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  #1  
Old 08-18-2011
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Default trauma

A 28-year-old male is brought to the trauma bay after being in a motor vehicle accident. He was an unrestrained passenger. On initial assessment, he is unresponsive and has the following vital signs: HR 110, BP 85/60, RR 22, SpO2 97% on 10L face mask. A bedside ultrasound reveals a large amount of pericardial fluid. All of the following statements are consistent with the ultrasound findings except:
A. Decreased cardiac output
B. Decreased jugular venous distention
C. Exaggerated decreased in blood pressure on inspiration
D. Equal diastolic pressures in all 4 chambers
E. Beat-beat alternations of QRS height
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  #2  
Old 08-18-2011
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Default b

B
the acute accumulation of pericardial fluid is cardiac tamponade
becks triad of .
1. Distended neck veins
2. Distant heart sounds
3. Hypotension

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Originally Posted by ricko335 View Post
A 28-year-old male is brought to the trauma bay after being in a motor vehicle accident. He was an unrestrained passenger. On initial assessment, he is unresponsive and has the following vital signs: HR 110, BP 85/60, RR 22, SpO2 97% on 10L face mask. A bedside ultrasound reveals a large amount of pericardial fluid. All of the following statements are consistent with the ultrasound findings except:
A. Decreased cardiac output
B. Decreased jugular venous distention
C. Exaggerated decreased in blood pressure on inspiration
D. Equal diastolic pressures in all 4 chambers
E. Beat-beat alternations of QRS height
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  #3  
Old 08-18-2011
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Default

B. Decreased jugular venous distention
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Old 08-19-2011
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Default

The correct answer is B.
The finding of fluid in the pericardium in the setting of significant trauma is suggestive of cardiac tamponade. Findings consistent with cardiac tamponade include:
1) decreased cardiac output as manifested by hypotension
2) increased venous pressure (JVD) secondary to increased intracardiac pressure
3) increased HR to maintain cardiac output
4) electrical alternans on EKG (beat to beat alternations of QRS height)
5) Pulsus paradoxus: an exaggeration of the normal variation in the pulse during respiratory inspiration such that the pulse becomes weaker during inspiration and stronger during exhalation. During inspiration, one can auscultate heart sounds but cannot palpate a radial pulse (thus a paradox).
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