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Click here to view the video (reproduced with permission of Ruoss JL and Doherty EG and the Boston Children’s Hospital Simulator Program).
Note: To learn to perform a procedure, both cognitive and procedural steps should be followed. These steps are explained and demonstrated in this month’s Video Corner and are summarized for quick reference in the list below.
Step by Step: Emergent Pericardiocentesis
Indications
a. Evacuation of a pericardial effusion and pneumopericardium in the setting of cardiac tamponade and hemodynamic instability.
b. Signs of cardiac tamponade
i. Possible signs (NOTE: These signs may not always be present):
1. Hypotension
2. Diminished heart sounds
3. Increased jugular venous pressure
4. Tachycardia
5. Pulsus paradoxus
ii. If an infant has pulseless electrical activity in the setting of a central line, cardiac tamponade should be considered in the list of possible etiologies.
iii. Potential chest radiographic findings:
1. Cardiomegaly (not usually present)
2. If pneumopericardium, lucency surrounding cardiac border
Contraindications
a. There are no absolute contraindications to this procedure in an emergent setting.
b. This is an invasive procedure and should not be performed if the decision to redirect or provide compassionate …
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