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The patient should be started immediately on therapeutic heparin.
1%
1/108
A finding of an increase in arterial pressure during inspiration > 10 mm Hg would be indicative of this condition.
18%
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Chest radiograph is the gold standard in diagnosis.
7%
8/108
EKG may show electrical alternans.
65%
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Cardiac catheterization would show higher pulmonary capillary wedge pressure than right ventricular pressure during diastole.
8%
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This patient with chest trauma, jugular venous distension (JVD), tachycardia, and hypotension despite aggressive fluid resuscitation is likely suffering from cardiac tamponade. Electrical alternans may also be seen. In cardiac tamponade, a pericardial effusion impairs diastolic filling of the heart. Ventricular filling becomes impaired as pressures in the right ventricle, left ventricle, right atrium, and left atrium all begin to equalize during diastole. With decreased filling, there is decreased stroke volume and cardiac output. Since the pericardium has the ability to stretch and adapt to increasing volume with time, the total amount of fluid buildup is not as significant as the rate of fluid buildup. Causes vary from penetrating or blunt trauma to the thorax to pericarditis (which may be idiopathic, neoplastic, or uremic), free wall rupture, and iatrogenic causes. Illustration A depicts an echocardiogram showing a large pericardial effusion. In live motion on echo in cardiac tamponade, one would see bowing of the septum or RV collapse during diastole. Illustration B depicts the EKG for electrical alternans. Incorrect Answers: Answer 1: This would be an appropriate treatment for a pulmonary embolism but is not the correct treatment for a tension pneumothorax. Answer 2: A decrease in arterial pressure during inspiration (> 10 mmHg) would be expected. This is pulsus paradoxus. Answer 3: Chest radiography is not as effective as echocardiogram in diagnosis of tamponade. However, enlargement of the cardiac silhouette will occur when substantial fluid has accumulated. Answer 5: In cardiac tamponade, pressures in all four chambers will equalize during diastole.
3.3
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