What is the initial management of this patient’s condition?

What is the initial management of this patient’s condition?

Temporizing measures include volume infusion to increase central venous pressure to promote right ventricular filling. Vasoconstrictor and inotropic medications might not be fully efficacious, but can occasionally provide temporary benefit. Dobutamine has been used for its pos-itive inotropic effects. α-Agonists may improve coronary perfusion and protect the heart from ischemia. Heart rate is critical to the maintenance of cardiac output because of the fixed stroke volume. Therefore, β-blockade would be contraindicated. Vagal reflexes should be treated with atropine. It is also important to maintain spontaneous respiration because positive pressure ventilation will further reduce right ventricular filling.

Pericardiocentesis is therapeutic and should be per-formed as soon as possible. Pericardiocentesis is often performed with local anesthesia through a sub-xiphoid approach using electrocardiographic guidance. This is accomplished by connecting the needle to the V lead of the ECG and looking for ST segment elevation (the current of injury) when the needle contacts the epicardial surface. Echocardiographic guidance has also increased the safety and decreased the complication rate of pericardiocentesis. Complications include pneumothorax, right ventricular puncture, left ventricular puncture, coronary artery lacera-tion, and dysrhythmias.

Treatment for Cardiac Tamponade

Definitive

·              Pericardiocentesis

Temporizing

·              Volume expansion

·              Vasoconstrictors

·              Inotrope

·              Atropine