Chest
Volume 116, Issue 2, August 1999, Pages 275-276
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Editorials
Pericardiocentesis: Blind No More!

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    Emergency medicine service crews have demonstrated the ability to acquire and interpret images of a pericardial effusion in an educational environment.33 An article from 1999 at the Mayo Clinic concluded that blind pericardiocentesis should not be performed when echocardiography was available for guided pericardiocentesis.34 However, HEMS crews still often perform blind pericardiocentesis on trauma arrests.

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    Diagnostic indications are outlined in Table 1A. Cardiac ultrasound is central to the detection and assessment of pericardial fluid and enables estimation of size and location, its haemodynamic effects and the most suitable approach.2 These comprise uncorrectable thrombocytopenia/coagulopathy, a posterior, loculated or small effusion, and aortic dissection (where immediate surgery is preferable).

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    The atypical clinical presentation of these events may simulate other disorders like severe hypovolemia, left ventricular dysfunction, major ischemic events, or systemic inflammatory response syndrome, and, therefore, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of low-output failure occur in the postcardiotomy patient.28 Although the diagnosis of cardiac tamponade is predominantly clinical, symptoms are usually nonspecific in postoperative cardiac patients and may complicate the decision-making process.1,29 If there is clinical suspicion of cardiac tamponade, an echocardiographic examination by transthoracic or transesophageal echocardiography must be performed without delay.2,28,30

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Dr. Fagan is a Fellow in Echocardiography at the University of Ottawa Heart Institute. Dr. Chan is Professor of Medicine at the University of Ottawa Heart Institute.

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