CTXMEDIC Posted January 7, 2009 Posted January 7, 2009 Nice try clown. You mentioned you'd get about 5 heart beats worth of relief, suggesting you are talking about BLOOD, not all fluids. Nice try at a cover up, but you FAIL. Want to try again? Naw, Im good. youre a waste of time. when you actually complete a medic course come back and we'll discuss the pathophys of inflammation and infection. FYI, I WAS talking about blood in that instance but i dont believe that can be the ONLY cause of a tamponade.
spenac Posted January 7, 2009 Posted January 7, 2009 Just to get back on track. Look forward to details. Again to get back on track.
ERDoc Posted January 7, 2009 Posted January 7, 2009 I think I can see where this thread is going... Maybe it can be saved. CTX, if you'd like to discuss the failure of the US EMS education, there are plenty of other threads where you will find most on here agree with your views (though presented with a little less holier-than-thouness). Like spenac said, let's keep this thread alive for educational purposes. Tamponade can be caused by hemorrhage or an effusion. Identification is fairly easy. Muffled heart sounds are pretty subjective so they may not be too useful. You will have a decreased pulse pressure. From my experience you will also have distended jugulars that look like pipes. In the clinical setting huge jugulars will seem odd (should be a tip-off). A quick bedside US will seal the deal. So now, what do you do? Take the largest needle you can find (I personally like a 16G spinal needle on a 60cc syringe). Insert the needle at a 45 degree angle to the skin, just to the left of the xyphoid. Aim at the right shoulder. Obviously the pt should be hooked up to a monitor. It's pretty simple.
tniuqs Posted January 8, 2009 Posted January 8, 2009 I think I can see where this thread is going... Maybe it can be saved. CTX, if you'd like to discuss the failure of the US EMS education, there are plenty of other threads where you will find most on here agree with your views (though presented with a little less holier-than-thouness). Like spenac said, let's keep this thread alive for educational purposes. Tamponade can be caused by hemorrhage or an effusion. Identification is fairly easy. Muffled heart sounds are pretty subjective so they may not be too useful. You will have a decreased pulse pressure. From my experience you will also have distended jugulars that look like pipes. In the clinical setting huge jugulars will seem odd (should be a tip-off). A quick bedside US will seal the deal. So now, what do you do? Take the largest needle you can find (I personally like a 16G spinal needle on a 60cc syringe). Insert the needle at a 45 degree angle to the skin, just to the left of the xyphoid. Aim at the right shoulder. Obviously the pt should be hooked up to a monitor. It's pretty simple. Tamponade can be caused by hemorrhage or an effusion This is an acute issue, bottom line ANY narrowing of Pulse Presures and resulting in EMD ... your a fool not to try this, granted with a PMHX of so whats to lose ? ps try search Pericardiocentesis on this website ... maybe ? cheers
Niftymedi911 Posted January 8, 2009 Posted January 8, 2009 I just happen to work for an agency that allows us to peform pericardialcentisis. It's protocol for a trauma arrest patient with subsequent blunt force trauma to the chest. Bi-lateral chest decompression and pericardialcentisis. No online medical direction needed. Now, to do one in a live patient requires online medical control. The only way to fix the tamponade is to fix the cause. Wether it's infection in the pericardial sac (high dose anti-biotics and a centsis), a hemorragic anurism, or an effusion. Fix them, you fix your tamponade.
p3medic Posted January 9, 2009 Posted January 9, 2009 Unfortunately the time to fix the underlying pathology takes much longer than the procedure.
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