Hypotension due to unexpected cardiac tamponade

Abstract

SummaryWe report a case df profound hypotension, after induction of Key wormComplications; cardiac tamponade, bradycardia. Case historyA 25-year-old male student was admitted as an emergency after transfer by mountain rescue RAF helicopter over a distance of 60 miles. He had fallen some 30 metres on to scree while hill-walking in the Scottish Highlands.He was pale in appearance, drowsy but conscious and orientated, on arrival in the Accident and Emergency Department. He gave a history of a few seconds loss of consciousness but no retrograde amnesia. On examination, there were multiple superficial abrasions over legs, buttocks, chest, back, arms and face, and a large haematoma over his forehead with a laceration at the hair line. His back was tender over the upper lumbar vertebrae and there was a compound fracture dislocation of the right elbow. Sternal tenderness was noted but rib springing was pain free. Pupils were equal and reacting to light and there were no focal neurological signs. His core temperature was 32°C increasing to 3 5 T , and his arterial blood pressure was 90 mmHg systolic on admission. For this reason he had received 400 ml of plasma protein solution and 1 unit of SAG-M blood. These had been administered into a central vein cannula inserted via a low right supraclavicular approach. Arterial blood pressure was subsequently recorded as 120/56 mmHg, and pulse as 80/minute, sinus rhythm. Air entry on chest auscultation was equal on both sides with no added sounds. Abdominal palpation revealed neither tenderness nor distension.Chest and skull X rays were normal in appearance but abdominal films showed evidence of ileus, as well as some free peritoneal fluid. Dorsal spine X ray revealed a compression wedge fracture of the body of the first lumbar vertebra. A right elbow dislocation and separated fracture of the medial epicondyle were noted.White cell count was raised at 42.5 x 109/litre, haemoglobin was 120 g/litre, platelets 400 x 109/litre. Electrolytes were normal and the urea was 8.7 mmol/litre. Arterial blood gas analysis (no2, 0.5) showed a pH of 7.1 I , Pco2 6.3 kPa, Po2 24 kPa, and a base deficit of 13.5 mmol/litre. The orthopaedic surgeons wished to proceed with internal fixation urgently, in view of the compound dislocation fracture of the elbow, accompanied by lavage and dressing of the various lacerations and abrasions. Arrangements for theatre were made, since the patient was apparently stable.Peripheral venous access was established with an intravenous 16-gauge cannula inserted into a left forearm vein, after arrival in the anaesthetic room. Blood was already being given slowly via the internal jugular cannula. Anaesthesia was induced, after 5 minutes pre-oxygenation, with intravenous alfentanyl 1 mg, thiopentone 150 mg and suxamethonium 100 mg, and cricoid pressure was applied. A 9-mm cuffed oral tracheal tube was inserted and the lungs were ventilated using a Manley Pulmovent ventilator, set to deliver a minute volume of 9 litres of 50% nitrous oxide in oxygen with isoflurane 0.5-...

Delayed diagnosis of cardiac tamponade following isolated blunt abdominal trauma

“…10 The anaesthetic aims are therefore to maintain adequate ®lling pressures, adequate heart rate and maintain contractility. Anaesthesia for the laparotomy was induced with thiopentone, which is not the agent of choice as this can cause hypotension by venodilation and decreased venous return decreasing cardiac output with potentially disastrous consequences as was reported by Cyna et al 11 Propofol is similarly contraindicated.…”

Survival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery

“…Of these report of survivors of such potentially lethal injury 69% are males in their teens with a median age of to the left ventricle (2). The overall mortality in children with various causes requiring emergency thoracotomy blunt chest trauma is 25% and much higher with has often been reported in adult patients (3)(4)(5)(6)(7)(8)(9)(10)(11). The overall mortality in children with various causes requiring emergency thoracotomy blunt chest trauma is 25% and much higher with has often been reported in adult patients (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…Acute cardiac tamponade from 13 yrs (1). The overall mortality in children with various causes requiring emergency thoracotomy blunt chest trauma is 25% and much higher with has often been reported in adult patients (3)(4)(5)(6)(7)(8)(9)(10)(11). In children there are reports of cardiac tamponade due (13) in addition to more common causes.…”