Pulsus paradoxus

The so-called paradoxic pulse or pulsus paradoxus is an exaggerated pattern of change in arterial pressure with ventilation. By definition, it occurs when the systemic arterial pressure decreases by more than 15 mmHg with inspiration. Normal variation in arterial pressures is less than 10 mmHg and is not clearly evident by examination with stethoscope and sphygmomanometer. Pulsus paradoxus may be detectable by careful examination of the radial pulse, but is more easily detected with direct recording of arterial pressures and the ventilatory cycle. It is a useful sign in slowly developing pericardial effusions, but is not very useful in rapidly developing tamponade from penetrating injuries.

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