ACUTE CARDIAC TAMPONADE: MANAGEMENT
MANAGEMENT:ACUTE CARDIAC TAMPONADE: A rising venous pressure coupled with a falling arterial pressure (below 90 mm Hg) warrants immediate intervention.
1. iParacentesis. This should preferably be done by a person experienced in the procedure and under complete asepsis. Any of the following sites may be used for removal of the fluid: (a) in the epigastrium in the angle between the xiphoid process and the left costal margin directing the needle upwards, backwards and to the left; (b) fourth or fifth left intercostal space just outside the sternal margin; and (c) fifth left intercostal space 1-2 cm inside the left border of the cardiac dullness. This site is safer when apex beat can be localized. Needle should then be inserted between the apical impulse and the (enlarged) border of cardiac dullness (Fig. 10),
2. Other Measures. In all cases of cardiac tamponade an attempt should be made to find out the cause of pericardial effusion, which should then be treated appropriately. When no cause is obvious and the effusion is serous (or even haemorrhagic), it should be presumed to be tubercular in origin (in this country, at any rate) and treated accordingly.
Tags: CARDIAC TAMPONADE, epigastrium, pericardial effusion
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