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Ultrasound Guided Pericardiocentesis

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STAB Conference with Courtney Elm, MD

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Ultrasound Guided Pericardiocentesis

  1. 1. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Every Life Matters ULTRASOUND GUIDED PERICARDIOCENTESIS
  2. 2. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Indications and Complications • Indications = Tamponade • Complications – Ventricular or atrial puncture – Coronary artery injury – Pneumothorax – Internal mammillary artery injury – Rib Neurovascular bundle injury Every Life Matters
  3. 3. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Dark Ages (Before US)
  4. 4. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Step 1 – Visualize the Effusion Every Life Matters
  5. 5. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Locations for Pericardiocentesis Every Life Matters
  6. 6. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Step 2 – Insert the Needle To Confirm Placement of the Needle Tip • Aspirate • Directly visualize the Needle Tip • Bubble Test Every Life Matters
  7. 7. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Bubble Test Every Life Matters
  8. 8. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Step 3- Place the Guidewire Every Life Matters
  9. 9. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Step 4 – Place Catheter Seldinger Technique Pro Tip: Do not aspirate all the fluid prior to placing the catheter Confirm Placement • Decreased Effusion size • Improved Hemodynaimcs Every Life Matters
  10. 10. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Summary Direct Visualization avoids vital structures Bubble test to confirm placement
  11. 11. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE Thank You – Questions?
  12. 12. HENNEPIN COUNTY MEDICAL CENTER EMERGENCY MEDICINE REFERENCES 1. Rob Reardon. Ultrasound Guided Pericardiocentesis 1. Tsang TM. Echocardiography-Guided Pericardiocentesis for Effusions in Patients With Cancer Revisited∗. J Am Coll Cardiol. 2015;66(10):1129-1131. doi:10.1016/j.jacc.2015.07.027. 2. Tsang, Teresa S.M. et al. Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years. Mayo Clinic Proceedings , Volume 77 , Issue 5 , 429 - 436 Every Life Matters

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