Diagnosis

Beck’s Triad: muffled heart tones, distended neck veins, decreased systolic blood pressure.
Pulsus Paradoxus: cyclic inspiratory decrease in systolic BP of more than 10mmHg
Electrical Alternans: cyclic alteration in magnitude of p waves, QRS complex & t-waves
Typical presentation of acute tamponade = sudden HYPOTENSION, TACHYCARDIA & tachypnea; patient may be unable to lie flat.

Pericardiocentesis awake/local for large effusions prior to GA
Surgical for postoperative tamponade (cause is often local collections of clotted blood)
Anesthetic Considerations
Progressive decrease in SV with an increased CVP → systemic hypotension → cardiogenic shock
Goals: maintain sympathetic tone and CO via ↑ HR and contractility/fluid bolus prn
- Induction: Ketamine (1-2 mg/kg IV), muscle relaxant
- Epinephrine 0.05-0.1 MICROgrams/kg IV bolus or infusion (0.01-0.1 MICROgrams/kg/min)
- Access: Large bore PIV; arterial line ideal but should not delay treatment in hemodynamically unstable patient
- Avoid: cardiac depression, vasodilation, ↓ HR; ↑ airway pressure (will ↓ venous return) - so may need small tidal volumes or hand ventilation
- 1-2 mg/kg IV
- 0.05-0.1 MICROgrams/kg IV bolus or infusion 0.01-0.1 MICROgrams/kg/min
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
- 0.05-0.1 MICROgrams/kg IV bolus or infusion 0.01-0.1 MICROgrams/kg/min
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

Beck’s Triad: muffled heart tones, distended neck veins, decreased systolic blood pressure.
Pulsus Paradoxus: cyclic inspiratory decrease in systolic BP of more than 10mmHg
Electrical Alternans: cyclic alteration in magnitude of p waves, QRS complex & t-waves
Typical presentation of acute tamponade = sudden HYPOTENSION, TACHYCARDIA & tachypnea; patient may be unable to lie flat.

Pericardiocentesis awake/local for large effusions prior to GA
Surgical for postoperative tamponade (cause is often local collections of clotted blood)
Anesthetic Considerations
Progressive decrease in SV with an increased CVP → systemic hypotension → cardiogenic shock
Goals: maintain sympathetic tone and CO via ↑ HR and contractility/fluid bolus prn
- Induction: Ketamine (1-2 mg/kg IV), muscle relaxant
- Epinephrine 0.05-0.1 MICROgrams/kg IV bolus or infusion (0.01-0.1 MICROgrams/kg/min)
- Access: Large bore PIV; arterial line ideal but should not delay treatment in hemodynamically unstable patient
- Avoid: cardiac depression, vasodilation, ↓ HR; ↑ airway pressure (will ↓ venous return) - so may need small tidal volumes or hand ventilation
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

Drugs

Ketamine	1-2 mg/kg IV
Epinephrine	0.05-0.1 MICROgrams/kg IV bolus or infusion 0.01-0.1 MICROgrams/kg/min