following major trauma to chest
Signs & Symptoms
Chest wall injury
Shallow / laboured breathing
Poor quality rapid pulse
Enlarged neck veins (CVPá)
Low pulse pressure (difference between
systolic and diastolic BP)
State of Shock
Heart Sounds - Distant / Muffled
Tachycardia - Cyanosis ±
To aspirate the collection of blood in the pericardial sac and improve venous return to heart (relieve cardiac tamponade).
Betadine or other skin prep solution Long (15 cm 6") 18 gauge needle & 20-50 cc syringe
- Supine position
- Sterile skin prep (xiphoid area)
- 1% xylocaine local infiltration as needed
- A small puncture with a 11 blade knife on the skin just below and to the left of xiphoid process
- The long needle is positioned at 45º above the body surface and 45º to the right of midline
- Through the skin puncture the needle is advanced in the position as above cephalad (towards head) and towards the left scapula.
- With-draw the syringe and aspirate unclotted blood from pericaridal sac
- Improvement is usually seen on prompt withdrawal of pericardial collection
- Through the needle a catheter can be passed and aspiration carried out periodically till patient handed to trauma center for further surgical care.
- ECG monitoring before during and after procedure helps