Unbounded Medicine

Physical findings & Clinical Presentation:

• Severeconstant pleuritic pain that localizes over the anterior chest and may radiateto arms and back; it is differentiated from myocardial ischemia, becausethe pain intensifies with inspiration and is relieved by sittingup and leaning forward.
• Pericardial friction rub is best heard with patientupright and leaningforward and by pressing the stethoscope firmly against the chest; itconsists of three short, scratchy sounds:
• Signs and symptoms:

1. Dyspnea
2. Orthopnea
3. Interscapular pain
4. Tachycardia
5. Refractary hypotension
6. Distended neck veins
7. Paradoxicalpulse
8. Chest x-ray: Cardiomegaly, clear lungs (may be normal)
9. ECG: Low amplitude of QRS, electrical alternans

Treatment:
Immediatepericardiocentesispreferably by needle paracentesis with the use of echocardiography, fluoroscopy,orCT Aspirated fluidshould be sent for analysis (protein, LDH, cytology, CBC, Gram stain, AFBstain) and cultures for AFB, fungi, and bacterial C&S.

Cardiac Tamponade

Cardiac Tamponade

Regards,
Jon Mikel Iñarritu, M.D.

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