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GUIDELINE FOR PBSM MEMBERS...ADDTIONAL NOTES ABOUT CARDIAC TAMPONADE..VERY USEFUL THE PEOPLE WHO TAKING PFA EXAM AND WILL HELP ALL THE PBSM MEMBERS IN THEIR CAREER.CARDIAC TAMPONADE IS ABOUT HUMAN HEART AND THEIR FUNCTION...
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Cardiac TamponadeCardiac Tamponade
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Cardiac TamponadeCardiac Tamponade
Clinical signs
• Pulsus paradoxus It is an exaggerated drop (> 10mm Hg) in the systolic
arterial blood pressure upon inspiration.
** palpate the brachial or radial pulse maximally, slowly decreasing your pressure on the pulse while watching
the patient breathe. If pulsus paradoxus is present, you will get to a point where the pulse during inspiration decreases or disappears, while it remains palpable during expiration.
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Cardiac TamponadeCardiac Tamponade
Clinical signs……………..
• Pericardial friction rub may be present
• Heart size on x-ray may be normal or enlarged
• Echocardiogram
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Pericardial TamponadePericardial Tamponade
Chest x-ray
• Widened mediastinum
• Pneumo- or hemothorax Electrical alternans
• Note rounded bottle shape to left side of heart
• Compare with next 2 slides
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Cardiac TamponadeCardiac Tamponade
Pathophysiology
• Impairment of ventricular diastolic filling caused by pressure of pericardial sac
• And by bulging of ventricular septum into LV
• Stroke volume and cardiac output fall
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PericardiocentesisPericardiocentesis
Indications
• Immediate threat to life
• Severe hemodynamic impairment
• Fall in systolic blood pressure >30 mm Hg
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PericardiocentesisPericardiocentesis
General principles
• As of 2000 = echocardiography used to guide pericardiocentesis
• Direct subxyphoid techniques only used in dire medical emergency
• ECG and hemodynamic monitoring
• Full resuscitation equipment available
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PericardiocentesisPericardiocentesis
Equipment
• 16-gauge short-bevel large-bore needle
• 30- or 50-mL syringe
• Echo- or ECG-guided (V lead)
• Local anesthetic
• Sterile supplies and povidone-iodine solution
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PericardiocentesisPericardiocentesis
Technique• Patient in supine position, upper
torso elevated• ECG limb leads attached to patient• Use echocardiography guided procedure
(rarely: ECG-guided, V lead)• Subxiphoid approach• Continuous aspiration
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PericardiocentesisPericardiocentesis
For historical interest: ECG-guided needle advancement
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PericardiocentesisPericardiocentesis
Hazards• Cardiac arrhythmias• Laceration of myocardium or
coronary arteries• Injection of air into cardiac chambers• Hydrothorax or pneumothorax• Hemorrhage from laceration may
produce tamponade