Pericardial Tamponade for Certified Emergency Nursing (CEN)

Definition/Etiology:

When enough fluid accumulates in the pericardial sac compressing the heart. This causes a decrease in ventricular filling which leads to a decrease in cardiac output and shock. Trauma is the number one cause and usually from penetrating injuries such as gunshots or stab wounds.

Pathophysiology:

When the fluid within the pericardium builds up too fast (usually from a medical or traumatic event), the chambers of the heart are compressed, and tamponade physiology develops. Under this pressure, the chambers of the heart are unable to relax leading to decreased venous return.

Clinical Presentation:

General assessment findings-

• Restlessness
• Impending doom
• Dyspnea
• Localized chest pain

• Becks triad: Hypotension, JVD, muffled heart tones.
• Pulsus Paradoxus: Systolic decreased >10mm.hg with inspiration
• FAST exam – visible fluid in pericardium

Collaborative Management:

• X-Ray
• EKG
• Fluids: Increase preload…increase ventricular filling…increase output? Not for long
• Possible CT Chest if time permitting
• Pericardiocentesis: MD performs…we watch and go “ooooooooh”.
• Possible CVP monitoring
• Antidysrhythmic meds if necessary
• Possible surgical intervention

Evaluation | Patient Monitoring | Education:

• Hemodynamic monitoring
• Intra-pericardiocentesis – watch for ventric perf, pneumo, v-fib!
• Post pericardiocentesis management and monitoring. – How do we know the doc is in the right spot? (Pericardial fluid does not clot!)
• Treat overall patient: What caused the tamponade, is it part of a larger trauma condition? Take off the blinders.

Linchpins: (Key Points)

• Observe for signs of shock:
• Becks is not terribly common, but if you see it…..you know!
• Prep for a biiiiig needle to the chest
• Continue to monitor hemodynamic status after intervention