29. A 47-year-old woman who is 2 weeks post triple - highsky

[ArchivalUser]

29. A 47-year-old woman who is 2 weeks post triple
bypass surgery presents to the ED with a chief
complaint of sudden-onset, sharp chest pain
for several hours. She is fatigued and short of
breath. On physical examination, she has distended
neck veins that grow more distended
on inspiration. Muffled heart sounds are
heard. Her temperature is 37.0°C (101.8°F),
pulse is 133/min, blood pressure is 70/50 mm
Hg, and respiratory rate is 30/min. Her O2 saturation
is 100%. An echocardiogram shows a
large pericardial effusion and chamber collapse;
therefore, pericardiocentesis is performed.
Although a large amount of blood is
aspirated, the patient™s clinical picture acutely
worsens. Her pain level increases substantially,
with pulse 150/min, blood pressure 60/41 mm
Hg, and respiratory rate 30/min. Her O2 saturation
is 100%. Repeat echocardiogram shows an
even larger pericardial effusion with chamber
collapse. Which complication of pericardiocentesis
is most likely in this patient?

(A) Acute left ventricular failure with pulmonary
edema
(B) Aspiration of 10 mL air into the pericardium
© Laceration of a coronary vessel
(D) Pneumothorax
(E) Puncture of the left ventricle

[ArchivalUser]

CC?

[ArchivalUser]

I think it is EEE

[ArchivalUser]

may be EEE

[ArchivalUser]

The correct answer is C. Laceration of a
coronary vessel is the most dangerous complication
of pericardiocentesis. It can lead to
worsened cardiac tamponade, myocardial infarction,
and even death. This patient has
worsening chest pain and hemodynamics during
pericardiocentesis, the most likely cause of
which is laceration of a coronary vessel.
Answer A is incorrect. Acute left ventricular
failure with pulmonary edema is a rare complication
of pericardiocentesis. This patient™s
lungs are clear to auscultation bilaterally after
the procedure, which makes this complication
unlikely.
Answer B is incorrect. Aspiration of air into
the pericardium typically does not cause clinical
signs or symptoms, unless the amount of
air aspirated into the pericardium exceeds the
amount of fluid withdrawn.
Answer D is incorrect. Pneumothorax is a
rare complication of pericardiocentesis. This
patient™s lung examination and x-ray of the
chest are not consistent with the diagnosis of
pneumothorax.
Answer E is incorrect. Puncture of the left
ventricle during pericardiocentesis rarely
causes significant bleeding. Although a small
pericardial bleed may be painful, it typically
resolves on its own and does not lead to he

[ArchivalUser]

eeeeee