Trauma Discussion:
A patient with blunt cardiac injury after a MVC is dyspneic, confused, and cyanotic. 2 hours after ICU admission, the patient's blood pressure has 'dropped' and the patient is exhibiting jugular venous distention, or JVD. What is the most likely cause of these findings?
A. Cardiogenic Shock
B. Pulmonary Edema
C. Hypovolemia
D. Cardiac Tamponade
Beck's Triad: Muffled Heart Tones, JVD, & Hypotension. Classic test question for cardiac tamponade. While it is rare to witness all 3 signs at once, at a minimum the pt will exhibit at least one, possibly two of them. The entirety of all 3 signs may be experienced by the patient imminently prior to cardiac arrest. Muffled heart tones results from valvular activity auscultated through fluid or blood. Hypotension results from decreased cardiac output as forward blood flow decreases or ceases. And jugular venous distention results from backed-up blood from the right atrium. In cardiac tamponade, right and left-sided heart pressures equalize, thus compressing arterial & venous structures and negative forward blood flow & cardiac output. Hypotension is the logical end-point of no cardiac output.
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