Rule Out Cardiac Tamponade

In the presence of low arterial blood pressure and a rapid and feeble pulse, it is necessary to rule out the presence of cardiac tamponade. A valuable clinical sign suggestive of cardiac tamponade is the presence of a marked paradoxical pulse (also known as a pulsus paradoxus), which is characterized by an exaggeration of the normal inspiratory fall in systolic pressure. There is much confusion about the definition of a normal paradoxical pulse. A normal paradoxical pulse should be defined as the normal fall (about 5 mm Hg) in systolic arterial pressure during inspiration. It is the magnitude of the phenomenon that should determine whether the pulsus paradoxus is normal or abnormal.

The technique for assessing the magnitude of a paradoxical pulse is as follows: Have the patient breathe as normally as possible. Inflate the blood pressure cuff until no sounds are heard. Gradually deflate the cuff until sounds are heard in expiration only. Note this pressure. Continue to deflate the cuff slowly until sounds are heard during inspiration. Note this pressure. If the difference in these two pressures exceeds 10 mm Hg, a marked (abnormal) pulsus paradoxus is present; cardiac tamponade may be the cause. Cardiac tamponade results when there is an increase in intrapericardial pressure that interferes with normal diastolic filling. A marked paradoxical pulse is not a specific phenomenon for tamponade because it is also seen in large pericardial effusions, in constrictive pericarditis, and in conditions associated with increased ventilatory effort, such as asthma and emphysema.

Figure 14-22 Technique for evaluating the radial artery pulses.
Dealing With Asthma Naturally

Dealing With Asthma Naturally

Do You Suffer From ASTHMA Chronic asthma is a paralyzing, suffocating and socially isolating condition that can cause anxiety that can trigger even more attacks. Before you know it you are caught in a vicious cycle Put an end to the dependence on inhalers, buying expensive prescription drugs and avoidance of allergenic situations and animals. Get control of your life again and Deal With Asthma Naturally

Get My Free Ebook

Post a comment