allow the skin incision to heal by secondary intention
What can be done to improve comfort levels if there is pleural irritation caused by a drain?
Instillation of dilute long acting local anaesthetic
How much pleural fluid is typically produced as a result of a chest drain?
0.5-1 ml/kg/day
Where is the skin incision made for placement of a guidewire chest drain?
At the junction of the middle and dorsal two thirds of the thorax over the 8th intercostal space
What is the purpose of holding the guide wire in place during a guidewire chest drain procedure?
To prevent accidentally losing it completely into the pleural space
How is the catheter introduced during a guidewire chest drain procedure?
Along the cranial border of the rib to avoid the intercostal vessels and nerves
How is the catheter secured to the skin in a guidewire chest drain procedure?
Using suture material passed through the holes in the wings
What is the key step in classifying effusions?
Determining the type of effusion present
Why are saphenous catheters not recommended in animals with a GDV?
Venous return may be impeded in animals with a GDV.
In extremely hypovolemic animals, how many peripheral catheters may be needed?
2 or more peripheral catheters may be needed in extremely hypovolemic animals.
What is the advantage of using central jugular lines with multiple lumens?
Different ports can be used for different functions.
When are central lines used?
Central lines are used when perfusion is very poor.
What can be administered through a central line?
Hyperosmolar solutions such as parenteral nutrition and glucose solutions >5%.
What can blood collected from the hub of a catheter be used for?
Obtaining an emergency database including PCV/TS, blood glucose, and electrolyte analysis.
Why is anaesthesia not usually needed for placement of a Central Line?
Placement usually only requires sedation or brief anaesthesia.
What is the Seldinger technique?
A technique where a wire is passed through a small gauge catheter before exchanging it for a larger bore central catheter over the wire.
What should be done to make the jugular vein more prominent during placement of a central line?
A small fluid bag can be placed under the neck.
What are the preferred sites for placement of intraosseous catheters in pediatric patients?
Trochanteric fossa of femur, medial aspect of proximal tibia, or greater tubercle of humerus.
What can be substituted for commercially available intraosseous catheters in young animals?
A suitably sized injection needle can be used.
What is the first step in placing an intraosseous infusion needle?
Inject a small amount of 2% lignocaine at the insertion site.
What samples are collected for cytology, biochemistry, and culture?
Cytology, biochemistry, and culture samples are collected.
How can protein content in fluid be measured?
Protein content in fluid can be measured using a refractometer.
What does a high protein content in effusion suggest?
A high protein content in effusion suggests an exudate.
What does a low protein content in effusion suggest?
A low protein content in effusion suggests a transudate.
What are the characteristics of a transudate fluid?
Transudate fluid has a specific gravity <1.017, protein <25 g/L, and <1000 nucleated cells/mm3.
What are the characteristics of a modified transudate fluid?
Modified transudate fluid has a specific gravity of 1.017-1.025, protein content of 25-60 g/L, and 7000 nucleated cells/mm3.
What are the characteristics of an exudate fluid?
Exudate fluid has a specific gravity >1.025, protein >25 g/L, and >7000 nucleated cells/mm3.
What is the importance of oxygen in the medical management of respiratory distress?
Oxygen is the most important drug in most patients with respiratory distress.
What medication should be administered if congestive heart failure is suspected?
Frusemide (2mg/kg) should be administered if congestive heart failure is suspected.
What medication is effective for cats with dyspnoea secondary to feline asthma?
Intramuscular terbutaline or inhaled salbutamol can be effective for cats with dyspnoea secondary to feline asthma.
What is the shock dose for dogs?
The shock dose in dogs is 90ml/kg.
What is the shock dose for cats?
The shock dose in cats is 40-60ml/kg.
What is the bolus dose given to dogs prior to assessing response?
Boluses of 30ml/kg are given to dogs.
What is the bolus dose given to cats prior to assessing response?
Boluses of 15ml/kg are given to cats.
When are colloids considered appropriate in fluid resuscitation?
Colloids are appropriate in cases with severe hypovolaemia/hypoproteinaemia.
