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Patient Details

Met call (299 days ago 13:28)

Met call Wed 11 June 2025 13:28

Last Modified: 299 days ago

MRN:

Content:

Reason for Call:
Emergency consultation for patient with persistent hypotension following pericardial drainage. Patient presenting with 3-week history of worsening shortness of breath, found to have pericardial effusion requiring drainage.

A-E Assessment:
A - Airway: Patent

B - Breathing: 3-week history of worsening shortness of breath. Patient more awake following drainage but remains unwell.

C - Circulation: Persistent hypotension despite drainage of 400ml+ pericardial fluid. Requiring fluid resuscitation. Had episode of becoming non-responsive during admission.

D - Disability: Patient more awake post-drainage but had episode of non-responsiveness

Investigations:
Echocardiogram: RV appears improved post-drainage. Pericardial effusion depth increased from <1cm to maximum 1.9cm
BNP: 317
CTPA: Reviewed - suggests possible myocardial inflammation

Impression:
Pericardial effusion successfully drained (400ml+) but persistent unexplained hypotension. Query myocardial inflammation secondary to pericardial irritation. Differential includes tamponade physiology despite drainage.

Plan:
- Urgent CT cardiac angiogram to assess for myocardial inflammation
- Continue fluid resuscitation
- Cardiology input obtained
- Consider transfer with appropriate support if further deterioration
- Investigate underlying cause of pericardial effusion

Team Leader: Unknown
Documentation Date: 25/06/2025 13:28

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Met call (299 days ago 10:18)

Met call Wed 11 June 2025 10:18

Last Modified: 299 days ago

MRN:

Content:

Reason for Call:
Triggered by: Ward staff - patient deterioration with tachycardia
Initial Concern: Episode of atrial fibrillation with rapid ventricular response (rate 170bpm) and haemodynamic compromise
Duration of Deterioration: Acute deterioration today following admission on 4th June

A-E Assessment:
A - Airway:
Patent: Yes
Interventions: None required initially, oxygen mask removed during assessment
Concerns: Gargling noted in throat initially, resolved

B - Breathing:
Respiratory Rate: Not documented
Oxygen Saturations: 100% on oxygen
Work of Breathing: Shortness of breath, decreased exercise tolerance
Air Entry: Bilateral pleural effusions (small left, moderate right)
Interventions: Oxygen therapy via face mask initially

C - Circulation:
Heart Rate: 170bpm in atrial fibrillation, later reduced to 58bpm
Blood Pressure: 98/50mmHg
Capillary Refill Time: Not documented
Peripheral Circulation: Bilateral IV access established
Interventions: IV access x2, continuous cardiac monitoring

D - Disability:
GCS/AVPU: Initially became slightly unresponsive, improved during assessment
Pupils: Reactive to light bilaterally
Blood Glucose: Not documented
Limb Movement: No focal neurology
Interventions: Neurological observations

E - Exposure:
Temperature: Not documented
Rash/Skin Changes: None noted
Other Findings: Large pericardial effusion noted

Immediate Management:
Primary Interventions: Continuous cardiac monitoring, urgent echocardiography
Medications Given: None documented during emergency response
Procedures Performed: Bedside echocardiography, arterial blood gas sampling
Monitoring Established: Continuous cardiac monitoring, regular observations

Clinical Assessment:
Working Diagnosis: Cardiac tamponade secondary to large pericardial effusion
Differential Diagnoses: PE excluded on CTPA
Severity: Critical - haemodynamic compromise requiring urgent intervention

Investigations Requested:
- ECG - showed AF rate 170
- Urgent bedside echocardiography - confirmed large pericardial effusion (2cm at apex)
- Arterial blood gas
- Routine bloods
- CTPA already performed - no PE, confirmed large pericardial effusion with IVC contrast reflux

Management Plan:

[✓] Immediate: Urgent pericardiocentesis in cardiac catheter laboratory
[✓] Monitoring: Transfer to CCU for stabilisation pre-procedure
[✓] Investigations: Pericardial fluid analysis post-drainage
[✓] Medications: Last dose of treatment dose Clexane was 3pm yesterday
[✓] Specialist Input: Cardiology registrar attended, arranged urgent pericardiocentesis
[✓] Family Communication: Son present and updated regarding management plan

Patient Outcome:
Response to Treatment: Stabilised following initial management
Final Disposition: Transfer to CCU then cardiac catheter laboratory for pericardiocentesis
Ongoing Concerns: Large pericardial effusion requiring drainage, underlying cause unclear

Follow-up Required:
Senior Review: Cardiology team taking over care
Repeat Observations: Continuous monitoring in CCU
Investigation Results: Pericardial fluid analysis pending post-procedure

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