Case of the Month #28 Cardiac Tamponade
What is the definitive emergency management?
Management should also include oxygen therapy, leg elevation, volume expansion with small boluses. Positive pressure ventilation should be avoided as it reduces venous return.
Pericardiocentesis should be performed under echocardiogram guidance but can be performed with a para-xiphoid approach using landmarks in the emergency setting. The Cardiothoracic or Cardiology teams should be involved. A needle is inserted at 15 degrees passing below the costal margin. It is then directed parallel with the chest towards the scapula whilst aspirating until the pericardium is reached. If required, a catheter can be inserted using the Seldinger technique for continuous drainage.
Other surgical options include direct surgical and video assisted approaches although trials are ongoing to determine outcomes .