1
TCRN Review - Trunk (Thoracic Trauma,
Abdominal Trauma, Genitourinary Trauma,
Obstetrical Trauma)
What is a collection of excess fluid between the visceral
pericardium and the parietal pericardium? - Correct
answer- Pericardial Tamponade
What are the classic signs and symptoms of a pericardial
tamponade? - Correct answer- Beck's Triad
What are the 3 findings in Beck's Triad? - Correct answer-
Muffled heart tones
Systemic Hypotension
Distended Neck Veins (may not be present with
hypovolemia)
What are the cardiovascular effects of Pericardial
Tamponade? - Correct answer- Elevated CVP
Narrowed Pulse Pressure
Rapidly falling cardiac output
1
, 2
Tachycardia
Pulsus alternans
Blunting of the QRS complex
Pulseless Electrical Activity
Pulsus paradoxus or paradoxical pulse
What is Pulsus Alternans? - Correct answer- Alternating
morphology of the QRS complex
What is pulsus paradoxus or paradoxical pulse? - Correct
answer- A change of more than 10 mmHg in arterial
pressure during inspiration
How is pulsus paradoxus or paradoxical pulse found? -
Correct answer- Usually seen as a decreased amplitude on
the arterial waveform, but may also be palpated as a
reduction in the strength of the radial pulse during
inspiration.
What are the non-cardiac indications of a pericardial
tamponade? - Correct answer- Grey, death-like appearance
Extreme anxiety
Inability to lie supine
Dyspnea
2
, 3
Cyanosis
How is pericardial tamponade diagnosed? - Correct
answer- Clinically or via FAST exam
What is the treatment for pericardial tamponade? - Correct
answer- Pericardiocentesis
Observe monitor for ventricular irritation during insertion
How do you determine if blood aspirated from a
pericardiocentesis is pericardial blood or ventricular blood?
- Correct answer- Pericardial blood WILL NOT clot
Ventricular blood WILL clot
In blunt cardiac injury, what part of the heart is most likely
to be injured? - Correct answer- Right ventricle (anterior
chest)
Blunt cardiac injury is frequently associated with _____
and _____. - Correct answer- External chest wall trauma
Fractures of the sternum or ribs overlying the heart
What are the symptoms of blunt cardiac injury? - Correct
answer- Electrical disturbances
3
, 4
Chest Pain
Heart Failure
Describe electrical disturbances associated with blunt
cardiac injury. - Correct answer- PVC's
A-Fib
Atrioventricular blocks
S-T segment changes
What is the treatment for electrical disturbances associated
with blunt cardiac injury? - Correct answer- Continuous
ECG monitoring
Antiarrhythmics for clinically significant arrhythmias
Describe chest pain associated with blunt cardiac injury
and its treatment. - Correct answer- Does not radiate or
respond to standard treatment for chest pain.
Treatments: analgesia and treat as per MI
Describe heart failure associated with blunt cardiac injury.
- Correct answer- Right sided heart failure (JVD,
Hypotension, Tachycardia)
4
TCRN Review - Trunk (Thoracic Trauma,
Abdominal Trauma, Genitourinary Trauma,
Obstetrical Trauma)
What is a collection of excess fluid between the visceral
pericardium and the parietal pericardium? - Correct
answer- Pericardial Tamponade
What are the classic signs and symptoms of a pericardial
tamponade? - Correct answer- Beck's Triad
What are the 3 findings in Beck's Triad? - Correct answer-
Muffled heart tones
Systemic Hypotension
Distended Neck Veins (may not be present with
hypovolemia)
What are the cardiovascular effects of Pericardial
Tamponade? - Correct answer- Elevated CVP
Narrowed Pulse Pressure
Rapidly falling cardiac output
1
, 2
Tachycardia
Pulsus alternans
Blunting of the QRS complex
Pulseless Electrical Activity
Pulsus paradoxus or paradoxical pulse
What is Pulsus Alternans? - Correct answer- Alternating
morphology of the QRS complex
What is pulsus paradoxus or paradoxical pulse? - Correct
answer- A change of more than 10 mmHg in arterial
pressure during inspiration
How is pulsus paradoxus or paradoxical pulse found? -
Correct answer- Usually seen as a decreased amplitude on
the arterial waveform, but may also be palpated as a
reduction in the strength of the radial pulse during
inspiration.
What are the non-cardiac indications of a pericardial
tamponade? - Correct answer- Grey, death-like appearance
Extreme anxiety
Inability to lie supine
Dyspnea
2
, 3
Cyanosis
How is pericardial tamponade diagnosed? - Correct
answer- Clinically or via FAST exam
What is the treatment for pericardial tamponade? - Correct
answer- Pericardiocentesis
Observe monitor for ventricular irritation during insertion
How do you determine if blood aspirated from a
pericardiocentesis is pericardial blood or ventricular blood?
- Correct answer- Pericardial blood WILL NOT clot
Ventricular blood WILL clot
In blunt cardiac injury, what part of the heart is most likely
to be injured? - Correct answer- Right ventricle (anterior
chest)
Blunt cardiac injury is frequently associated with _____
and _____. - Correct answer- External chest wall trauma
Fractures of the sternum or ribs overlying the heart
What are the symptoms of blunt cardiac injury? - Correct
answer- Electrical disturbances
3
, 4
Chest Pain
Heart Failure
Describe electrical disturbances associated with blunt
cardiac injury. - Correct answer- PVC's
A-Fib
Atrioventricular blocks
S-T segment changes
What is the treatment for electrical disturbances associated
with blunt cardiac injury? - Correct answer- Continuous
ECG monitoring
Antiarrhythmics for clinically significant arrhythmias
Describe chest pain associated with blunt cardiac injury
and its treatment. - Correct answer- Does not radiate or
respond to standard treatment for chest pain.
Treatments: analgesia and treat as per MI
Describe heart failure associated with blunt cardiac injury.
- Correct answer- Right sided heart failure (JVD,
Hypotension, Tachycardia)
4
