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Nature Reviews. Disease Primers Jul 2023Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the... (Review)
Review
Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.
Topics: Humans; Cardiac Tamponade; Pericarditis, Constrictive; Pericardial Effusion; Pericardiocentesis; Pericarditis
PubMed: 37474539
DOI: 10.1038/s41572-023-00446-1 -
Home Healthcare NowRespiratory illnesses often require acute care admissions and are a leading cause of death globally, thus creating a financial burden for healthcare systems. Home... (Review)
Review
Respiratory illnesses often require acute care admissions and are a leading cause of death globally, thus creating a financial burden for healthcare systems. Home healthcare clinicians can significantly reduce morbidity and hospital readmissions by becoming proficient at respiratory assessment. This article aims to assist homecare clinicians in performing a respiratory assessment in a logical and structured approach, including inspection, palpation, percussion, and auscultation. This article reviews the anatomy and physiology of the respiratory system and describes subjective and objective respiratory assessment. It is anticipated that becoming adept at these skills will enable home healthcare clinician to assess and identify those patients at risk for deterioration and readmission.
Topics: Humans; Physical Examination; Auscultation; Percussion; Palpation; Hospitalization; Patient Readmission
PubMed: 37417569
DOI: 10.1097/NHH.0000000000001184 -
The Nursing Clinics of North America Sep 2023Many healthy children may be found to have a murmur on physical exam. Whether this murmur is discovered at a routine health maintenance visit or as a result of a focused... (Review)
Review
Many healthy children may be found to have a murmur on physical exam. Whether this murmur is discovered at a routine health maintenance visit or as a result of a focused exam on a child with illness, it is just one finding and must be considered in the context of the child's history and other physical exam findings. Murmurs associated with heart defect or dysfunction occur most often in infancy. Most murmurs discovered in children, especially after infancy, between ages 3 to 6 and in young-adulthood, are innocent or benign murmurs and less likely a symptom of cardiac dysfunction or defect.
Topics: Child; Humans; Adult; Heart Auscultation; Heart Murmurs; Heart Diseases; Physical Examination
PubMed: 37536793
DOI: 10.1016/j.cnur.2023.05.013