This document provides guidance on performing pericardiocentesis for cardiac tamponade. It discusses the pathophysiology of cardiac tamponade, including how an increased volume in the pericardial space can compress the heart and reduce cardiac output. It also outlines the bedside ultrasound findings for tamponade and describes the subxiphoid and parasternal approaches for performing pericardiocentesis to drain fluid from the pericardial space.

1. Emergency
Pericardiocentesis
Just in Time Training
Nikita Joshi MD
Stanford University
Emergency Division
njoshi8@gmail.com
Nikita Joshi MD

2. Cardiac Tamponade
Factors Leading to
Tamponade
Rate of accumulation
Amount of fluid in pericardium
Compliance of pericardium
Pathophysiology
Rate of accumulation
Amount of fluid in pericardium
Compliance of pericardium
Increased Volume in
Space
Compresses atria,
vena cava, pulm veins
Reduced RV
filling in diastole
Decreases stroke vol
Decreases
cardiac output
RV
Collapse
Cardiac Arrest
Nikita Joshi MD

3. Bedside Ultrasound Findings
Early diastolic RV collapse
Late diastolic atrial collapse
IVC usually dilated, no variation
with respiration
Nikita Joshi MD

4. Subxiphoid Approach
Needle inserted btwn the
xiphoid process and L
costal margin
30° to 45° angle
Aim for L mid-clavicle
Directs needle toward
Anterior wall of R
ventricle
Pericardiocentesis
Nikita Joshi MD

5. Pericardiocentesis
Parasternal
Approach
Needle is inserted
perpendicular to skin,
L 5th intercostal
space
Penetration
immediately
lateral to sternum
Nikita Joshi MD