In a cardiac tamponade is an accumulation of blood in the pericardial sac with sufficient volume and pressure to affect the cardiac filling. Patients have low blood pressure, muffled heart sounds and extended neck veins usually. The diagnosis is made clinically, often with echocardiography at the bedside. Treatment consists of prompt Perikardpunktion or pericardiotomy.

Fluid in the pericardium can affect the heart filling and leads to a low cardiac output and sometimes shock and death. If liquid accumulates slowly (z. B. due to chronic inflammation), the pericardium can stretch to 1 up to 1.5 liters of the fluid before the cardiac output is compromised. But in a rapid accumulation of fluid, such as occurs in a traumatic bleeding, as little as 150 ml can cause tamponade.

In a cardiac tamponade is an accumulation of blood in the pericardial sac with sufficient volume and pressure to affect the cardiac filling. Patients have low blood pressure, muffled heart sounds and extended neck veins usually. The diagnosis is made clinically, often with echocardiography at the bedside. Treatment consists of prompt Perikardpunktion or pericardiotomy. Fluid in the pericardium can affect the heart filling and leads to a low cardiac output and sometimes shock and death. If liquid accumulates slowly (z. B. due to chronic inflammation), the pericardium can stretch to 1 up to 1.5 liters of the fluid before the cardiac output is compromised. But in a rapid accumulation of fluid, such as occurs in a traumatic bleeding, as little as 150 ml can cause tamponade. In trauma, the cause is often penetrating than blunt trauma. The wound often runs medial to the nipple (for anterior wounds) or the shoulder blades (for posterior wounds). Tamponade due to a dull trauma includes Herzkammerruptur, which is typically fatal before the patient can be brought to the treatment. Symptoms and complaints Traditionally, patients have a Beck’s triad, consisting of: hypotension Muted heart sounds Venous pressure increase (eg expansion of the jugular vein.) However, a hypotension in trauma patients several possible causes, muffled heart sounds can be difficult during a noisy trauma resuscitation need to be assessed and a Halsvenendistention may be absent due to hypovolemia. Paradoxical pulse (Cardiovascular examination: paradoxical pulse), a decrease in systolic blood pressure during inspiration of> 10 mm Hg, is also suggestive, but again not easy to assess, in a noisy environment. Diagnosis Clinical Investigation Open echocardiography at the bedside The diagnosis can be difficult. The Beck’s triad is considered to be diagnostic, but may not be available or easy to recognize. In addition, tension pneumothorax (pneumothorax (voltage)) should also be considered in patients with hypotension and expansion of the jugular vein into consideration, even if this disorder usually caused significantly decreased breath sounds and hyperresonance on the affected hemithorax. A transthoracic echocardiography at the bedside can be diagnostic, and are performed during the initial examination and resuscitation, but may incorrectly be negative. The diagnosis is sometimes respond by inexplicable failure on the volume of resuscitation, suspected. Sometimes therapy Perikardpunktion pericardiotomy or creating a Perikardfensterung A subxiphoidale pericardiocentesis is performed in unstable patients when cardiac tamponade is suspected. If possible, an ECG monitoring is introduced during the needle for ST elevation (indicating contact with the epicardium, and the need to retract the needle) is performed. Perikardpunktion is a temporary measure. Distance of less than 10 ml of blood may be able to normalize blood pressure. However, the failure of blood does not mean suck that the diagnosis is excluded; fresh blood in the pericardium often coagulates. Thoracotomy with pericardiotomy or setting up a subxiphoid Perikardfensterung are more definitive treatments that are indicated in patients in whom the diagnosis is confirmed or strongly suspected. If sufficient trained staff is available and the patient is unstable and does not respond to other resuscitation measures, one of these procedures can be performed in the emergency situation at the bedside. Otherwise, the procedure is done in the operating room as soon as possible. Important Points cardiac tamponade is most commonly caused medial to the nipple by a stab wound (with anterior wounds) or the shoulder blades (for posterior wounds). The triad of muffled heart sounds, hypotension and expansion of the jugular vein is diagnostic, but not always available; if not available, an echocardiogram at the bedside should be performed if the diagnosis is suspected. A subxiphoidale pericardiocentesis is a temporary measure and may be false negative; Perikardfensterung or pericardiotomy are final.

Health Life Media Team

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