# Pericardial Effusion
# Cardiac Tamponade
-- ABCs: If unstable, STAT CT surgery page for pericardiocentesis once dx established
-- Chart Check: prior EKG, echos, recent procedures
-- Thorough HPI Intake: recent illnesses, h/o cancer (and cancer sxs) and treatment with radiation, h/o autoimmune disease (and rheum ROS)
-- Can't Miss: tamponade leadng to obstructive shock
-- Other Workup: CBC, coags, T+S, viral panel, EKG, echo, pericardial studies (see below)
-- Initial Treatment to Consider: pericardiocentesis is the only treatment to fix hemoynamic instability
-- History: *** timing, recent procedures, infections, previous MI, cancer screening, prev radiation, FHx autoimmune
-- Clinical: *** Beck Triad - hypotension, muffled heart signs, distended neck veins (JVP)
-- Exam: *** pulsus paradoxus (sens 82%, LR 5.9 >13; LR 3.3 if >10, LR 0.03 if <10), tachy (sens 77%), hypotension (sens 26%); friction rub (30% of cases) best heard end-expiration when leaning forward; Volume - JVP (sens 76%), Kussmaul Sign (sens 26%), crackles, edema, hepatomegaly
-- Data: *** EKG, Echo, CXR, troponin, creatinine, BUN
-- Etiology/DDx: *** Etiology: surgery, pericarditis, malignancy, radiation, uremia, autoimmune dx; hemopericardium from dissection, free wall rupture, trauma
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Continuous telemetry
-- Serial pulsus paradoxus measurement
-- Pericardiocentesis: f/u *** cell count, total protein, LDH, cytology and tumor markers, gram stain and culture, AFB smear and culture, viral markers for coxsackie, HSV, CMV, EBV, HIV
-- IV fluids: *** s/p ***
-- Inotropes: *** dobutamine
PDF template coming soon!
The classic Beck triad (hypotension, muffled heart sounds, distended neck veins) is not very sensitive - instead look for effusion on POCUS, pulses paradoxus, cardiomegaly on CXR. Pericardiocentesis should not be delayed if the patient is unstable - nothing else will fix the patient's hemodynamics. Tamponade can lead to PEA arrest. In terms of etiology, iatrogenic, infectious, malignant, and autoimmune are the most common.