Cardiac tamponade medical therapy: Difference between revisions

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{{Cardiac tamponade}}
{{Cardiac tamponade}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar]], M.B.B.S.


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
If the patient is symptomatic, and if there are signs of cardiac tamponade, urgent [[pericardiocentesis]] should be performed.  Additional supportive therapy includes the administration of [[oxygen]], fluid repletion, echocardiographic monitoring, treatment of underlying pathology, reversal of anticoagulation and monitoring.


OR
==Treatment==
===Pre-Hospital Care===
* There is not much pre-hospital care that can be provided other than general treatment for [[shock]] which includes [[intravenous fluids]].
* Some pre-hospital providers will have facilities to provide [[pericardiocentesis]], but this is generally futile if the patient has already suffered a [[cardiac arrest]] before arrival of the healthcare professional. <ref>Greaves, I., Porter, K. (2007). Oxford handbook of pre-hospital care. Oxford: Oxford University Press ISBN 9780198515845</ref>Rapid evacuation to a hospital equiped to perform invasive procedures is usually the more appropriate course of action.


Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
===Supportive Care===
Tamponade presents as a spectrum of illness.  There is not much debate about the course of management in the treatment of the very sick or the asymptomatic patient with a large effusion who has no signs or symptoms of cardiac tamponade.  The course of treatment is often debated in those patients with echocardiographic evidence of tamponade but no clinical findings.  A prudent strategy in these cases is to observe the progression of the disease process and intervene at the onset of any evidence of compromise.  Volume repletion, serial echocardiographic and clinical assessment is warranted in these cases.
* Watchful monitoring of a patient's clinical status
* Serial echocardiography
* Volume repletion ([[saline]], [[plasma]], or [[blood]])
* Treatment of underlying etiology and reversal of anticoagulation
* The role of ionotropic agents is unclear


OR
===Hospital Management===
 
If the patient is symptomatic and has signs of [[cardiac tamponade]] the initial management in the hospital setting is by urgent [[pericardiocentesis]]. <ref>Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097 </ref> This involves aspirating the fluid by inserting a needle through the skin and into the pericardium. Often, a [[cannula]] is left in place during resuscitation following initial drainage so that additional fluid can continue to drain. If there is distortion of anatomy, a small effusion, or if the effusion is loculated or located posteriorly,  an emergency [[pericardial window]] may be performed instead. <ref>Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097 </ref> This procedure involves cutting the pericardium open to allow the fluid to drain. Following stabilization of the patient, surgery is provided to seal the source of the bleed and mend the pericardium.
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


===Drug Contraindication===
[[Nitroglycerin]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WS}}
{{WH}}
{{WH}}
{{WS}}
[[CME Category::Cardiology]]
[[Category: (name of the system)]]
 
[[Category:Cardiology]]
[[Category:Echocardiography]]
[[Category:Intensive care medicine]]
[[Category:Chest trauma]]
[[Category:Diseases involving the fasciae]]
[[Category:Emergency medicine]]
[[Category:Disease]]

Revision as of 17:48, 8 January 2020

Cardiac tamponade Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Overview

If the patient is symptomatic, and if there are signs of cardiac tamponade, urgent pericardiocentesis should be performed. Additional supportive therapy includes the administration of oxygen, fluid repletion, echocardiographic monitoring, treatment of underlying pathology, reversal of anticoagulation and monitoring.

Treatment

Pre-Hospital Care

  • There is not much pre-hospital care that can be provided other than general treatment for shock which includes intravenous fluids.
  • Some pre-hospital providers will have facilities to provide pericardiocentesis, but this is generally futile if the patient has already suffered a cardiac arrest before arrival of the healthcare professional. [1]Rapid evacuation to a hospital equiped to perform invasive procedures is usually the more appropriate course of action.

Supportive Care

Tamponade presents as a spectrum of illness. There is not much debate about the course of management in the treatment of the very sick or the asymptomatic patient with a large effusion who has no signs or symptoms of cardiac tamponade. The course of treatment is often debated in those patients with echocardiographic evidence of tamponade but no clinical findings. A prudent strategy in these cases is to observe the progression of the disease process and intervene at the onset of any evidence of compromise. Volume repletion, serial echocardiographic and clinical assessment is warranted in these cases.

  • Watchful monitoring of a patient's clinical status
  • Serial echocardiography
  • Volume repletion (saline, plasma, or blood)
  • Treatment of underlying etiology and reversal of anticoagulation
  • The role of ionotropic agents is unclear

Hospital Management

If the patient is symptomatic and has signs of cardiac tamponade the initial management in the hospital setting is by urgent pericardiocentesis. [2] This involves aspirating the fluid by inserting a needle through the skin and into the pericardium. Often, a cannula is left in place during resuscitation following initial drainage so that additional fluid can continue to drain. If there is distortion of anatomy, a small effusion, or if the effusion is loculated or located posteriorly, an emergency pericardial window may be performed instead. [3] This procedure involves cutting the pericardium open to allow the fluid to drain. Following stabilization of the patient, surgery is provided to seal the source of the bleed and mend the pericardium.

Drug Contraindication

Nitroglycerin

References

  1. ↑ Greaves, I., Porter, K. (2007). Oxford handbook of pre-hospital care. Oxford: Oxford University Press ISBN 9780198515845
  2. ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
  3. ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097

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