Have a look at these three short videos… Taken on a recent Sydney HEMS mission.
Can you guess the diagnosis??
NB. Art line trace is in yellow, SaO2 in blue.
Post your answers below. First correct answer wins a crate of beer (maybe)!
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Pericardial tamponade.
Agree. Pulsus paradoxus happening from tamponade. Maybe caused from pericarditis with the ST elevation?
STEMI (can’t make out which lead is shown but looks like III from QRS axis)
ventilated patient with pulsus alternans
My guess is aortic root dissection with RCA occlusion and pericardial tamponade?
Pulsus paradoxus. Cardiac tamponade would be my guess
Is it STEMI?
Pericardial tamponade causing PEA
No idea – I would have put that Sa02 down to interference.
Thanks to everyone that commented.
This patient did indeed have pericardial tamponade!
Kudos to those that spotted the pulsus paradoxus on the arterial line tracing (systolic BPs varying from 50 to 100mmHg across the respiratory cycle).
In this case, the cause was a misplaced transvenous pacing wire causing RV perforation with acute haemopericardium.
The pacer wire remains in situ and the patient is VVI paced at 80bpm, which explains the ST elevation seen on the ECG tracing.
The patient was retrieved by helicopter for emergent sternotomy after failed pericardiocentesis.
Vibrations in the aircraft caused interference with the SaO2 probe, hence the bizarre (almost Torsades-like) SaO2 tracing.
Would never have guessed that! Good job!
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