Tamponade Flashcards
What are the complications of pericardiocentesis?
- Dysrhythmia
- Pneumothorax
- Lacerations of:
a. Coronary artery
b. Mammary artery
c. Liver - Perforation of myocardium
State the definitive management of tamponade
Pericardiocentesis
State the supportive management for tamponade.
Give oxygen
Give IV fluids: AVOID in Euvolemic and hypervolemic patient
Why must positive pressure ventilation be avoided in tamponade?
Positive intrathoracic pressure will further decrease venous return and blood pressure – leads to impaired cardiac filling and worsen tamponade
List 5 indications for pericardiocentesis
- Haemodynamic compromise (pre-arrest) if patient too unstable to await pericardial window in operating room
- Tamponade
- Cancer patients to determine malignant vs. post-radiation vs. infectious pericarditis
- Failure to respond to treatment
- Suspected bacterial infection
What is the standard approach of pericardiocentesis?
Subxiphoid, with you standing on the patient’s right.
The hallmark ECG finding of cardiac tamponade
Electrical alternans
What are the CXR findings of cardiac tamponade
Bottle sign: occurs after accumulation of 200-250 ml of pericardial fluids
Usually normal
List 5 echo findings in tamponade (Dose not affect management)
- Pericardial effusion (Fluid around the heart will show up as a black stripe)
- Collapse of the right atrium in late diastole Collapse of the right ventricle free wall in early diastole
- Left atrial collapse is highly sensitive for tamponade
- A small, slit-like, hyperdynamic LV
- Swinging to and fro of the heart within the pericardial fluid
- IVC plethora (Dilation of the IVC and hepatic veins)
Why are CT/MRI and echo rarely done in acute management of cardiac tamponade?
Cardiac tamponade is a clinical diagnosis and intervention is needed quickly.
List components of the beck’s triad
Hypotension
Distant heart sounds
Raised JVP
OF NOTE: PULSUS PARADOXUS IS NOT PART OF THE TRIAD AND THE TRIAD ONLY OCCURS IN 33% of patients
On how much percentage will you find chest pain, palpitations, fever and cough in patients and ith a cardiac tamponade?
25%
What are the differential diagnosis for a suspected cardiac tamponade?
Massive PE
Tension Pneumothorax
SVC obstruction
Chronic constrictive pericarditis
Air embolism
RV Infarct
Severe CCF/cardiogenic shock
Extrapericardial compression: haematoma, tumour
List 6 non-traumatic causes of cardiac tamponade
- Malignancy
- Uraemia
- Infections both viral and TB
- Autoimmune conditions
- Iatrogenic due to radiotherapy and drug reactions
- Bleeding from MI or aortic dissection
Remember; CAN BE IDIOPATHIC
State the most common symptom of cardiac tamponade.
Dypnoea
What is the most guided ult
List 4 indications for a thoracotomy.
- Posttraumatic tamponade
- Dissecting thoracic aorta aneurysm
- Rupture of the myocardium
- Pericardiocentesis is often unsuccessful in patients with haemorrhagic tamponade
Name a definitive surgical procedure for pericardial effusions.
Pericardial window
The patient comes in with clinically compensated pericardial effusions, what is your next step?
Admit to a high-dependency area for close observation while a definitive drainage procedure is planned and organized.
A patient comes in with decompensated pericardial effusions,what is your next step?
Pericardiocentesis
Outline three stages of pericardial effusions.
- Fluid filling the recesses of the parietal pericardium
- Fluid accumulating faster than the rate of the parietal pericardium’s ability to stretch
- Accumulation that exceeds the body’s ability to increase blood volume to support RV filling pressure
