How do you find the pulsus paradoxus?

How do you find the pulsus paradoxus?

To measure the pulsus paradoxus, place a blood pressure cuff on the patients arm and very very slowly deflate the cuff while listening for brachial pulsations. Note the pressure that you first hear with pulsations during expiration (which will be the highest).

What is the most common cause of pulsus paradoxus?

Pulsus paradoxus results from alterations in the mechanical forces imposed on the chambers of the heart and pulmonary vasculature and is often due to pericardial disease, particularly cardiac tamponade and to a lesser degree constrictive pericarditis.

Why does pulsus paradoxus occur in cardiac tamponade?

This increase in pressure prevents the heart chambers from collapsing. And the increased heart rate preserves cardiac output despite decreased stroke volume. At some point in the accumulation of fluid (around 250-300 ml), the pericardium reaches maximal distension and results in a phenomenon called pulsus paradoxus.

Why is it important to know about pulsus paradoxus?

Blood pressure is an important vital sign. Measurement errors are common so it is important to understand factors that affects results. Pulsus paradoxus is a very sensitive and valuable tool to diagnosis or ruling out cardiac tamponade. Few realize that the measurement of blood pressure is highly skill-dependent.

When is pulsus paradoxus most likely in a tamponade?

Pulsus paradoxus is most likely to be present in tamponade if the heart is structurally normal, the respirations are spontaneous, and the pericardial fluid is circumferential, not loculated. Only about 35% of tamponade cases are recognized to have pulsus paradoxus when they are assessed at the bedside. 10

How is pulsus paradoxus detected in blood pressure cuff?

Pulsus paradoxus is detected by palpating the pulse or using the blood pressure cuff, although only paradoxical pulses exceeding 15 to 20 mm Hg are palpable.45,46 For this reason, most clinicians use the blood pressure cuff, which has the added advantage of quantifying the finding ( Fig. 15.2 ). FIG. 15.2. Technique for measuring pulsus paradoxus.