Gastric POCUS, 3-Part Episode
April 2024 OA-POCUS Case of the Month
Anesthesia Services in Tanzania and Kenya
OA-Global Health Equity Ask the Experts - April 2024
REPOST: October 2021 – Pediatric Tracheal Extubations
April 2024 OA-SPA Ask the Expert
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Question of the Day
Which of the following is MOST correct regarding the hemodynamics and management of patients presenting with cardiac tamponade?
Explanation
The hemodynamic goals in cardiac tamponade include maintaining preload (“full”), maintaining slightly elevated heart rate (“fast”), and maintaining systemic vascular resistance (SVR) (“tight”). Premedication should be avoided if possible because it may compromise SVR or respiratory function. Given the dependence on SVR, the best options for induction include ketamine, etomidate, and opioids. Alternatively, inhaled induction with volatile anesthetics may be considered. In extreme cases, drainage using only local anesthetics may be necessary. An anesthetic technique that maintains spontaneous ventilation and avoids positive pressure ventilation prior to drainage of pericardial fluid is beneficial as positive pressure ventilation further impairs venous return and can precipitate hemodynamic collapse. A trial of positive pressure ventilation with low pressures can be used to determine the effect on blood pressure prior to drainage of fluid. Standard ASA monitors as well as an arterial catheter to monitor blood pressure throughout induction should be placed prior to induction along with large bore peripheral access. Induction of anesthesia should absolutely not be performed without the surgical team prepared, because there may be a need for emergent drainage of the effusion if hemodynamic collapse occurs with induction. Many centers advocate prepping and draping the patient as well prior to induction of anesthesia.
References:
Cardiac tamponade – Diagnosis Cardiac tamponade: Pulsus paradoxus OpenAnesthesia Intraoperative TEE of the Month for November 2013: Cardiac tamponadeBarash PG, Cullen BF, Stoelting RK, Cahalan M, Stock MC, eds. Clinical Anesthesia, 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2009: pp. 904-905.
OA Series: April 2024
Vodcast
06:08
OA-POCUS Case of the Month
Gastric POCUS, Part 1 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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Vodcast
17:46
OA-POCUS Case of the Month
Gastric POCUS, Part 2 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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Vodcast
04:43
OA-POCUS Case of the Month
Gastric POCUS, Part 3 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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Podcast
41:04
OA Global Health Equity Ask the Expert
Anesthesia Services in Tanzania and KenyaSamuel Percy, MD, Children's Hospital Colorado
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Podcast
16:40
OA-SPA Ask the Expert
REPOST: October 2021 – Pediatric Tracheal ExtubationsDebnath Chatterjee, MD, FAAP, Children’s Hospital Colorado
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