Title of Case: Etiology and treatment of pericardial tamponade.
Background: While in the SICU, I was involved in the care of a patient that presented with pericardial tamponade. He subsequently underwent a pericardiocentesis and a pericardial window. I was interested in the specific causes of pericardial effusions/tamponade as well as the incidence of each cause. Furthermore, I was interested in the treatment of cardiac tamponade. Specifically deciding between pericardiocentesis versus pericardial window.
Case presentation:
HPI: 45-year-old male with past medical history of hypercholesterolemia and hypertension who presented with chest pain. Patient had been moving furniture with his wife all morning. After some time he developed chest
…show more content…
SVC appeared normal
Patient Management:
He immediately had a stat CTA performed and was found to have a pericardial effusion. A pericardiocentesis was then attempted yielding a minimal amount of bright red blood. Patient then proceeded to code in the ER and was revived. It was then decided to take the patient to the OR to perform pericardial window. The pericardial window yielded 300ml of blood. Following the pericardial window he remained in critical condition in SICU.
Following this presentation he underwent a workup for the possible etiology of the pericardial effusion including pericardial fluid pathological analysis and culture, pericardial tissue pathological analysis, thyroid function tests, HIV and TB tests, and a rheumatic
…show more content…
Benefits of a pericardial window include the ability to take diagnostic biopsies as well as to perform pericardiectomy if needed. Surgical exploration is also useful for cases that involve fluid reaccumulation and loculated fluid. In terms of traumatic cases a pericardial window may be more preferred especially in cases of aortic dissection or myocardial rupture. One study looked at 100 patients presenting with cardiac tamponade at a single center. Of the patients, 38% received pericardiocentesis only, 26% received surgical treatment only and 26% received pericardiocentesis followed by surgical treatment. Complication rates and mortality rates were highest in the two surgical groups leading the authors to conclude that pericardiocentesis should be performed first in idiopathic cases and in patients with hemodynamic instability. However, they further concluded that surgery may be the best approach for trauma and those with recurrent effusions where mortality rates may be higher
The Burden of the disease is high with a prevalence of 3.4% 2. With the progressive nature of the disease and the increased severity of the symptoms made the surgery the gold standard for symptomatic AS patients ,however up to 30% of cases are considered too high risk for classical valve replacement surgery and remain untreated and experiencing poor prognosis . Fortunately , with the introduction of TAVR its offer a valuable option for the inoperable or at high risk of surgery patients3..the annual eligible candidate for this procedure expected to be 27,000 in 19 European countries and North America according to recent meta-analysis an...
Cardiovascular disease has become an increasingly significant issue in many countries as it is the leading cause of death for the whole human population. According to World Health Organization, ischemic heart disease had caused about 7 million people to lose their life in 2011. One of the most common cardiovascular illnesses is myocardial infarction. It is defined as the death of cardiac myocytes due to complete blockage of a coronary artery. t-PA is a thrombolytic drug that used to treat myocardial infarction by dissolving the thrombus that causes the occlusion.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Some of the daily preparations that are performed by a perfusionist would consist of reading through a patient’s records to check out the patients history, family history, laboratory tests, cardiology reports and so on. Following this the heart and lung machine needs to be inspected and tested to make sure that it is in proper working order and that the disposables that are used are properly loaded and functional. Next the perfusionist needs to discuss with the surgeon what the needs of the patient may be and also what the needs of the surgeon may be. The perfusionist does this in order to use the correct disposables and correct pump to meet both the demands of the patient and that of the surgeon.
759. Mr. Miller is likely presenting with an acute myocardial infarction. Based on his past medical history of hypertension, hyperlipidemia, obesity, and diabetes, along with his current symptoms of chest pain, shortness of breath, pale skin with beads of sweat on the forehead, as well as elevated lab 's Troponin, CK, and CK-MB, he is most likely presenting with an acute myocardial infarction.
left ventricular function and heart failure.” Clinical Investigative Medicine. 31.2 (2008): E90-E97. Web. 15 Feb. 2014.
...ts, electrocardiogram, sonogram and cardiac rehabilitation. As a clinical observer, I found an opportunity to create a solid foundation on patient diagnosis and treatment, and not to mention, long hours with charting and recording patients’ information.
Look, I didn’t want to tell you this story. If you are afraid of germs, grossed out by toilets, or have any sense of personal hygiene I suggest you quit reading now. Believe that this is a disgusting horrifying terrible experience and move on to happier things because if you continue reading this you will most likely experience nausea, queasiness, and an overall feeling of absolute and horrible sickness. I’m sorry, your insides will be outside.
Dr. Ally, a 49-year-old professor, has been diagnosed with essential hypertension 12 years ago and was on antihypertensive drugs. However, he did not take his medications last year because he was feeling just fine. In addition, he was very busy with work. Nevertheless, he felt tired after work and developed dyspnea while climbing the stairs. Recently, he had a bout of epistaxis (severe nose bleed) with dizziness and blurred vision. He went to the doctor for a check up. His blood pressure was 180/110, and the doctor found rales or crackles on his chest upon auscultation. The doctor ordered rest and asked him to start his medication again.
The purpose of this research paper is that to present the difficulties Procter & Gamble faced in the early 1980¡¦s due to a correlation between the company¡¦s Rely tampon and the disease Toxic Shock Syndrome (TSS). Also, how the company handled the findings before and after new laws were passed by Congress giving the Food and Drug Administration (FDA) the authority to regulate medical devices, which included tampons. Thereafter, I will analyze the ethical issues relevant to this case within a SWOT analysis.
Which essential questions will you ask a pediatric patient or their caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child's age? Why or why not?
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.