Management of Cardiac Tamponade

In this article, we will discuss the Management of Cardiac Tamponade. So, let’s get started.

Management

It includes:

1. Treatment of shock: If patient is in shock state, treat it like cardiogenic shock. After assessment, maintain basic life support measures, i.e. airway, breathing and circulation. Fluid therapy is given to maintain preload under CVP monitoring. Inotropic agent may be used if fluid therapy alone is insufficient to restore the shock. Metabolic acidosis may
be corrected.

2. Pericardiocentesis (removal of pericardial fluid): It is the mainstay of management because it provides rapid relief and restores the circulation and diastolic filling of the ventricles. Unless situation is immediately life-threatening, tapping should be done by an experienced personnel under echo or fluoroscopic guidance with ECG monitoring

Procedure: Left subxiphoid approach
with patient propped up to 45ºis preferred. Rarely apical or parasternal approach may be required in loculated effusions. The procedure is as follows:
a. The patient is made to liein propped up position with back rest.

b. The patient is premedicated with
atropine and diazepam.

c. The skin over the precordium and
upper part of the abdomen is shaved.

d. Under aseptic precautions and local
anaesthesia, a large bore long needle
or IV. cannula connected to a syringe
is inserted and then connected to a
3-way stopcock for rapid aspiration.
The fluid is continuously aspirated.
Fluid is removed as much as possible
till patient feels relief in dyspnoea and BP is restored above 90 mmHg.

e. If at any stage during procedure, frank blood is seen entering the syringe, the tip of the needle should be repositioned.

f. Always look at the ECG monitor for any VPC as this may indicate the presence of the needle in the myocardium.

g. If the fluid drawn is purulent, then itshould be drained by an indwelling
catheter connected to an underwater
seal.

h. After removal of the fluid, patient is
made to lie comfortably on the bed and observed for pulse, BP for few hours. The L.V. line is maintained during this period.

3. Surgical pericardiotomy or pericardiectomy: It is indicated for recurrent, frequent, disabling pericardial effusion.

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