Highlights
- •Temporizing measures of volume resuscitation and vasopressor therapy are generally used in the prehospital setting for the management of cardiac tamponade.
- •Pericardiocentesis is indicated and can be successfully performed in the prehospital setting for patients with hemodynamic compromise secondary to cardiac tamponade.
- •The addition of positive pressure, whether via intubation, continuous positive airway pressure, or BiLevel positive airway pressure, can aggravate hypotension, especially in preload-dependent conditions, such as cardiac tamponade or hypovolemia.
- •Hypotension, oxygenation, and pH (also known as HOP killers) should be considered before intubation.
Abstract
There are few procedures performed in the prehospital setting as intimidating as pericardiocentesis.
We report a case in which lifesaving pericardiocentesis was performed in the back
of an ambulance after temporizing measures of volume resuscitation and vasopressor
therapy failed.
Fluid accumulation within the pericardial sac can increase pressures around the heart
and lead to cardiac tamponade. Helicopter emergency medical service crews may be called
to transport patients with cardiac tamponade physiology to definitive care where removal
of the pericardial fluid can be achieved. Pericardiocentesis is indicated as an emergency
procedure in patients with hemodynamic compromise secondary to cardiac tamponade.
1
Because most HEMS crews do not routinely perform pericardiocentesis because of the
rare need or crew scope of practice limitations, the general approach to management
in the prehospital setting is volume resuscitation, to overcome decreased preload,
and vasopressor support. Here, we report a case in which lifesaving pericardiocentesis
was performed in a ground ambulance after temporizing measures of volume resuscitation
and vasopressor therapy failed.To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: July 27, 2019
Identification
Copyright
© 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
