A 22 year old female in her third trimester of pregnancy was involved in an moto

Question

A 22 year old female in her third trimester of pregnancy was involved in an motor vehicle accident. She was belted. Paramedics report the patient was alert and oriented and der vital signs was stable. In the ER, she complains of pain on the left rib cage and shortness of breath. Physical examination was significant for increased jugular venous pressure, hypotension, and paradoxical examination was significant for increased jugular venous pressure, hyportension, and paradoxical pulse of 20 mmHg. EKG monitoring showed amplitude change with each heart beat (eletrical alternans).
1. What is the most likely diagnosis?
2.What is the best course of management for this patient at this time?
3. For any EKG reading, describe the waves and their respective corresponding electrical and mechanical activities.

Explanation / Answer

the combination of jugular distention, hypotention, pulsus paradoxus is known as beck's triad and is suspicious for a pericardial tamponade. the additional finding of electrical alternans suggests that the heart is floating in the pericardial sack, and this is supicious for either a pericardial effusion, which takes a long time to develop, or more likely hemopericardium, because of the car accident. most likely Dx - hemopericardium and cardiac tamponade. management - this person needs an emergency pericardicentesis. take a large-bore spinal needle, inject at the level of the xyphoid and aim for the tip of the left scapula while placing traction on the syringe, advancing until you see blood enter the syringe. once youre in the pericardium, drawn out as much blood as possible without causing injury to the heart muscle. 3. because the EKG reads average direction of depolarization, i.e. vectors, any cahnge in orientation of the heart (i.e. turning in the pericardium) will cause a change in the direction of the vector the EKG reads. this is because the pericardial sack is now full of fluid (blood) and so the heart can swing and spin like a pendulum, and the ekg reads this as the electrical alternans hope that helps jonathan

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