cardiac tamponade
| One cause of obstructive shock | |
|---|---|
| Etiology | - Traumatic - Chest and lung injury - Infective (Tuberculosis), malignancy, uraemia - Pericarditis - post-MI - iatrogenic - post-sternotomy, more commonly for heart transplant or valve surgery |
| clinical presentation | - SOB (most sensitive symptom) - Refractory shock = obstructive = tachycardia, tachypnoea, hypotension - Beck's triad = muffled heart sounds, hypotension, raised CVP - Distended neck veins - Pulsus paradoxus (visible on ECG or arterial waveform = ↓ BP during inspiration) - Kussmaul's sign = ↑ JVP on inspiration |
| Diagnostic investigations | Echo: RV diastolic collapse, dilated IVC ECG: low-voltage QRS complexes, electrical alternans |
| Differentials | Cardiogenic shock, restrictive cardiomyopathy |
| Immediate management | - Thoracotomy - if traumatic mechanism is sharp penetrating injury, otherwise pericardiocentesis - HR control if inappropriately normal or bradycardic - Drain before sedation/IPPV |
| Ongoing management | - Risk of recurrence, cardiogenic shock |
sources/links
https://litfl.com/refractory-shock-in-trauma/
https://litfl.com/thoracotomy/
https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-114/cardiac-tamponade
https://emcrit.org/pulmcrit/tamponade/ or https://emcrit.org/ibcc/tamponade/
https://bestpractice.bmj.com/topics/en-gb/459