Guest Posted February 22, 2006 Share Posted February 22, 2006 Narrowing pulse pressures....? Duh! Link to comment Share on other sites More sharing options...
ERDoc Posted February 22, 2006 Author Share Posted February 22, 2006 Holy heck batman well with muffled heart tones I suspect that she has cancer around the heart and it's prohibiting her ability to pump. Or she could have a tamponade. Any history of trauma after her syncopal episode?? We have a winner!!!! Yes, this woman has a malignant pericardial effusion causing tamponade. The previous syncopal episode was probably related to a pericardial effusion, but this time the effusion has become so severe as to cause tamponade physiology. Pts with cancer can get pericardial effusions. These effusions are usually chronic in nature, whereas in trauma they are acute. Tamponade in a trauma pt can be caused by as little as 100cc of fluid in the pericardium. With tamponade you can see what is called Beck's Triad which is a decreased pulse pressure, muffled heart sounds and JVD. What happens is that the fluid in the pericardium compresses the right ventricle to the point where it cannot fill up with blood. In this woman's case, as her pressure is dropping, despite getting 4 liters of fluid and started on Dopa, we were at a loss to explain why she was crashing. When I first saw her I was thinking dehydration also. As a last ditch thing we put the ultrasound on her and found nothing in her belly, so we took a look at her heart and saw a huge effusion. Performed a pericardiocentesis and got about 500cc of fluid out :shock:. As the fluid was being drained, she starts telling us that she is feeling better. Her pressure starts coming up and stabilizes at 140/72. The cardiologists come by and do an echo on her and she still has a moderate effusion with some evidence of tamponade. This was a tough case, even for us. Looking back on it, the diagnosis was staring us right in the face. When she presented she had a pulse pressure of about 12 with muffled heart sounds. When we put the EJ in she had huge EJs, not what you would expect in someone with dehydration. She had a classic Becks Triad but it wasn't picked up on. Obviously in the field there is no ultrasound, so it would be more difficult to make the dx. Like I said, tough case. You guys gave some really good answers. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 22, 2006 Share Posted February 22, 2006 so what do I win ER DOC Link to comment Share on other sites More sharing options...
ERDoc Posted February 22, 2006 Author Share Posted February 22, 2006 My respect. That and 39 cents will buy you a postage stamp. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 22, 2006 Share Posted February 22, 2006 Oh that's fair. Cool Link to comment Share on other sites More sharing options...
NYAEMT-I Posted February 27, 2006 Share Posted February 27, 2006 What about a right ventricle MI? Link to comment Share on other sites More sharing options...
paramedicmike Posted February 28, 2006 Share Posted February 28, 2006 What about a right ventricle MI? Please read all the posts in this thread. The answer has been made available to all just above your post. Reading = good -be safe. Link to comment Share on other sites More sharing options...
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