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Published byCameron Robinson Modified over 6 years ago
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Cardiac Tamponade Dr Neeraj Aggarwal Consultant Pediatric Cardiologist
Department of Pediatric Cardiac Sciences Sir Ganga Ram Hospital New Delhi
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Cardiac Tamponade Cardiac tamponade results from an accumulation of pericardial fluid under pressure, leading to impaired cardiac filling and hemodynamic compromise.
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Tamponade – Clinical signs
Tachycardia, Tachypnoea and hepatomegaly Beck triad –uncommon Raised JVP Hypotension Diminished heart sounds
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Pulsus Paradoxus (or paradoxical pulse) is an exaggeration (SBP fall>10 mm Hg ) of the normal inspiratory decrease in systemic blood pressure.
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Bottle shaped heart and absence of pulmonary vascular markings-but may not be seen in acute cases
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Electrical alternans on ECG- beat to beat variations in QRS complex-specific but less sensitive
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Dilated IVC ,non collapsing and distended
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RV collapse
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Supportive Volume expansion with blood, plasma, dextran or isotonic sodium chloride solution, as necessary to maintain adequate intravascular volume. Bed rest with leg elevation - This may help increase venous return Inotropic drugs (e.g. dobutamine/Levosimendan) - increase cardiac output without increasing systemic vascular resistance
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Pericardiocentesis Position of pt
Semi recumbent position at a 30- to 45-degree angle. This position brings the heart closer to the anterior chest wall. The supine position is an acceptable alternative.
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needle at 45-degree angle to the abdominal wall and 45 degrees off the midline sagittal plane
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APICAL APPROACH
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Most reliable - USG guidance
Pericardial Aspirate Intracardiac Blood No Clotting except in tumours Lower Hb than pts blood Clotting of blood Same Hb as pts blood
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