Train the eye - part 3. Cardiac tamponade! #askpocus #echofirst #pocus @NephroP @Wilkinsonjonny @icmteaching @IMPOCUSFocus @dr_benoy_n_shah @cianmcdermott @EmergencyEcho @KalagaraHari @RJonesSonoEM @DRsonosRD @SonoSerious @iceman_ex @daniel_opazo
https://twitter.com/eabramsmd/status/935510082875478016?s=21
There are several sonographic signs of cardiac tamponade...
https://twitter.com/emedicalacademy/status/1229784920198991874?s=21
Right ventricular end diastolic collapse – relatively low sensitivity, relatively high specificity
https://twitter.com/drshukla14/status/1205380670677225472?s=21
Right atrial systolic collapse – low specificity, high sensitivity
https://twitter.com/fazalabul/status/1256833032855539712?s=21
More than 25% mitral/tricuspid inflow velocity variation
https://twitter.com/BrooksWalsh/status/657246838777495552?s=20
Plethoric IVC – highly sensitive but not specific
https://twitter.com/POCUSClub/status/1005145951802200065?s=20
Swinging heart – although this can simply be secondary to a significant amount of fluid without tamponade
https://twitter.com/hearttoprove/status/959433026370441216?s=21
In a tachycardic patient – it can be really difficult to assess for diastolic RV collapse. M mode can be really useful here along with ECG monitoring.
https://twitter.com/Callum__Swift/status/1067413427675717633?s=20
Can be particularly useful in trauma!
https://twitter.com/MetroHealth_EM/status/1293670622443319297?s=20
It is important to note that you can have cardiac tamponade without sonographic evidence of tamponade. This one is definite sonographic evidence though!
https://twitter.com/ultrasound_vcu/status/1356766718400622593?s=21
In the case of a big effusion and any haemodynamic compromise then consult cardiology ASAP.
https://twitter.com/vlsorrellimages/status/1200164100573151232?s=21
Typically the RA collapses followed by RV but in loculated effusions around LA/LV these chambers can collapse first.
https://twitter.com/nagdevarun/status/1019642188240543744?s=21
Check out this case with multiple septations!
https://twitter.com/waltrickroberto/status/926615494739873792?s=21
Here is one mid-arrest. Secondary to a dissection!
https://twitter.com/virginiazarama/status/1127188695222767616?s=21
Another one – see the pattern on RV/RA collapse?
https://twitter.com/emuss_uk/status/886668932618362880?s=21
And just to add fuel to the fire: Is cardiac tamponade a clinical diagnosis? (I don’t know why I did it)
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