Physical exam. Pulsus paradoxus, classic sign of
cardiac tamponade. What is that mean?
Here’s is the definition. Now, in case you
actually needed in words here it is,
I would recommend that you are able to interpret
the graph that we just saw prior. Quite important.
Cause there was a kind of questions
and there was a type of interpretations
such as responsible for being an effective clinician.
Pulsus paradoxus refers to decrease in systolic blood pressure,
decrease of more than 10 millimiters mercury with inspiration.
There you have it. Why?
More blood? Well, we just walked through that
in great detail in a previous discussion.
Jugular veins will be distended because of restriction.
Heart sounds, you tell me about those are
able to listen to your heart sounds well.
No, you cannot muffled. Move on.
What about EKG?
You have increased effusion in any of
thickness within the pericardium.
So therefore, when you put electrode to your heart,
how well is that going to measure the voltage?
Not very well. Low voltage is what you are looking for.
What is that even mean?
You take a look in an EKG, what is the voltage?
Is that the X-axis or Y-axis? Voltage is amplitude.
Aright, I need you to think, R wave can you see it.
Close your eyes. R wave, major, major positive deflexion.
And that is going to be reduced low voltage because of effusion.
Electrical alternans, which are alternating large and
small QRS complexes, may be seen that’s important
because you don’t have the sustained increase in QRS complex
consistently because of the increase fluid by pericardial cavity.
That has to be cleared. So a couple of things that
you wanna pay attention to in terms of medical terminology,
so that you understand what’s going on with your patient.
Chest X-ray, well it’s more important that we take
a look of our Echo. And where it you are going to find
actual increase fluid within the pericardial cavity.
Echo revels pericardial fluid, collapse the ventricle
during diastole. If without hemodynamic consequences,
what does this mean to you? Watch while waiting with treatment
because ultimately, if your patient goes into decompensation,
you need to get in there remove that fluid.
In draining the fluid, what’s this called pericardiocentesis.
What you’re doing? You opening up a window
and literally removing the fluid especially
when you patient pay attention hemodynamically instable.
Increased risk recurrence may require pericardial
window and at some point. Remember,
steroids and such sure band aid therapy, anti-inflammatory
but ultimately when you have recurrences
you’re definitive treatment is going
to be your pericardial window.
And that’s what exactly what you’re seeing here.
You will open up a window surgically.
You will then literally drain the fluid right out of your
pericardial cavity. So that you can relieve that pressure ASAP.
Why how would you know that your
patient is going into decompensation?
There is going to be a decrease cardiac output.
That blood pressure hypotension is what you are looking for.
Looking for positive JVD and might be looking for dyspnea.
So that means that the heart right now
is being majorly, majorly handicapped.
And so, therefore, you need to get in
there and relieve your patient.