Pericardial Tamponade

Question 1

What causes Pericardial Tamponade

Answer 1

Accumulation of fluid in the pericardium preventing venous return and ventricular filling.

Question 2

Etiology for pericardial tamponade

Answer 2

(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

What is this grouping of symptoms
Muffled heart sounds
Jugular venous distension
Hypotension unresponsive to fluid challenge.

Answer 3

Becks Triad

Question 4

Symptoms for pericardial tamponade

Answer 4

Becks Triad
Tachycardia
Chest pain
tachypnea
Hypotension
Pulsus Paradoxus: > 10 mmHg fall in SBP during inspiration

Question 5

What are some DD for tampanode

Answer 5

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

Question 6

What Labs/Studies/EKG would you order for Pericardial tamponade

Answer 6

(1) EKG: Sinus tachycardia
(2) Telemetry may see electrical alternans
(3) Echocardiogram: Gold standard
(4) CXR may reveal cardiomegaly (enlarged cardiac silhouette).

Question 7

what is electrical alternans on a telemetry

Answer 7

alternating amplitude in the precordial leads, meaning that every other QRS complex has reduced amplitude alternating with increased amplitude

Question 8

Treatment for Pericardial tamponade

Answer 8

-IV fluid bolus to help correct hypotension
-Pericardiocentesis is required treatment for life threatening Tamponade

Question 9

Steps for Pericardiocentesis

Answer 9

(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 10

Initial Care for pericardial tamponade

Answer 10

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

Question 11

What can cause myocardial contusion and
necrosis?

Answer 11

Blunt force trauma to the chest
Commonly caused by high speed MVA, steering wheel in motor vehicle accidents and other blunt force trauma.

Question 12

True/false
Myocardial tissues once contused begins to swell, causing pressure on capillaries and decrease blood flow to injured myocardium which then can lead to necrosis.

Answer 12

True

Question 13

Symptoms/Physical Findings for cardiac contusion

Answer 13

(1) Commonly asymptomatic except for chest wall pain.
(2) Severe anterior chest injury (broken ribs, chest wall contusion with ecchymosis).
(3) Tachycardia disproportionate to the degree of trauma.

Question 14

DDxs for Cardiac contusion

Answer 14

(1) Aortic dissection
(2) Esophageal rupture
(3) PTX
(4) Pericardial Tamponade
(5) AMI

Question 15

Labs/Studies for Cardiac contusion

Answer 15

(1) EKG: Sinus tachycardia is the most common finding. Look for possible life threatening arrhythmias.
(2) CXR: Look for rib fractures, pulmonary contusion, broken collar bone.

Question 16

Cardiac contusion Treatment

Answer 16

(1) ABC, IV, O2, Monitor
(2) Analgesics for pain control
(3) Monitor for 4-6 hours, if there is no hemodynamic instability apparent, repeat EKG in 24 hours.
(4) Diagnose and treat any cardiac arrhythmias accordingly.

Question 17

Cardiac contusion initial care

Answer 17

(1) Pain control with analgesics
(2) Monitor
(3) If suspect cardiac or pulmonary contusion then need to transfer to higher level of care.

Question 18

Complications for cardiac contusion

Answer 18

(1) AMI
(2) Cardiac Dysrhythmias
(3) Pericardial effusion
(4) Pericardial Tamponade
(5) Aortic dissection
(6) Pericarditis