EMERGENCY INDICATION
Pericardial Tamponade
following major trauma to chest
Signs & Symptoms
- Chest wall injury
- Shallow / laboured breathing
- Poor quality rapid pulse
- Enlarged neck veins (CVPá)
-
Low pulse pressure (difference between
systolic and diastolic BP)
- Anxious-Confused
- State of Shock
- Heart Sounds - Distant / Muffled
- Tachycardia - Cyanosis ±
Objective
To aspirate the collection of blood in the pericardial sac and improve venous return to heart (relieve cardiac tamponade).
Require
Betadine or other skin prep solution Long (15 cm 6") 18 gauge needle & 20-50 cc syringe
Procedure
- Supine position
- Sterile skin prep (xiphoid area)
- 1% xylocaine local infiltration as needed
- A small puncture with a 11 blade knife on the skin just below and to the left of xiphoid process
- The long needle is positioned at 45º above the body surface and 45º to the right of midline
- Through the skin puncture the needle is advanced in the position as above cephalad (towards head) and towards the left scapula.
- With-draw the syringe and aspirate unclotted blood from pericaridal sac
- Improvement is usually seen on prompt withdrawal of pericardial collection
- Through the needle a catheter can be passed and aspiration carried out periodically till patient handed to trauma center for further surgical care.
- ECG monitoring before during and after procedure helps
