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Table of Contents
- Course Home
- Objectives
- Matching Exercise
- Introduction
- Anatomy: The Heart
- Anatomy: The Vessels
- Physiology: Introduction
- Physiology: Review of Circulation
- Physiology: The Cardiac Cycle
- Physiology: Innervation of the Heart
- Cardiac Electrophysiology: Introduction
- Cardiac Electrophysiology: Electrolytes
- Cardiac Electrophysiology: The Cardiac Conduction System
- Sample Cases
- Case 1: Cardiac Tamponade
- Figure 1: Assessment
- Figure 2: Management
- Case 2: Cocaine Overdose
- Figure 3: Assessment
- Figure 4: Management
- Case 3: Hemorrhagic Shock
- Figure 5: Assessment
- Figure 6: Management
- Conclusion
- References
- Bibliography
Case 1: Cardiac Tamponade
-Presentation:
A 24 year old woman calls 911 and reports that her 15 year old brother has been shot while caught in the crossfire of a gang gun battle.
You arrive on the scene within 2 minutes and find a young male with a gunshot entry wound to the left side of his chest. The young man is no longer talking, but he is still breathing. He is sweaty and is clutching his chest. From brief questioning of the patient’s sister, you learn that the young man has had no previous medical problems and leads an active healthy life.
Physical examination reveals distended neck veins and muffled heart tones. You cannot palpate a blood pressure. The patient is deteriorating rapidly.
-Keys to the History and Physical Exam:
-The Patient History:
1) The patient’s sister states that the young man has no medical problems and leads an active lifestyle. This historical information is useful because you can expect that the patient’s cardiovascular anatomy will be normal.
2) The patient has been shot in the left chest, which means the patient may be suffering from a penetrating injury to the heart, lungs, or major blood vessels in the chest.
3) Despite arriving within 2 minutes of the incident, the patient’s condition is beginning to deteriorate rapidly, which helps us know that there is an acute process causing the patient to clinically worsen.
-The Physical Exam:
1) The patient’s neck veins are prominent, his heart sounds are difficult to hear, and you cannot measure his blood pressure. These three findings are known as Beck’s Triad, which consists of three clinical signs (hypotension, muffled heart tones, and distended neck veins) that occur in association with cardiac tamponade.
-Cardiac Tamponade:
Cardiac tamponade refers to a condition in which the sac encasing the heart becomes filled with fluid or blood. Initially the right ventricle will collapse and be pushed over against the left ventricle until the whole heart is compressed by the pericardial fluid. The collapse of the ventricles causes cardiac dysfunction and imminent death if interventions are not performed to quickly drain the fluid from around the heart.
-Initial Assessment and Management:
-See figures that follow.