Help with Heart Injuries and Disorders - Anatomy

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A 22-year old male was brought to the shock trauma bay after sustaining a gunshot to the chest. His blood pressure on arrival was 78/36 with a pulse of 78 and two large-bore IVs were inserted to begin fluid resuscitation. He is unresponsive with decreased breath sounds and is immediately intubated. He is not a heavy man, but his heart sounds are muffled and you note distention of his jugular veins. Ultrasound does not reveal any fluid collections in the abdomen, but does reveal fluid in the pericardium. After a liter of fluid is given, his pressure is now 50 systolic by palpation and pulse is 52. What is your diagnosis?

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Answer

This man is deteriorating from cardiac tamponade, a condition in which blood is pooling around the heart and hindering its ability to fill during diastole (relaxation).

Doctors should suspect cardiac tamponade when a patient has hypotension, muffled heart sounds, and jugular venous distention (Beck's triad). Ultrasound will show a fluid collection in the pericardial sac surrounding the heart. Treatment is with immediate pericardiocentesis and fluid resuscitation.

Tension pneumothorax occurs when damage to the lung results in leakage of air into the pleural space. This causes equilibration of pressures between the lung and pleural space, leading to difficulty during inhalation. Positive pressure ventilation can help alleviate this condition. A splenic laceration will result in internal bleeding in the upper left quadrant of the abdomen. Pelvic fractures generally result from trauma during a fall or lateral impact and may cause damage to pelvic organs, but would not likely be linked to cardiac abnormalities. Acute myocardial infarction, or heart attack, occurs from blockage of or damage to the coronary arteries, resulting in a loss of blood flow to the tissues of the heart.

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