Cardiac tamponade

1
Cardiac tamponade

• 200cc ,can cause rt ventricle filling restricted
  and results in cardiac tamponade
• Becks triaddistended neck vein , hypotension,
  distant heart sound. pressure during inspiration

2

• Pulsus paradoxusgreater than 10mmhg decrease in
  systolic blood
• Symptomnonspecific,dyspnea and profound
  exertional intolerance
• CXRenlarge cardiac sihouette
• EKGlow voltage QRS complexes(less than 0.7
  mV).ST segment depression with PR segment
  depress.Electrical alternans(20 of
  case)(fig51-2)

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• Cause of Cardiac Tamponade in nontrauma
  patient(table 51-8)
• Echo finding in Cardiac Tamponade(table 51-9)
• Penetrating injury to the heart
• 1/3 came to ER with near normal V/S
• 1/3 saved by aggressive ressuscitation (survival
  rate70-gunshot,85-stab wd)

4

• Pericardiocentesisincrease tendency to avoid use
• False negative 80,false-positive 33
• It can cause heart injury or cause dangerous
  delays in needed surgery.
• Tecniqueparaxiphoid approach.18-gauge 10cm
  spinal needle and 20cc syringe.
• Needle is passed upward and backward at an angle
  of 45for 4-5 cm and advanced slowly,aspirate

5

• Every 1-2 mm as the needle advance ,and one can
  inject 0.5-1 cc of NS to avoid the needle occlude
  by plugged, until blood is obtain, cardiac
  pulsations are felt or the EKG showed and abrupt
  change
• If 20 cc of blood drawn out easy and rapid,it
  indicate aspirate blood from right ventricle

6

• Subxiphoid pericardial windowV/S atable and echo
  is not available or equivocal,an alternative
  method for diagnosis
• TEEmore frequently use in penetrating chest
  trauma for evaluate of potential cardiac
  tamponade,because more rapid diagnosis, faster
  time to surgical intervention.

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• Treatment
• Fluid replacement2-more large iv line.one line
  in a leg in the event that superior venacava or
  one of its major branches is injury.
• Pericardiocentesisremove of 5-10cc of blood,may
  increase stroke volume by 25-50.if V/s stable
  for24-48h after this procedure, thoracotomy may
  not require

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• Thoracotomy5th intercostal,incision as long as
  possible,extend from lateral to sternum to apoint
  high in the axilla.
• Pericariotomy
• Clamping the descending aorta
• Clamping the injured lung
• Exam the heart and control the cardiac wound
• Cardiac massage
• Air embolism

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