DrVirgo
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What is the diagnosis here?
E pericarditis/cardiac tamponade (Beck’s triad) Do paracentesis
Or A. Echo.
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| dr_arc
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ans A do an echo to confirm diagnosis.this looks like tamponade.
would have picked pericardiocentesis if there was a choice but there isnt.
paracentesis is tapping the ascitic fluid.
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| Drtweetie
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i would do pericardiocentesis too, but since that choice is not there, echo is the best choice!
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| robin082006
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Tamponade, I go with E, paracentesis
Drtweetie: paracentesis is a general term, this means pericardiocentesis in this question
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| DrVirgo
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I think E Paracentesis as well (if it DOES in fact mean do a Pericardiocentesis)
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| Drtweetie
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Per Emedicine
Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity with the purpose of sampling or draining ascitic fluid
Percutaneous pericardiocentesis-- preferred technique for the treatment of patients with pericardial effusion or for diagnostic purposes.
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| cirus
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C X-Ray-----> Globular cosistency??
chemotherapy 3 years ago, shifting abdominal dullness (chronic condition)
the ans is echo--> restrictive cardiomyopathy d t amyloid
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| radonc
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I would go with E. paracentesis.
This lady has pericardial effusion, likely malignant in nature secondary to recurrence of right breast CA. I initially thought 'paracentesis' was limited to abdominal paracentesis. I just 'googled' it; the word 'paracentesis' simply means removal of fluid with a needle or similar instrument. It can apply to the abdo and chest.
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| hanwin
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ECHO first.
Then pericardiocentesis.
This is routine.
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| dr in trouble
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I am agree, u shud have to do echo first as it is not an emergency situation,it is pericardal effusion not a tamponade as tamponade is acute accumulation of fluid in pericardial sac while here it is progressive accumulation, first do echo and then paracentesis.
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| DrVirgo
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So its 50/50 between A and E!
In this case, the patient is hyptensive, tachycardic, with messed up ABGs, and the CXR confirms pericardial effusion, do we still need to do an Echo? Why not just do a Pericardiocentesis/Paracentesis (assuming it's synonamous). ?
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| Justice
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A. Echo
which would be helpful to confirm exudative pericarditis (I see no reasons to suspect "...restrictive cardiomyopathy d t amyloid...") vs dilated cardiomyopathy as CXR suggests either... Then echo-guided centesis...
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| radonc
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In a pt that is breathless and sweating, and has BP of <100 systolic, I would treat first before doodling my fingers waiting for an echo.
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| dr_arc
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DrVirgo wrote:I think E Paracentesis as well (if it DOES in fact mean do a Pericardiocentesis)
so whats the final word does paracentesis mean tapping any fluid anywhere?
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| DrVirgo
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radonc wrote:
In a pt that is breathless and sweating, and has BP of <100 systolic, I would treat first before doodling my fingers waiting for an echo.
Yes! I agree.
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| DrVirgo
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dr_arc wrote:
so whats the final word does paracentesis mean tapping any fluid anywhere?
Yes, I believe so.
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| hanialkhadher
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Sure paracentesis is a general term for Surgical puncture or tapping of a fluid-filled body cavity, especially the abdomen, with a hollow needle or trochar to withdraw fluid.
and as the patient is diaphoretisc and in resp.distress i think we should take some fluid out of the pericardial sac.
thanks for this nice q.
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| DrVirgo
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dr in trouble wrote:
I am agree, u shud have to do echo first as it is not an emergency situation,it is pericardal effusion not a tamponade as tamponade is acute accumulation of fluid in pericardial sac while here it is progressive accumulation, first do echo and then paracentesis.
What do you consider an emergency? Isn's his situation urgent? -hypotensive, tachycardic, tachypneic, 70 PO2, etc...
Waiting to do an echo would be harmful.
I think we disagree on this question because those who think Echo don't think it's urgent, and those who think paracentesis think it is an emergency.... SO can we differentiate between those two situations? WHEN should you do an Echo? and WHEN should you have to do paracentesis?
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| dr19
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we should decide if she is hemodynamically stable or not.
Considering ...pH=7.50...she is dyspneic and diaphoretic,it seems that she is NOT stable.
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| Drtweetie
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Agree that he's hemodynamically unstable--dyspneic, diaphoretic, and considering his vitals, I would go with "paracentesis" providing it means tapping fluid anywhere. He's not just having pericardial effusion, he's in tamponade, so tap him now!
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| dratish
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Lets stop this discussion at this stage.
Pulsus paradoxus is an indicator of cardiac tamponade. Pericardiocentesis is required but first confirm cardiac tamponade with ECHO. CXR NEVER confirms pericardial effusion. Cardiac tamponade is ventricular function compromise due to accumulation of pericardial fluid - which can be both ACUTE and CHRONIC. Pericardiocentesis is never done without confirming the diagnosis with ECHO. Imagine putting a long needle into the LV cavity because of your "feeling" - thats a very unsafe practice. Even if it means "doodling with your fingers". Stabilize this patient with IV fluids while you get an ECHO
Answer is A. ECHO
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| hanwin
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I agree. Even in emergency situation, u can do bedside ECHO.Nobody do pericardiocentesis without ECHO.
( If u do , you are very brave)
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| dr19
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I would suggest a case comparison between this case and thread 56174,
noting the answer options.
what are your comments
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| DrVirgo
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dr19 wrote:I would suggest a case comparison between this case and thread 56174, noting the answer options. what are your comments
Which thread is that? Can you post the question here please?
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| coolmavs
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Guys and this is not an emergency, developed over a period of 2 weeks......not due t sudden trauma or something!
I also go with ECHO!
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