PowerPoint presentation about CARDIAC_TAMPONADE.pptx

An overview of cardiac tamponade

1. CARDIAC TAMPONADE

2. Objectives: You will be able to , define CT Enlist the causes of CT discuss the manifestations of CT Enlist diagnostic procedures of CT brief out management of CT

3. Pre-Test You are a nurse At emergency department and you have 3 patient

4. Thin double layered sac that encloses the Pathophysiology

5. lubricate the heart as it contracts and expands a tougher layer attached to other body organs like the diaphragm and cartilages between the ribs. 20-50 ml

6. 2 Types of cardiac tamponade

7. 1. Acute cardiac tamponade (rapid accumulation of fluid, 100-200 ml fluid) Causes: Chest trauma leading to rupture the free wall of the heart. Post mi Aortic dissection 2. Subacute/chronic cardiac tamponade (slow accumulation of fluid, up to 2000 ml fluid) Causes: Neoplasia. Tuberculosis.

8. Risk Factors for Cardiac Tamponade

9. There are many reasons why you might have a cardiac tamponade. The three most common causes of cardiac tamponade are malignancy, uraemia (a toxic condition resulting from kidney disease due to retention in the bloodstream of waste products normally excreted in the urine), and irritation of the sac surrounding the heart, due to unknown causes . Malignancy: If you have cancer, fluid can accumulate in the pericardial sac surrounding the heart. This fluid can build up and cause an increased pressure on the heart. Cancers can also cause bleeding into the pericardial sac. This build up of blood in a confined space can further compromise the heart.

10. Penetrating or blunt injury: A penetrating cardiac injury such as a stab wound to the chest, can result in leakage of blood into the pericardial sac (known as haemopericardium ) and cause a rapid rise in the pressure around the heart. Iatrogenic causes: Occasionally, cardiac tamponade can be a result of medical interventions and procedures. These include; during central line placement, cardiac catheterization and pacemaker insertion.

11. Heart attacks (myocardial infarction): After a heart attack, your heart muscle is weaker and more likely to rupture around the site of tissue that has sustained injury. Infection: Cardiac tamponade is often associated with pericarditis (inflammation of the pericardial sac) caused by bacterial or viral infections.

12. Signs and symptoms Low O2 Restlessness and Confusion Dizziness Fatigue SOB Tachycardia

13. How is Cardiac Tamponade Diagnosed?

14. These tests may be helpful in helping determine the presence and cause of cardiac tamponade. Lab Studies: Full blood picture   – blood is taken to measure the level of haemoglobin , red cells, white cells, etc. Creatine kinase and isoenzymes – Enzymes released when heart muscle is damaged, such as CK-MB, Troponin T/I, may be elevated. ECG   – provides an electrical picture of the heart and can demonstrate low voltages and/or alternating sizes of complexes.

15. Imaging Studies: Chest  x-ray : The heart may appear large, globular or pear shaped with sharp outlines. In cardiac tamponade, the chest x-ray may demonstrate an enlarged heart shape after 200-250 mL of slow fluid accumulation. A normal cardiac picture seen in patients with rapid accumulation of fluid or blood. Echocardiography : Most useful technique for demonstrating fluid in the pericardial sac and can show collapse of the right pumping chamber of the heart (ventricle) when the heart relaxes. Doppler : May show increased flow through specific valves in the heart. Magnetic Resonance Imaging : May detect blood or fluid around the heart

16. How is Cardiac Tamponade Treated?

17. The mainstay of treatment is drainage of the pericardial fluid ( pericardiocentesis ), preferably under echocardiographic guidance, to relieve the pressure. Drainage of as little as 30-50ml of fluid may result in a dramatic improvement in symptoms. If untreated, cardiac tamponade may lead to pulmonary fluid collections, shock and even death. However, with prompt recognition and treatment, most patients recover well. Patients require close monitoring, usually in an intensive care unit.

18. Nursing interventions

19. When signs and symptoms related to cardiac tamponade are present, call a rapid response, immediately notify the patient's healthcare provider, and prepare the patient for diagnostic testing and therapeutic interventions. Nurses have a primary role in monitoring patients for any deterioration in clinical status. Keep patients with cardiac tamponade who are hypotensive on bed rest with their legs elevated above heart level to increase venous blood return to the heart. Patients who aren't hypotensive should be maintained on bed rest in semi-Fowler position or leaning forward.

20. Assess for respiratory distress and prepare to administer supplemental oxygen as needed. Place the patient on continuous cardiac monitoring to assess for dysrhythmias. Prepare for volume repletion with isotonic solutions such as 0.9% sodium chloride solution, or inotropic support with agents such as I.V. dobutamine , depending on the patient's hemodynamic status. Monitor intake and output closely, especially hourly urine outputs.

21. If the patient undergoes percutaneous pericardiocentesis, monitor and document the amount and characteristics of the drainage and obtain specimens for lab analysis as prescribed. Monitor the catheter insertion site for signs and symptoms of infection. Anticipate preparing the patient for emergent pericardiocentesis with echocardiographic guidance. 

22. Nursing diagnosis

23. Cardiac Tamponade References Kasper DL. Harrisons Principles of Internal Medicine. New York: The McGraw-Hill Companies; 2006 Kato N. Cardiac Tamponade [online]. 2006 [cited 2006 April 25th]. Available from: URL: http://www.nlm.nih.gov/medlineplus/ency/article/000194.htm Longmore JM, Hope RA, Longmore M. et al. Oxford Handbook of Specialties; USA: Oxford University Press Inc. 2001 Valley VT, Fly CA. Pericarditis and Cardiac Tamponade. E-medicine [serial online]. 2005 [cited 23rd April 2006]. Available from URL: http://www.emedicine.com/EMERG/topic412.htm