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18. A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks two ounces of alcohol daily. She is dyspneic and diaphoretic. Her temperature is 37.2 C (99 F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. Examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, PCO2 of 30 mm Hg, and PO2 of 70 mm Hg. An x-ray film of the chest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?
A ) Echocardiography
B ) CT scan of the abdomen
C ) Ventilation-perfusion lung scans
D ) Bronchoscopy
E ) Paracentesis
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Isnt it pericardial effusion ? Shouldn't it be e ?
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ans in a..similar Q in uworld
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Please can anyone explain the reason for doing echo ??
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Aaa. patient is having cardiac tamponade secondary to massive pericardial effusion, so we can done echo first ,,,,, the eeeee choice is paracentesis not pericardiocentesis ,
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Thanks foodmonster. But please let me know the diff b/n paracentesis and pericardiocentesis. Please. I am really confused.
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Paracentesis is a procedure to take out fluid that has collected in the belly,and pericardiocentesis is a procedure where fluid is aspirated from the pericardium, soo its simple gaurav
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Ya even i was thinking that eventhough its so simple then also y i am not able to get the point. So i saw the dictionary. Paracentesis is not specific for only belly. Its the fluid removal from any accumulation. Please check the dictionaries if possible..
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ok then go for paracentesis ,
Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites. Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.
Why It Is Done
Paracentesis may be done to:
* Find the cause of fluid buildup in the belly.
* Diagnose an infection in the peritoneal fluid.
* Check for certain types of cancer, such as liver cancer.
* Remove a large amount of fluid that is causing pain or difficulty breathing or that is affecting how the kidneys or the intestines (bowel) are working.
* Check for damage after a belly injury.
How To Prepare
Before you have paracentesis done, tell your doctor if you:
* Are taking any medicine.
* Are allergic to any medicines, including numbing medicines (anesthetics).
* Have had bleeding problems or are taking blood thinners, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or warfarin (Coumadin).
* Are or might be pregnant.
Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems. You will empty your bladder before the procedure.
You may be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .
How It Is Done
This procedure may be done in your doctor's office, an emergency room, the X-ray department of a hospital, or at your bedside in the hospital.
If a large amount of fluid is going to be taken out during the procedure, you may lie on your back with your head raised. People who have less fluid taken out may sit up. The site where your doctor will put the needle is cleaned with a special soap and draped with sterile towels.
Your doctor puts a numbing medicine into your belly. Once the area is numb, your doctor will gently and slowly put the paracentesis needle in where the extra fluid is likely to be. Your doctor will be careful to not poke any blood vessels or the intestines. If your test is done in the X-ray department, an ultrasound may be used to show where the fluid is in your belly.
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