Therapeutic management

In suspected cases of tamponade, regular measurement of arterial pressure, heart rate, and central venous presure should be made at intervals of 5 to 15 min. Hematocrit, urine output, and arterial blood gases should also be measured, but at less frequent intervals. While the patient is being prepared for drainage, a trial of volume loading may improve the hemodynamic picture. This confirms that hypovolemia and myocardial insufficiency are not major problems. Volume loading is not contraindicated by high central venous pressures, as tamponade is produced by inadequate ventricular filling rather than ventricular failure.

Figure 1 shows a clinical algorithm designed for the immediate treatment of patients suspected of having acute pericardial tamponade from blunt or penetrating injury of the chest or upper abdomen, after thoracotomy, cardiac catheterization, or placement of central venous catheters, and for patients with pericarditis, malignancies, or granulomatous diseases of the chest who become symptomatic.

Fig. 1 Clinical management algorithm: CNS, central nervous system; CPR, cardiopulmonary resuscitation; CVP, central venous pressure; CXR, chest radiography; ICU, intensive care unit; MAP, mean arterial pressure; MRI, magnetic resonance imaging; HS, heart sounds.

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