Cardiac Tamponade Medical Slides

Define pulsus paradoxus as a >10 mmHg drop in systolic BP during inspiration, caused by exaggerated interventricular dependence when the pericardium is non-compliant. Teach the bedside measurement technique using a manual sphygmomanometer. Note that pulsus paradoxus may be absent in severe aortic regurgitation, atrial septal defect, or positive pressure ventilation.

Present findings in order of sensitivity: right atrial systolic collapse (most sensitive, earliest sign), right ventricular diastolic collapse (more specific), IVC plethora without respiratory variation (>2.1 cm, <50% collapse), and exaggerated respiratory variation in mitral/tricuspid inflow velocities (>25% and >40% respectively). Emphasize that a circumferential effusion without these hemodynamic signs is not tamponade.

Show the subxiphoid approach with the needle directed toward the left shoulder at a 30-45 degree angle under continuous echo guidance. Cover the Seldinger technique for drain placement. Emphasize draining only enough fluid to restore hemodynamics initially (50-100 mL often suffices), agitated saline confirmation of needle position, and contraindications including aortic dissection and myocardial rupture where surgical repair is preferred.