Cardiac tamponade
Caused by an accumulation of blood, pus, effusion fluid or air. Most commonly seen in context of cardiothoracic surgery, trauma or iatrogenic causes, e.g. central line placement.
ULTRASOUND DIAGNOSIS IS THE PREFERRED TECHNIQUE.
Unexplained dyspnoea/tachypnoea and agitation if conscious.
At least one of 'Beck's Triad':
Jugular venous distension
Muffled heart sounds
Hypotension
Other signs: Pulsus paradoxus; ECG → low voltage QRS / electrical alternans / pulseless electrical activity; chest X-ray → enlarged cardiac silhouette.
ULTRASOUND GUIDANCE IS THE PREFERRED TECHNIQUE.
WARNING: Myocardial rupture, aortic dissection and severe bleeding disorder are relative contraindications.
Identify tip of xiphoid.
Prep and drape overlying skin.
Infiltrate local anaesthetic (if necessary and if time).
Ideally use ultrasound to identify pericardial fluid.
Insert pericardiocentesis needle immediately to left of tip of xiphoid.
Attach 3-way tap and 20 ml syringe.
Direct needle generally toward left shoulder but using ultrasound to direct needle toward the largest pericardial collection.
Aspirate and drain – aspiration of a small volume may cause a dramatic clinical improvement.
Cardiac arrest → 2-1