How do you handle patients who are in need of emergency pericardiocentesis?

Sample interview questions: How do you handle patients who are in need of emergency pericardiocentesis?

Sample answer:

• Initial Assessment:
  1. Quickly assess the patient’s ABCs (Airway, Breathing, Circulation).
  2. If the patient is in cardiac arrest, initiate CPR immediately.
  3. Obtain a 12-lead ECG to assess for signs of pericardial tamponade, such as electrical alternans.
  4. Check the patient’s vital signs, including blood pressure, heart rate, and oxygen saturation.
  5. Auscultate the heart sounds for muffled heart tones or pericardial friction rub.
  6. Perform a focused physical exam, looking for signs of circulatory collapse, such as jugular venous distension or pulsus paradoxus.
  7. Order laboratory tests, including CBC, electrolytes, BUN, creatinine, and troponin levels.

• Patient Stabilization:
  1. Administer high-flow oxygen to maintain oxygen saturation above 90%.
  2. Place the patient in a semi-recumbent position to improve venous return.
  3. Administer intravenous fluids cautiously to avoid volume overload.
  4. If the patient is hypotensive, administer vasopressors to maintain adequate blood pressure.
  5. Consider administering pain medication to relieve chest pain.

• Emergency Pericardiocentesis:
  1. Obtain informed consent from the patient or their legal representative.
  2. Prepare the patient for the procedure by explaining it in detail and ensuring that they are adequately sedated.
  3. Position the patient in a supine position with the head elevated 30-45 degrees.
  4. Identify the pericardial space using anatomical landmarks or ultrasound guidance.
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