Critical Care - IM EOR Study Guide Review
1. cardiac tamponade
- definition
- causes: Definition:
- pericardial ettusion causing significant pressure on the heart, impeding cardiac filling, leading to decreased CO and obstructive shock
- rate of fluid accumulation is more critical than volume
Causes:
- complication of pericarditis or trauma
- malignancy most common nontraumatic cause
2. cardiac tamponade
- presentation: *Beck's triad*: 3 D's
- distant (muffled) heart sounds
- distended neck veins (increased JVP)
- decreased blood pressure
*Pulsus paradoxus*:
- exaggerated (>10 mmHg) decrease in systolic BP with inspiration
- reflex tachycardia
- dyspnea, fatigue, peripheral edema, obstructive shock S/S, cool extremities
,3. cardiac tamponade
- diagnosis: *Need all 3*
- ECG
> electrical alternans, low voltage
- ECHO
> pericardial effusion + diastolic collapse of cardiac chambers
- chest XR
> might show enlarged cardiac silhouette
4. cardiac tamponade
- treatment: - immediate pericardiocentesis to remove fluid and relieve elevated intracardiac pressure
> will improve hemodynamic status
- treat underlying cause >> acute pericarditis> NSAIDs, aspirin, colchicine
- pericardial window procedure if recurrent
5. cardiogenic shock
- characteristics
- causes: Characteristics:
- Primary cardiac/myocardial dysfunction leading to *DECREASED CARDIAC OUTPUT*
- evidence of tissue hypoxia in the presence of adequate intravascular volume (isovolemia)
- high systemic vascular resistance (vasoconstriction)
, - increased pulmonary capillary wedge pressure > 15 mmHg
Causes:
- cardiac disease
> MI, myocarditis, valve dysfunction, congenital heart disease, cardiomyopathy, arrhythmias (brady or tachy)
6. cardiogenic shock
- presentation: - severe respiratory distress
- cool clammy skin
- general shock appearance:
> acutely ill
> altered mental status
> decreased peripheral pulses
> tachycardia
> hypotension
> oliguria/anuria
7. cardiogenic shock
- diagnosis: Labs to get:
- CBC, BMP, coagulation studies, cultures to look for potential source, ABG
- *elevated lactate*
8. cardiogenic shock
1. cardiac tamponade
- definition
- causes: Definition:
- pericardial ettusion causing significant pressure on the heart, impeding cardiac filling, leading to decreased CO and obstructive shock
- rate of fluid accumulation is more critical than volume
Causes:
- complication of pericarditis or trauma
- malignancy most common nontraumatic cause
2. cardiac tamponade
- presentation: *Beck's triad*: 3 D's
- distant (muffled) heart sounds
- distended neck veins (increased JVP)
- decreased blood pressure
*Pulsus paradoxus*:
- exaggerated (>10 mmHg) decrease in systolic BP with inspiration
- reflex tachycardia
- dyspnea, fatigue, peripheral edema, obstructive shock S/S, cool extremities
,3. cardiac tamponade
- diagnosis: *Need all 3*
- ECG
> electrical alternans, low voltage
- ECHO
> pericardial effusion + diastolic collapse of cardiac chambers
- chest XR
> might show enlarged cardiac silhouette
4. cardiac tamponade
- treatment: - immediate pericardiocentesis to remove fluid and relieve elevated intracardiac pressure
> will improve hemodynamic status
- treat underlying cause >> acute pericarditis> NSAIDs, aspirin, colchicine
- pericardial window procedure if recurrent
5. cardiogenic shock
- characteristics
- causes: Characteristics:
- Primary cardiac/myocardial dysfunction leading to *DECREASED CARDIAC OUTPUT*
- evidence of tissue hypoxia in the presence of adequate intravascular volume (isovolemia)
- high systemic vascular resistance (vasoconstriction)
, - increased pulmonary capillary wedge pressure > 15 mmHg
Causes:
- cardiac disease
> MI, myocarditis, valve dysfunction, congenital heart disease, cardiomyopathy, arrhythmias (brady or tachy)
6. cardiogenic shock
- presentation: - severe respiratory distress
- cool clammy skin
- general shock appearance:
> acutely ill
> altered mental status
> decreased peripheral pulses
> tachycardia
> hypotension
> oliguria/anuria
7. cardiogenic shock
- diagnosis: Labs to get:
- CBC, BMP, coagulation studies, cultures to look for potential source, ABG
- *elevated lactate*
8. cardiogenic shock
