Cardiac Tamponade - Dr. B. Johnson

Etiology  
- Idiopathic is most common
- Also:  trauma, malignancy, infection, uremia, collagen vascular disease, hypothyroidism, etc

Presentation 
- Dependent on rate of pericardial fluid accumulation
- Symptoms:  Sinus tach -> cardiogenic shock, distended neck veins, respiratory distress, Beck's triad
- Work-up:  EKG, chest x-ray, ultrasound (most important!)
- Tamponade is a clinical diagnosis NOT an echocardiographic diagnosis, but US is a crucial adjunct

Treatment 
- Definitive treatment = fluid removal (pericardiocentesis vs surgery)
- Fluid resuscitation to increase preload
- Avoid PPV and nitrates at all cost

Indication for ED thoracotomy 
- Penetrating thoracic trauma, with witnessed signs of life (on arrival or en route), and less than 15 min of arrest w/ CPR


Core Concepts:
1) Keep tamponade on your differential
2) Employ ultrasound early
3) Treatment = pericardial pressure relief
4) Fluid resuscitation can be life saving (increase preload)

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