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Evidence Based Cardiac Exam, Dyspnoea Triangle (Blog)

on Fri Sep 07, 2018 9:56 am
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Main points:

  1. A pulsus paradoxus of >10-12 mmHg has a +LR of ~3.3 and -LR of 0.03 which is the best diagnostic test we have for tamponade physiology (a reflection of a greater than expected drop in stroke volume during inspiration in the setting of high wall pressures and increased bowing of the septum towards the left side). With such a strong negative LR, pulsus is a good maneuver worth learning to make you feel more reassured that a patient does not have tamponade. Here is a great Stanford 25 page to review how to perform a pulsus.
  2. Things to do immediately in a patient with tamponade physiology include considering the following:

    • hemodynamic stability (consulting the ICU),
    • IV access,
    • coagulation status (reversal if indicated),
    • fluids to support preload,
    • other consultants (cardiology/ cardiothoracic surgery for definitive treatment)

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