Cardiac tamponade treatment
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.
Overview
Initial treatment will usually be supportive in nature, for example, administration of oxygen, fluid repletion, echocardiographic monitoring, treatment of underlying pathology, and monitoring.
Treatment
Pre-Hospital Care
- There is not much pre-hospital care that can be provided other than general treatment for shock which includes intravenous fluids.
- Some pre-hospital providers will have facilities to provide pericardiocentesis, but this is generally futile if the patient has already suffered a cardiac arrest before arrival of the healthcare professional. [1]Rapid evacuation to a hospital equiped to perform invasive procedures is usually the more appropriate course of action.
Supportive Care
- Watchful monitoring of a patient's clinical status
- Serial echocardiography
- Volume repletion (saline, plasma, or blood)
- Treatment of underlying etiology
- Use of ionotropic agents have an uncertain significance
Hospital Management
Initial management in a hospital is by pericardiocentesis. [2] This involves aspirating the fluid by inserting a needle through the skin and into the pericardium. Often, a cannula is left in place during resuscitation following initial drainage so that the procedure can be performed again if the need arises. If facilities are available, an emergency pericardial window may be performed instead. [3] This procedure involves cutting the pericardium open to allow the fluid to drain. Following stabilization of the patient, surgery is provided to seal the source of the bleed and mend the pericardium.
References
- ↑ Greaves, I., Porter, K. (2007). Oxford handbook of pre-hospital care. Oxford: Oxford University Press ISBN 9780198515845
- ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
- ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097