Pulsus Paradoxus Video [Stanford Medicine 25]

Pulsus Paradoxus Video [Stanford Medicine 25]


welcome to the Stanford 25 video on pulsus paradoxus pulsus paradoxus is defined as a systolic pressure drop greater than 10 with inspiration normally during inspiration the decrease in inch a thoracic pressure will cause an increase in blood flow to the right side of the heart leading to an increase in pressure transmitted to the right ventricular walls since more blood remains in the lungs during inspiration a small drop in systolic blood pressure is expected however in tamponade the increase in blood flow and pressure on the right ventricle during inspiration cannot be transmitted to the right in particular wall and is in turn transmitted to the ventricular septum this in turn leads to a decrease in left ventricular filling which causes a decrease in stroke volume and a much lower systolic blood pressure to measure pulsus paradoxus all you need is a stethoscope and a blood pressure cuff to test for pulsus paradoxus slowly look for the first quarter cough sound that will appear then disappear during inspiration next slowly listen for when the first quarter cough sound no longer disappears with inspiration this clip was recorded from a patient at Stanford University with a pericardial effusion pulsus paradoxus can be a valuable clinical tool and has been shown to have a sensitivity of 98% and a specificity of 83% in predicting cardiovascular compromise along with tamponade pulsus paradoxus can be seen in some patients with the constrictive pericarditis during asthma or COPD exacerbations and less commonly in other clinical scenarios importantly pulsus paradoxus may not be present despite a patient being in cardiac tamponade in certain situations such as a auric regurgitation and atrial septal defect in addition to other findings such as an elevated jugular venous pressure tachycardia and shortness of breath polster’s paradoxes can serve to be a valuable tool in the evaluation of a patient with suspected cardiac tamponade this has been the Stanford 25 video on pulsus paradoxus thanks for watching you

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