CardiovascularCritical care
Cardiac tamponade: recognition and drainage
5 questions on this concept, from 5 angles.
Brunner & Suddarth's Medical-Surgical Nursing 14e (2018), ch. 29 Management of Patients With Complications From Heart Disease
The idea in full
Cardiac tamponade is an obstructive shock in which pericardial fluid under pressure prevents the ventricles from filling, so it is recognized clinically by a rising venous pressure together with a falling and narrowing arterial pressure — the speed of accumulation mattering more than the volume — and it is relieved only by draining the pericardium, never by the diuretics or vasodilators that a failing circulation otherwise invites.
Beliefs this concept corrects
- 1Distended neck veins mean the patient is fluid overloaded and needs a diuretic
- 2A patient whose neck veins are that full must not be given more fluid
- 3It is not tamponade until all three classic signs are present, so escalation waits for the muffled heart sounds
- 4Chest pressure with a falling blood pressure is ischemia, and nitroglycerin is the answer
- 5An effusion the echo report called small cannot be compressing the heart
- 6A large effusion on the echo is an emergency in itself, however well the patient looks
- 7Once the pericardium has been drained the danger has passed
- 8Clear lungs rule out the heart as the cause of the shock
- 9A chest drain that has stopped draining means the bleeding has stopped
- 10A rising central venous pressure after heart surgery means the fluids are catching up
Your record
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