Cardiac Compressive Shock

• • Inadequate perfusion

  • Compression of the heart or great veins

Epidemiology

• • Pericardial tamponade

  • Tension pneumothorax

  • Abdominal compartment syndrome

  • Diaphragmatic rupture with abdominal viscera in chest

Symptoms and Signs

• • Distended neck veins

  • Postural hypotension

  • Oliguria

  • Sweating

  • Mental status changes

  • Kussmaul sign: Distention of neck veins with deep inspiration is pathognomonic of pericardial tamponade

  • Paradoxic pulse: A fall of > 10 mm Hg with inspiration supports diagnosis

  • Equalization of heart chamber pressures with pulmonary artery catheter placement

• • Mechanism of injury often raises suspicion

  • Decision must sometimes be made for intervention without full confirmation of diagnosis, eg, thrombectomy or pericardial aspiration for penetrating chest injuries and loss of signs of life

• • Physical exam/trauma work-up

• • Fluid infusion can bring transient improvement

  • Definitive treatment must correct mechanical abnormality

  • See Thoracic Injuries and Abdominal Injuries

  • See Small Intestine, Obstruction.

Surgery

Indications

• • See section on particular etiology

Treatment Monitoring

• • Blood pressure

  • ECG

Prognosis

• • Varies with etiology and severity

References