HTHSCI 2F03 Lecture Notes - Lecture 5: Pulsus Paradoxus, Pulmonary Contusion, Cardiac Tamponade
26 Dec 2020
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Accumulation of >1. 5l of blood in chest cavity. Usually caused by disruption of hilar vessels. Large-bore chest drain c hep saline for autotransfusion. # of 2 adjacent ribs in 2 places. Cxr / ct chest: pulmonary contusion (white) Disruption of myocardium or great vessels blood in the pericardium filling and contraction shock. Pulsus paradoxus: sbp fall of >10mmhg on inspiration. Ecg: low voltage qrs electrical alternans. Pericardiocentesis: spinal needle in r subxiphoid space aiming at 45o towards the r tip of left scapula. # of upper 4 ribs = high energy trauma. Usually due to rapid deceleration injury or shock waves. Rx: bed rest, cardiac monitoring, rx arrhythmias. Consider in penetrating injuries below 5th rib or high energy compression. All require exploration as tract may be deeper than it appears. Have a high index of suspicion for taking to theatre. Check for fluid in the abdomen, pelvis and pericardium. Can be extended to look for pneumothoraces.
