Pericardial Tamponade – The #FOAM Gods address the “full sack”

Cardiac Tamponade

It’s the trick-or-treat of trauma
As little Mollie’s bag of candy begins to fill with sweets on Halloween night, you’re stuck in the Emergency Department on the other side of the city with a post MVA chest trauma 40YOM with Dyspnea, Sinus Tach, c/o mild discomfort and bruising around the sternum and left chest.

There is no shortage in the literature and #FOAMed on this one, but after listening to this podcast by Dr. Haney Mallemat on ‘Managing Pericardial Tamponade in the Slowly Crashing Patient’  featured at freeemergencytalks.net I was inspired to re-visit the topic.

It’s a great podcast, around 13 minutes and covers a case study and some many seriously valuable clinical pearls in dealing with Pericardial Tamponade.
A few of my favorite take-home points from Dr. Haney were:

  1. Size doesn’t Matter (sound familiar?) – it’s all about timeframe
  2. Ultrasound Ultrasound, Ultrasound! – then again, I feel like the entire #FOAM world says that!
  3. There is only 1 cure – that’s drainage – everything else is a bandaid solution
  4. Don’t expect Beck’s Triad or even Pulsus Paradoxus  to slap you in the face, the pathophysiology doesn’t give a Cra* about traditional presentation – so ultrasound that sucker!
  5. Lastly, NO PPV – that includes PEEP, CPAP, BiPAP, even Intubation! and the rest!
    Positive Pressure Ventilation will inevitably cause your patient to crash because it removes the negative pressure mechanism in the intra-thoracic space that is being used to fill the chambers

Tamponade

Now, Here’s what the EM Gods have to say:

Articles:
http://www.cicm.org.au/journal/2004/march/Tamp1.pdf
http://www.health.ri.gov/publications/protocols/EMSProtocols_Aug2011_RevisedOnly.pdf

 

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