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.

References

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