Ultrasound signs of pericardial tamponade with my buddy, Jailyn Avila. This episode is simulcasted with Core Ultrasound.
Right Atrial Collapse
greater than 1/3 of the cycle is probably the most specific
Right Ventricular Collapse
If the RV is collapsing when the mitral valve is open, then that is specific for tamponade
IVC
Lead pipe is specific, flat doesn't rule it out (if pt is volume depleted, etc.)
Check Out my Prior Episode with Jailyn
Steve Alerhand has written a great review article in AJEM
Now on to the Wee…
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Whenever cardiac tamponade is discussed I cannot help but think of the NEEDLESS death of ‘First Man’ (on the Moon), Neil Armstrong. A guy who averted numerous near death moments dies in 2012 from what we now know was really bad handling of lead wire removal………
it would be better this particular podcast comes with vedio.
It’s interesting that you mention a lead pipe IVC as being specific for tamponade – I had always thought that you can get a big IVC for lots of different things (Overload, PE, heart failure etc..) but a collapsing IVC in tamponade is relatively rare. Obviously with all these things our pre-test probability will have a massive impact on our conclusions.
it’s specificity is in the setting of PERICARDIAL EFFUSION with suspected tamponade. of course, no specificity at all without that.
Hi Scott,
I was an intern during your last few months at Elmhurst.
Just FYI…my recent AmJEM publication covers precisely this topic:
What echocardiographic findings suggest a pericardial effusion is causing tamponade? https://pubmed.ncbi.nlm.nih.gov/30471929/
Hope it adds to the topic,
Stephen
fantastic! posted the article, can i post some of the videos in the shownotes?
Thank you. Of course.
FYI we published an update:
Pericardial tamponade: A comprehensive emergency medicine and echocardiography review https://pubmed.ncbi.nlm.nih.gov/35696801/
The POCUS sections are far more nuanced, with better images/clips.
Also included are pre- and peri-procedural pearls for pericardiocentesis.
FYI we published an evidence-based update: Pericardial tamponade: A comprehensive emergency medicine and echocardiography reviewhttps://pubmed.ncbi.nlm.nih.gov/35696801/
The POCUS sections are more nuanced, with better images/clips.
Also included are decision-making paradigms for effusions +/- tamponade, along with pre- and peri-procedural pearls for pericardiocentesis.
Hi Scott, Jacob, and Stephen. Well done. Scott your case of tamponade without apparent RV collapse could have been explained if they had any reason to have elevated right heart pressures-OSA/COPD/long term asthma. We’ve had a couple of patients in our community ED with clinical tamponade we’ve had to drain, that had no RV collapse. Both were obese and had OSA. One had asthma as well. With really bad PHT the LV can collapse before the RV, and the situation can be a risk factor for too rapid pericardial aspiration: Gollapudi RR, Yeager M, Johnson AD. Left ventricular cardiac tamponade… Read more »
Lindsay–fantastic comments!
dopamine at doses of 10-20 mg / kgc / min also has a positive inotropic and vasoconstrictor effect and then why in cardiogenic shock is combined dobutamine with dopamine
Hi Scott, I wonder if you could comment on the use of simply placing an arterial line to determine if tamponade physiology is present by the presence/absence of pulsus paradoxus on the aline wave form?
All the best,
Michael