In cardiac tamponade, blood fills the pericardial space which in turn raises intrapericardial pressure, compressing the heart and preventing it from expanding. As a result there is reduced cardiac output (Nolan & Gwinnutt 1998). Clinical features of cardiac tamponade include:
• raised jugular venous pressure (JVP);
• muffled heart sounds;
• pulsus paradoxus.
The classic clinical features of distended neck veins, hypotension and muffled heart sounds are absent in cardiac arrest. The preceding history and an account of the mechanism of injury are therefore important. Suspicion should be aroused if the patient has suffered any trauma to the thorax and complains of chest pain.
Fig. 11.2 Pericardiocentesis.
In order to treat this cause of cardiac arrest, a needle pericardiocentesis must be performed as an emergency procedure. An attempt is made to aspirate blood from the pericardial sac in order to enable the heart to fill again and produce a palpable cardiac output (see Figure 11.2). The patient would then need to undergo emergency cardiac surgery.
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