Magazine article American Nurse Today

Acute Cardiac Tamponade: Sudden Deterioration Requires an Immediate Response

Magazine article American Nurse Today

Acute Cardiac Tamponade: Sudden Deterioration Requires an Immediate Response

Article excerpt



Mr. Pace's nurse, John, notices on telemetry that his HR has increased along with a change to sinus rhythm, rate 88 bpm. Mr. Pace is short of breath with an RR of 22 breaths/minute, and his BP is 120/78 mm Hg.

John elevates the head of Mr. Pace's bed and performs a quick assessment, which reveals a neurologically awake and alert patient who is moving all extremities equally, cool skin with equal pulses, BP 105/80 mm Hg, clear lungs with [O.sub.2] sat 96% on room air, and RR 26 breaths/minute. John also notes bilateral jugular vein distention (JVD). Mr. Pace says he's not in pain.

John calls for a rapid response team (RRT) consultation for cardiac decompensation after pacemaker insertion.

Rapid response

When the RRT arrives, John has already placed Mr. Pace on oxygen at 2 L/min by nasal cannula, with bedside continuous electrocardiogram (ECG) monitoring, continuous noninvasive BP monitoring, and an 18-G I.V. with normal saline infusing. John also called for a 12-lead ECG, which is being completed at the bedside.

The RRT notes that Mr. Pace is in a progressive shock state. A normal saline bolus of 500 mL is given, and portable chest X-ray and multiple serum labs with a serum lactate are ordered. With fluid administration, Mr. Pace's BP begins to improve.

The 12-lead ECG shows sinus tachycardia with no ischemia or infarction. Mr. Pace's chest X-ray reveals a widened mediastinum with a small right pleural effusion. Hemoglobin and hematocrit are slightly lower than previous readings, coagulation studies are normal, and serum lactate is 3.8 mmol/L (normal is below 1.5 mmol/L).

An echocardiogram shows moderate pericardial effusion with right-sided compromise and low left ventricular output as a result of low filling volumes of the left ventricle. A diagnosis of cardiac tamponade is made.

The patient is taken to the cardiac catheterization laboratory, where, under fluoroscopy, the tamponade is tapped for 350 mL of bloody effusion. After the procedure, Mr. Pace's vital signs are normal, and his serum lactate falls to 1.8 mmol/L.

A dangerous development

Acute cardiac tamponade occurs quickly and can be caused by trauma, aortic dissection, ventricular rupture, or as a complication of any invasive procedure where the great vessels are manipulated (such as a permanent pacemaker or central line insertion). …

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