Cardiac tamponade resident survival guide: Difference between revisions
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==Don'ts== | ==Don'ts== | ||
* Never delay treatment whenever you suspect cardiac tamponade. | |||
* Avoid [[diuretic]]s because it may worsen the [[central venous pressure]]. | |||
* Avoid placing pericardial fluid drainage catheter in situ for > 3 days. | |||
* Avoid the subcostal approach of [[pericardiocentesis]] if [[coagulopathy]] is present. Iatrogenic injuries to the liver may be life-threatening. | |||
* Avoid positive pressure mechanical ventilation. It may further reduce cardiac filling. | |||
* The use of inotropic agents for hemodynamic support should not be a substitute or cause a delay to pericadiocentesis. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 21:56, 26 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2] Ayokunle Olubaniyi, M.B,B.S [3]
Definition
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Dos
- Always suspect cardiac tamponade in any patient presenting with hypotension, tachycardia and distended neck veins (or elevated jugular venous pressure).
- Always measure pulsus paradoxus whenever you suspect cardiac tamponade.
- Consider the intrapericardial pressure more than the volume of the pericardial fluid in the management of cardiac tamponade.
- The drainage of pericardial effusion should be gradual and slow to avoid the precipitation of pulmonary edema.
- Echocardiography is the primary modality of choice, considering its high specificity and sensitivity, low cost and lack of radiation. CT and cardiac MRI are indicated when echocardiography is inconclusive.
- Consider 2D and doppler echocardiography prior to discharge to confirm total removal or detect reaccumulation of pericardial fluid.
Don'ts
- Never delay treatment whenever you suspect cardiac tamponade.
- Avoid diuretics because it may worsen the central venous pressure.
- Avoid placing pericardial fluid drainage catheter in situ for > 3 days.
- Avoid the subcostal approach of pericardiocentesis if coagulopathy is present. Iatrogenic injuries to the liver may be life-threatening.
- Avoid positive pressure mechanical ventilation. It may further reduce cardiac filling.
- The use of inotropic agents for hemodynamic support should not be a substitute or cause a delay to pericadiocentesis.