Tamponade:

 Emergency and life threatening

 In acute as little as 200 ml cause S/S
 In chronic up to 1000 ml cause S/S
 Causes:
o Infection: bacterial, viral, fungal, TB
o Inflammatory disease with vasculitis: R.Arthritis, SLE, scleroderma
o Metabolic: RF, myxedema
o Radiation, malignancy, trauma, post-heart
 Pathophysiology:  VEDV,  SV,  CO,  SBP,  CVP, Rt=Lt pressure
 Dx by keeping in mind a high index of suspicion with clinical S/S and lab
 Beck’s triad: hypotension, distended neck veins, muffled heart sound
 S/S: tachypnea, BP, narrow pulse pressure, HR, pulses paradoxus
 Signs of systemic hypoprefusion: oliguria, lactic acidosis, cool extr
 DDx: tension Pneumo, RV infarction, Pul HTN, cardiac herniation
 ECG: diffuse ST-changes, low voltage
 Lab: ECG, Echo, CXR, CT
 Anesthesia Mx:
o The main goal is to maintain the hemodynamics by  preload for a
target CVP of > 20, and avoid PPV, HR, avoid cardiodepressant
drugs, maintain SVR
o So do a pericardiocentesis under LA  stable  GA
o Monitoring: CAS, CVP, Art-line, PAC
o For induction Ketamine, or Etomidate
o Have inotrops ready, as a bolus and infusion
 Potential complications: arrhythmias, bleeding, arrest, pul edema, and
reaccumulation of fluids