Case #3 A twenty-two year old female in her third trimester of pregnancy was inv

Question

Case #3 A twenty-two year old female in her third trimester of pregnancy was involved in a motor vehicle accident. She was belted. Paramedics report the patient was alert and oriented and her vital signs w stable. In the ER, she complains of pain on the left rib cage and shortness of breath. Physical examination is significant for increased jugular venous pressure, hypotension, and paradoxical pulse o mmHg. EKG monitoring shows amplitude change with each heart beat (electrical alternans), . What is the most likely diagnosis? What is the best course of management for this patient at this time? . 28

Explanation / Answer

All the physical examination findings are suggestive of cardiac tamponade; increased jugular venous pressure, hypotension coupled with muffled heart sounds[not known in this case] is called Beck's triad indicating cardiac tamponade.EKG findings electrical altermans and pulsus paradoxus of 20 mg are also supportive of this diagnosis.

It is a medical emergency which requires urgent drainage of the pericardial fluid. Pericardiocentesis is not contraindicated in pregnancy where there are clinical signs of cardiac tamponade. Echocardiographic guidance during the drainage is preferred to fluoroscopic guidance in order to avoid fetal x-ray exposure. The patient should receive oxygen. Volume expansion using blood, plasma, dextran or isotonic sodium chloride solution is needed to maintain intravascular volume to improve cardiac output. Bed rest with leg elevation help increase venous return.

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