Pericardial Tamponade Flashcards
Accumulation of fluid in the pericardium prevents the venous return and ventricular filling.
Pathophysiology: Tamponade
(a) Trauma: Blunt or penetrating.
(b) Pericarditis
(c) Neoplasm
(d) Uremia
(e) Radiation therapy
(f) AMI
(g) Infection
(h) Hypothyroidism
(i) Idiopathic (unknown) in up to 48%.
Etiology (causes): Tamponade
- Muffled heart sounds,
- Jugular venous distension,
- Hypotension,
- unresponsive to fluid challenge.
Becks Triad: Tamponade
(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.
Symptoms/Physical Findings: Tamponade
(1) Pericarditis
(2) Tension PTX
(3) AMI
(4) Myocarditis
(5) Dissecting Aortic aneurysm
Differential Diagnosis: Tamponade.
(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).
Labs/Studies/EKG: Tamponade
(1) IV fluid bolus to help correct hypotension.
(2) Pericardiocentesis is a required treatment for life-threatening _________
Treatment: 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 the tip of scapula.
(d) Aspirate as needle is advanced.
(e) Procedure complications include RV and coronary artery perforation and dysrhythmias.
Pericardiocentesis: Tamponade.
(1) IV, O2, monitor
(2) Higher level of care vs pericardiocentesis based on hemodynamic stability.
(3) MEDEVAC ASAP
Initial Care: Tamponade.
RV puncture/tear
PTX Pneumothorax
Arrhythmias
Cardiac arrest
Death
Complications: Tamponade
