A 25 yr old man came to emergency depament after A. On CXR, multiple ribs fractures were visible. On physical examination, blood pressure was 80/60 mmHg and hea rate 150/min. Patient was restless, and tachypneic with jugular veins distended. On auscultation, air entry equal on both sides, hea sounds very soft or inaudible. What is the immediate step of management?
The above clinical presentation is suggestive of Cardiac Tamponade. The presence of Beck's triad (Hypotension ,Soft or absent hea sounds and Jugular venous distention) ours the diagnosis of Cardiac Tamponade TOC for Cardiac Tamponade: - ECHO guided Pericardiocentesis Tension pneumothorax is ruled out as there isequal air entry on both sides Cardiac Tamponade 1. Exaggerated septal detion ++2. Pulsus Paradoxus: SBP ||, Hence an example of obstructive shock3. BECK'S TRIAD: - MUFFLED S1S2 HYPOTENSION Congested neck veins: Non pulsatile | JVP 4. Pulsus Paradoxus + Electrical Alternans = Cardiac TamponadeIf electrical Alternans is given alone in a MCQ, answer as Pericardial Effusion5. Kussmaul sign absent6. Electrical alternans present7. Money bag appearance+8. TOC: - Echo guided Pericardiocentesis (Xiphisternal approach)
Needle inseion in 5th ICS
Echo guided Pericardiocentesis
Intercostal tube drainage on both sides
IV fluids for Hypotension
Disease of pericardium