Cardiac tamponade treatment

Revision as of 07:39, 15 March 2016 by WikiBot (talk | contribs) (Bot: Adding CME Category::Cardiology)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

Cardiac tamponade Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cardiac Tamponade from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Cardiac tamponade treatment On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Cardiac tamponade treatment

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cardiac tamponade treatment

CDC on Cardiac tamponade treatment

Cardiac tamponade treatment in the news

Blogs on Cardiac tamponade treatment

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Cardiac tamponade treatment

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

Template:WS Template:WH CME Category::Cardiology