What is the total dose of colloid given for severe hypovolaemia/hypoproteinaemia?
Boluses of approx. 5ml/kg are given, repeated as required, up to 20ml/kg total dose.
How should the dose of crystalloid be reduced when colloids are administered?
The dose of crystalloid should be reduced by 50%.
What is the purpose of hypertonic saline in fluid resuscitation?
Hypertonic saline can be considered in simple hypovolaemic shock if dehydration is not present.
What is the dose of hypertonic saline used in fluid resuscitation?
A dose of 4-5ml/kg is used, followed by appropriate isotonic fluid therapy.
What situations require additional care in fluid resuscitation?
Ongoing bleeding, head trauma, concurrent heart disease.
How can abdominal bleeding be helped in fluid resuscitation?
Placement of an abdominal bandage to maintain pressure within the abdomen.
Why should a more cautious approach be taken in fluid resuscitation for patients with pulmonary contusions?
Aggressive fluid therapy can lead to increased pulmonary haemorrhage and/or fluid into the lungs.
What is the recommended initial bolus dose for fluid resuscitation in patients with pulmonary contusions?
Boluses of 3-5ml/kg of crystalloid should be used initially.
How should fluid resuscitation be managed in patients with head trauma?
A balancing act between maintaining arterial blood pressure and minimizing increases in intracranial pressure.
What combination of fluids may benefit head trauma patients in fluid resuscitation?
Hypertonic saline (3-5ml/kg of 7.5% NaCl) and colloid (2-3ml/kg of 6% Hetastarch).
What measures can be taken to reduce intracranial pressure in head trauma patients?
Elevation of the head, avoidance of jugular compression, use of mannitol, and ventilation.
What should be done when a dehydrated patient shows signs of hypovolaemia?
Initial shock boluses of crystalloid +/- colloid can be given until the patient is stable.
How should isotonic crystalloids be administered to replace fluid deficits in a dehydrated patient?
At a rate designed to replace the deficit and provide for maintenance requirements over 12-24 hours.
What is the replacement volume for a 10kg dog with signs of hypovolaemia and dehydration?
700ml (estimated dehydration of 7% = 350ml, replace over 6 hrs, then 350ml over next 18hrs).
What fluids are given to normalize heart rate and improve pulse quality in a dehydrated dog?
A 20ml/kg bolus of Hartmann’s solution is given over 10 minutes.
What is septic shock characterized by?
Septic shock often has components of absolute hypovolaemia, relative hypovolaemia, distributive shock, and sometimes cardiogenic shock.
What is central to the management of septic shock?
Fluid therapy, often requiring aggressive use of crystalloids and colloids.
What are some organs that can be affected by oedema?
Lungs and peripheral organs can be affected by oedema.
Which type of colloids can be useful for oedema?
Hetastarch can be useful for oedema.
How can plasma be beneficial for septic patients?
Plasma can provide colloidal support, clotting factors, and proteases for septic patients.
What should be carefully monitored to guide therapy for septic patients?
Physical parameters, urine output, arterial blood pressure, and CVP should be monitored.
What treatment can be considered if systolic arterial blood pressure remains <90mmHg despite aggressive fluid therapy?
Treatment with vasotropes and/or inotropes may need to be considered.
What is the recommended dose of dopamine for its vasopressor effects?
Dopamine can be used at doses of 3-10ug/kg/min for its vasopressor effects.
When is dobutamine typically used?
Dobutamine is typically used when a positive inotrope is required or systolic function is dramatically reduced in septic shock.
What should be monitored when administering dopamine or dobutamine?
Side-effects such as tachydysrhythmias should be closely monitored.
What type of antibiotics are indicated in patients with septic shock?
Intravenous antibiotics are indicated in patients with septic shock.
Why should broad-spectrum antibiotics be given until culture results are available?
Broad-spectrum antibiotics help protect against the effects of translocation of bacteria from the GI tract.
What are some recommended combinations of antibiotics for septic patients?
Cephalosporin or amoxicillin-clavulanic acid with a fluoroquinolone is recommended.
