Trauma Guideline Manual - SUNY Upstate Medical University
Trauma Guideline Manual - SUNY Upstate Medical University
Trauma Guideline Manual - SUNY Upstate Medical University
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<strong>Trauma</strong> <strong>Guideline</strong> <strong>Manual</strong>______________<strong>SUNY</strong> <strong>Upstate</strong> <strong>Trauma</strong> Center151PROCEDURE GUIDELINES: PERICARDIOCENTESISOBJECTIVES:1. Provide indications for the performance of a pericardiocentesis and suxiphoid pericardialwindow.DEFINITIONS:Needle pericardiocentesis: A procedure in which a needle is placed into the pericardial sac toremove blood that has resulted in a pericardial tamponade.Subxiphoid pericardial window: An emergency surgical procedure to diagnose pericardialtamponade and decompress blood from within the pericardium.GUIDELINES:1. Needle pericardiocentesis:a. Indications:i. Evidence of cardiac tamponade in the face of deteriorating vital signs:a) FAST pericaridial view positive with hypotensionb) Distended neck veins with blue facies.c) CVP (if measurable) >20 mmHg.d) Narrowed pulse pressure with other source of bleeding.e) No other explanation of hypotensionii. Consider when there is a penetrating injury to the chest between nipples.iii. This is not a primary diagnostic procedure (i.e., don’t do it when the vital signs arenormal).iv. Consider ultrasound as primary diagnostic modality for pericardial tamponade.b. Procedure:i. If positive:Notify the OR immediately and being making preparations to transfer tothe OR for median sternotomy.c. Complications:i. Aspiration of ventricular blood rather than pericardial blood.ii. Laceration of coronary artery or vein.iii. Laceration of myocardium.iv. Hematoma.v. Pneumothorax.vi. Infection.