On exam the patient was short of breath had a systolic blood pressure of 90mm with a 15-20mm pulses paradox. The patient had a urgent 2D Echo which demonstrated a large pericardial effusion with collapse of the right ventricle in diastole.
The patient was taken urgently to the procedure room and elevated to a 30-45 degree angle 2 D Echo of the 5th intercostal space left parasternal view demonstarted a acceptable location for paricardiocentesis. The area was sterilized with antiseptic cleaning fluid and sterile drape applied. After local anesthesia with 2% lidocaine a pericardiocentesis needle was inserted anteriorly into the pericardium after again confirming on ultrasound that this was the optimum location. Bloody fluid was withdrawn while continuously pulling back on the syringe. The syringe was disconnected from the needle and bloody fluid was dripped on a cloth 4x4 to confirm in did not clot. A soft-tipped guide wire was then inserted and the needle withdrawn. A small incision was made over the entry site and a dilator catheter is inserted to enlarge the track. A multiple side-hole pigtail catheter was then inserted and the guide wire removed. Multiple 20cc syringes were then used to withdraw over a liter of bloody pericardial fluid.
Samples of pericardial fluid were sent for analysis cytology, C&S and biochemistry etc. There was marked improvement in the patients blood pressure and 2D Echo confirmed nearly complete resolution of the pericardial effusion. The pig-tail cannula was sutured in place and connected to a negative pressure vacuum. It is important to leave the drain in until the drainage from the pericardium stops. There is roughly a two liter capacity of the pericardium so until you drain more than two liters of pericardial fluid you should not be concerned about further accumulation of pericardial fluid. When the pericardium is dry the patient will start to develop discomfort from the pericardial drainage tube.
The patient became completely asymptomatic and was able to walk out of the hospital 3 days later.
Cytology of the pericardial fluid unfortunatley returned positive for adenocarcinoma. We all felt we had saved this man by our prompt actions and had given him a few more weeks or months of quality time with his family. Kia Ora from New Zealand!
PS: Don't try to drain traumatic pericardial effusions without a Heart Surgeon being present!
What a wonderful blog Dr Stowers. Do you blog all the material yourself or do you get assistance from Bonny?. Mandy :)
ReplyDeleteThis is a good ole DIY blog.
ReplyDeleteThis will guarantee that you get the greatest advantage out of the arrangement and not be in for any sort of shock if any claim should be put forth in the defense of any deplorable occasion, for example, a sickness or harm.rhinoplasty Charlottesville Va
ReplyDeleteI’m trampled by your contents carry on the wonderful work. er near me
ReplyDeleteThe leads were on the floor. At the point when I asked who was observing the screen, the charge nurture rapidly reattached the leads and we could see that Mom's heart beat was quick and sporadic.
ReplyDeleteDisposable OT Gowns
Rather it has an inseparable tie to your video's capacity to speak with your intended interest group individuals on a human, individual, and passionate level. VIDEO PRODUKCIJA
ReplyDeleteAdventure travel is the point at which you get yourself associated with a captivating encounter. It incorporates drifting, kayaking, climbing, sky jumping, hiking, scuba plunging, cruising, bicycling and substantially more! Cuttyhunk Fishing Club
ReplyDeleteOffered programs. Some camps run different programs that can enhance the skills and talents of your kids. There are also camps that have game activities for the families. Camping Legends
ReplyDeleteThe term gutsy is an idea that isn't characterized genuinely when you talk about adventure travel. adventure lifestyle
ReplyDeleteTo begin, let's turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. peanut butter weight gain
ReplyDeleteThank you for your post. I sincerely thank you for your post. If you are interested in purchasing our products, you can contact us through this website Eyelash Packaging Boxes۔
ReplyDeleteI am sure you see the trend here 토토커뮤니티
ReplyDeleteThis post is genuinely incredible. I really like this post. It is remarkable among different posts that I ve read in a long time. You shake for this alright post. I genuinely welcome it! 토토사이트
ReplyDeleteI have seen some great stuff here. Worth bookmarking for revisiting. I surprise how much effort you put to create such a great informative website. Your work is truly appreciated around the clock and the globe. 카지노사이트
ReplyDeleteI've been looking for info on this topic for a while. I'm happy this one is so great. Keep up the excellent work antminer s19
ReplyDeleteMerely a smiling visitant here to share the love (:, btw outstanding style. Courtier immobilier Hull
ReplyDeleteI’ve been searching for some decent stuff on the subject and haven't had any luck up until this point, You just got a new biggest fan!. used motorcycles for sale
ReplyDeleteI’ve been searching for some decent stuff on the subject and haven't had any luck up until this point, You just got a new biggest fan!. polaris dealer
ReplyDeleteI personally use them exclusively high-quality elements : you will notice these folks during Compliance Services Malta
ReplyDeleteI really enjoyed reading this post, big fan. Keep up the good work and please tell me when can you publish more articles or where can I read more on the subject web design malta
ReplyDeletethanks for the tips and information..i really appreciate it antique display cabinet
ReplyDeleteyou are in point of fact a excellent webmaster. The site loading pace is amazing. It seems that you are doing any distinctive trick. In addition, The contents are masterwork. you have done a magnificent task on this subject! melbourne podiatrists
ReplyDeletethanks for the tips and information..i really appreciate it ppc marketing company
ReplyDeleteGreat posts! I am actually getting ready to across this information, is very helpful my friend. Also great blog here with all of the valuable information you have. Keep up the good work you are doing here. bib smock
ReplyDeleteThanks so much for this information. I have to let you know I concur on several of the points you make here and others may require some further review, but I can see your viewpoint Skip Hire Lake District
ReplyDeleteI was able to find good information from your blog posts. 바카라사이트
ReplyDeleteIt is moreover an outstanding release we actually liked going through. It isn’t really day-to-day i develop the chance to discover anything 그래프사이트
ReplyDelete