What can provide supplemental oxygen to maximize oxygen delivery in septic patients?
Supplemental oxygen can provide increased oxygen delivery to the tissues in septic patients.
What is DIC and how can it be treated in septic patients?
DIC is disseminated intravascular coagulopathy and it may require treatment with plasma +/- heparin.
What should be paid attention to in septic patients besides therapy?
Appropriate analgesia and nutrition should be considered in septic patients.
How can adequate nutrition reduce the risk of intestinal translocation of bacteria in septic patients?
Adequate enteral nutrition via feeding tubes can reduce the risk of intestinal translocation of bacteria.
What are the different types of crystalloid solutions?
Hypotonic, hypertonic, and isotonic solutions are the different types of crystalloid solutions.
Why should great care be taken when administering hypotonic fluids?
Hypotonic fluids can cause marked drops in serum tonicity and severe changes in electrolytes.
Which fluids are commonly used as replacement fluids and maintenance fluids in veterinary practice?
Hartmann’s solution and 0.9% NaCl are commonly used as replacement and maintenance fluids.
How much of the infused volume remains in the vasculature after 30 minutes with crystalloid solutions?
Only 25% of the infused volume remains in the vasculature after 30 minutes with crystalloid solutions.
What is pulsus paradoxus?
Pulsus paradoxus describes the apparent absence of a peripheral pulse during inspiration despite the presence of a heartbeat.
How is pulsus paradoxus defined?
Pulsus paradoxus is defined as a drop in systolic arterial blood pressure (SABP) of ≥10mmHg during inspiration.
Why does pulsus paradoxus occur?
During inspiration, the intra-thoracic pressure falls, leading to increased blood flow preferentially into the pulmonary vasculature and the right side of the heart.
What happens to right ventricular filling during inspiration?
During inspiration, the right ventricular filling is accentuated, increasing right ventricular volume at the expense of the left ventricle.
How can pericardial effusion be confirmed?
Pericardial effusion can be confirmed through further investigation, such as thoracic radiographs or echocardiography.
What are the clinical examination findings associated with pericardial effusion?
Pericardial effusion may present with a very large cardiac silhouette, increased sternal contact, elevated trachea, and a globular heart on thoracic radiographs.
What are the ECG findings in pericardial effusion?
ECG usually reveals a normal sinus rhythm or a compensatory sinus tachycardia, with low voltage QRS complexes (<1mV in all leads) occurring in approximately 50% of cases.
What is electrical alternans in pericardial effusion?
Electrical alternans is the beat-to-beat variation in the size of the QRS and ST segments seen in two-thirds of pericardial effusion cases, caused by the movement of the heart within the fluid-filled pericardium.
What is the most sensitive and specific way to diagnose pericardial effusion?
Echocardiography is the most sensitive and specific way to diagnose pericardial effusion, allowing for the assessment of the atrial free wall and exclusion of heart base masses.
What is the purpose of pericardiocentesis?
Pericardiocentesis is both a diagnostic and therapeutic technique used to relieve pericardial tamponade and improve cardiac output.
What is the equipment used for pericardiocentesis?
Pericardiocentesis can be performed using a commercial Seldinger pericardiocentesis kit with a stiff pericardial catheter or a wide bore catheter.
What can the analysis of pericardial fluid retrieved during pericardiocentesis help with?
The analysis of pericardial fluid can help exclude sepsis and look for evidence of neoplasia in pericardial effusions.
What are some good choices for reducing steroid dose and side effects?
Azathioprine and Cyclosporine.
How long does it take for Azathioprine and Cyclosporine to have full immunosuppressive action?
Between 7-10 days.
What should be considered to reduce the risk of steroid-associated GI hemorrhage?
Gastro-protection.
What are some options for gastro-protection?
Sucralfate, cimetidine, ranitidine.
What is the recommended dose of Sucralfate for gastro-protection?
0.5-1g/QID p.o.
What is the recommended dose of Cimetidine for gastro-protection?
5-10mg/kg/TID SLOW i/v.
