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Pericardial Tamponade
1.
Pericardial Tamponade
2.
3.
Pathophysiology
4.
From Shoemaker WC,
Carey SJ, Yao ST, et al: Hemodynamic monitoring for physiologic evaluation, diagnosis, and therapy of acute hemopericardialtamponade from penetrating wounds. J Trauma 13:36, 1973.
5.
6.
7.
8.
RV early diastolic
collapse
9.
10.
pericardial effusion
11.
pericardial effusion
12.
IVCdistension
13.
14.
Pericardiocentesis From Custalow
CB: Color Atlas of Emergency Department Procedures. Philadelphia, Elsevier Saunders, 2005, p 123.
15.
16.
17.
18.
19.
20.
21.
Pericardiotomy or Pericardiocentesis
22.
Treatment of Cardiac
Tamponade
23.
Management of traumatic
cardiac tamponade
24.
25.
30 歲男性病人由救護車送達急診,主訴剛剛發生車禍有撞擊到胸口,現覺胸口悶痛且呼吸不順暢。血壓 98/62
mmHg、心率 120 次/分鐘、呼吸 26次/分鐘、體溫 37.2 ℃。有關此病患可能出現的症狀及徵候,下列敘述何者錯誤? 心包膜填塞表現出來的 Beck triad 包括頸靜脈怒張、低血壓及低沉的心音。 心包膜填塞可能會有的 Kussmaul signs,病人深吐氣時頸靜脈會更加擴張。 若病人出現 Hamman sign,要考慮病人有 pneumo-mediastinum的可能性。 若理學檢查發現病人的右鎖骨中線有穿刺傷,需將心臟損傷列入鑑別診斷。 創傷性主動脈破裂在胸部 X 光上可能出現食道偏離胸椎第 4 節棘突(spinous process)的右側大於 1-2 公分。 九十九年 急專考題
26.
關於心包膜積液的敘述,下列何者錯誤? 可能的病因包括心包膜炎、甲狀腺功能低下、癌症、尿毒症、心臟腔室破裂、創傷等。 典型的臨床表徵為低血壓、靜脈怒張,及遙遠、低沉的心音(muffled
heart sound),若沒有出現這些表徵,即可排除急性心包膜積液。 若急性胸痛病患突然昏厥且血壓突然測量不到,床邊超音波發現中量之心包膜積液,應考慮心肌梗塞併心肌破裂或主動脈剝離。 若血壓偏低,治療上首先應給予靜脈輸液以增進右心的壓力,克服心包膜積液的壓迫。 若已出現心包膜填塞,而以針抽吸又無法引流出積液,則應考慮以手術方式將心包膜打開(pericardiotomy)。 九十九年 急專考題
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