Best Case Ever 31: Emergency Pericardiocentesis

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 14 January 2015

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

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Summary

On this EM Cases Best Case Ever, Andrew Sloas, the brains behinds the fabulous PEM-ED podcast tells the tale of a pericardiocentesis gone bad and what he learned from it. Emergency pericardicentesis can be life saving, but it also carries risks. Dr. Sloas reviews the steps to take to ensure that the pericardiocentesis needle is the the correct place to minimize the risk of intubating the right ventricle of the heart. A discussion of errors of omission and ones of commission follows.... [wpfilebase tag=file id=540 tpl=emc-play /] [wpfilebase tag=file id=541 tpl=emc-mp3 /]

Transcript

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0:00.0	Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.
0:29.8	On today's best case ever, we're going to have Dr. Andrew Slowis.
0:33.2	He's an emergency physician and assistant professor of EM at the University of Kentucky.
0:37.5	He's trained in both pediatric and adult EM, and he's the host of the fantastic PEMED podcast.
0:44.4	So I was working one night in Janus General, that's Scott Weingart's emergency department.
0:49.6	And I was there one night with my resident, and I had a really sick 60 year old female role in borderline
0:55.9	bradycardia with hypotension. So her blood pressure was in the 80s and her heart rate was in the 80s
1:00.5	and you would expect that heart rate to be significantly higher. There's only five things that
1:04.8	caused that and that's electrolytes, drugs, eschemia, pacemaker malfunction and neurogenic shock.
1:10.2	And we quickly ruled out most of them by putting
1:13.1	an ultrasound on our heart, and we got to the differential, honed it right down to one thing
1:19.0	almost immediately when we saw paracardial tamponot. She had a huge paracartial effusion with the actual
1:26.0	man jumping on the trampoline. You could see the man
1:29.0	jumping on the trampoline. So very sensitive for the actual diagnosis. Called our cardiology
1:36.1	colleagues, called our CV surgery colleagues to come help us because we knew more than likely
1:40.6	she was going to definitively need a paracardial window. However, they were a long way away.
1:45.6	We tried push-dose pressers, but she really wasn't getting any better.
1:48.7	Not a lot of volume depletion, so we were scared to give too much volume.
1:53.6	So we gave just a little bit of volume, and then we decided we had to cowboy up and go ahead and put in the, do the paracardias and disease.
2:00.1	I think Anton and Canada is probably Mountie up. Maybe, maybe, maybe, let in. Cowboy up. I love that. In Janis General and in the U.S., it's cowboy up. So we did the standard cleaning prep and drape in the usual sterile fashion and proceeded with a paracardiocytosis kit to draw off a little
2:17.9	bit of blood. Standard 10 cc's or less that you would do. And immediately her blood pressure got up.
2:24.2	By this point, we had an art line. Her blood pressure popped right back up and we had given her
	...

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