Hey folks, Scott Wongard here, and this is an MCRIT podcast. Today on the podcast, we're going to talk

about paracardiocytocentesis and tamponad temporization. So why don't we roll right in? First of all,

you have to ask yourself, is it a tamponaut? I've gone over that before. I've had a discussion

with Jalen Avala on this exact topic, and you could find that. It's the MCrit We, and it's linked in

the show notes for this episode, mcrit.org slash 391. So now you've determined the tamponad,

and maybe you're going to see if you could temporize it a little bit and have it drained in the

Cath Lab. We'll talk about whether that's a good idea or not. Or maybe you just don't have the

skill set, though, after this episode, hopefully you will. But let's actually talk about the

temporization. Maybe you're gathering the supplies to do this and so you have to temporize. The way I've heard this stated in the primarily the anesthesia literature is fast, filled,

and then either squeezed or strong.

So fast filled and squeezed or fast filled and strong.

What does that mean?

It means fast is keep the heart rate up.

Tachycardia is the compensatory mechanism here. Don't do anything that's going to cause

bradycardia. No vagal tone, no agents that cause bradycardia. Full is keep them volume loaded.

Now, there's not much evidence for this and there's theoretical reasons. You're going to increase

the sided heart pressures that allow them to overcome the outside pressures pushing on those chambers and causing right ventricular collapse and therefore lack of left ventricular filling.

It makes sense.

I haven't seen great data for it, but it's usually what we do.

So you're going to give a few liters of fluid.

And then strong or squeezed is vasopressors.

Now, there's really, if you look at the physiology on paper, not great reasons why

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