Witt et al evaluated patients with pericardial fluid following blunt trauma. The authors are from University of Washington and Harborview Medical Center in Seattle.
Patient selection: blunt chest trauma
Evaluation: thoracic computed tomography on admission
Parameters:
(1) hypotension or clinical findings of cardiac tamponade (hemodynamic instability)
(2) amount of pericardial fluid
Thickness of Fluid in mm
Distribution
Amount
0
NA
none
< 5 mm
noncircumferential
minimal
< 5 mm
circumferential
small
5.0 to 9.9 mm
circumferential
moderate
>= 10 mm (1 cm)
circumferential
large
Clinical Findings
Pericardial Fluid
Management
present
any
pericardial drainage and/or exploration
absent (hemodynamically stable)
moderate or large
careful observation and hemodynamic monitoring
absent (hemodynamically stable)
minimal to small
observation with hemodynamic monitoring
where:
• The authors found that hemodynamically stable patients with large amounts of pericardial fluid could be managed conservatively but the sample size was small. An increasing amount of fluid on repeat studies might trigger an intervention.
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