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Transcript
Learning Objectives • Define cardiac tamponade. Cardiac Tamponade • Identify causes of cardiac tamponade. • Enumerate signs and symptoms of disease. • Explain how to diagnose the case. • Discus the Principles of care. 1 Cardiac Tamponade 2 Cardiac Tamponade Definition • It is a result of accumulation of excess pericardial fluid that compress the heart. • Bleeding into the pericardial sac or small pericardial rupture may or may not cause cardiac tamponade, depending on the amount of pressure in the • It is causing decreased cardiac filling, which leads to reduced cardiac output and shock. 3 pericardium. 4 1 Cardiac Tamponade Cardiac Tamponade • The pericardial sac normally holds about 25 ml of • Continued bleeding increases the pressure rapidly fluid, which serves to cushion and protect the heart. • Only a small amount of pericardial blood (50 to 100 ml) is necessary to increase intrapericardial and the patient present with signs of cardiac tamponade. pressure. 5 6 Cardiac Tamponade Cardiac Tamponade Signs and Symptoms 5. Ankle or sacral edema; 1. Decreased blood pressure. 6. Ascites; 2. Abnormal heart sounds. 7. Hepatosplenomegaly. 8. Dyspnea, cough, and retrosternal pain that is relieved by 3. Increased central venous pressure. leaning forward 4. Distended neck veins during inspiration 9. Epigastric pain, hiccups, hoarseness, nausea, and vomiting. 7 8 2 Cardiac Tamponade Cardiac Tamponade Diagnostic Studies. Patient care • A chest film is used to determine the presence of cardiac enlargement, 1. Place the patient in Trendelenburg position, notify the physician. mediastinal widening. 2. Administer oxygen as ordered. • The electrocardiogram (ECG) may show nonspecific abnormalities, including ST segment elevations, and T-wave changes. 3. Prepare the patient for Pericardiocentesis. 4. Emergency Pericardiocentesis is life saving. • Echocardiography. 5. Removal of 50 to 100 ml of fluid can bring major hemodynamic • Catheterization of the right side of the heart reveals pericardial tamponade. improvement. 9 10 Cardiac Tamponade Pericardiocentesis Patient care 5. If a pericardial catheter is present, aspirate pericardial fluid, per orders. 6. Give fluids to increase preload ( The amount of cardiac • Pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart). muscle fibres tension or stretch that existing at diastole, just before ventricular contraction). 7. Discontinue agents that decrease preload ( diuretic, nitrates, morphine) 11 12 3 Position Process • The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised to a 30- to 60-degree angle. • This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac. • Anatomically, the procedure is carried out under the xiphisternum up and leftwards • It is generally done under ultrasound guidance, to minimize complications. • There are two locations that pericardiocentesis can be performed without puncturing the lungs. • One location is through the 5th or 6th intercostal space at the left sternal border at the cardiac notch of the left lung. • The other location is through the infrasternal angle. 13 14 Indications • Indications include cardiac tamponade, as well as the need to analyze the fluid surrounding the heart. • The removal of the excess fluid reverses this dangerous process. • Cardiac tamponade is a condition in which an accumulation of fluid within the pericardium creates excessive pressure, which then • Examples of the need for fluid analysis would be to differentiate whether a fluid collection within the prevents the heart from filling normally with blood. • This can critically decrease the amount of blood that is pumped pericardium is due to an infection, spread of cancer, or possibly an autoimmunecondition. from the heart, which can be lethal. 15 16 4