Page 67 - Critical Care Notes

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■ Transesophageal echocardiogram
■ CT scan
■ Aortic angiography
■ MRI
■ Doppler imaging
■ Cardiac biomarkers if coronary ischemia suspected
■ Routine preoperative blood work if surgery anticipated
Management
■ The goals of therapy are to control BP and manage pain.
■ Measure BP in both arms. Monitor HR, RR, and pain level.
■ Perform frequent peripheral pulse checks, ankle brachial index measure-
ments, and neurological assessments.
■ Administer beta blockers as first line of treatment; if hypertensive → give
nitroprusside IV.
■ Administer analgesics for pain as appropriate.
■ Plan for emergency surgery.
Pericardial Effusion
Pericardial effusion is the abnormal accumulation of more than 50 mL of fluid
(normal: 15–50 mL to serve as lubricant for the visceral and parietal layers of
pericardium) in the pericardial sac that may lead to noncompression of the
heart, which interferes with heart function.
Pathophysiology
Causes: chest trauma, accidents, stab wounds, gunshot wounds, rupture of
tumors, obstruction of lymphatic or venous flow, pericarditis, viral infections, can-
bacterial infections, or idiopathic → accumulate blood in the pericardial sac →
cer, MI, uremia, autoimmune diseases (lupus, rheumatoid arthritis, and others), ↓
pressure → compresses or does not compress the heart.
Clinical Manifestations
Pericardial effusion can be asymptomatic with up to 2 L accumulated fluid in the
pericardial sac. Pericardial effusions caused by pericarditis manifest with its
main symptom of chest pain; chest pain may be worsened by deep breathing

CV