Mrs. M, 86 year-pld, female, was admittted due to complaint of difficulty breathing associated with pulmonary tuberculosis. She has edema of the lower extremities and was diagnosed to have pleural effusion or accumulation fo fluid in the interstitial space sorrounding her lungs. She also had fluid in her lungs and pericardial effusion or lung accumulation in the pericardial space. She is was started on Furosemide diuretic via IV to help her evacuate excess fluid through urine. Also, her lab works show low red blood cell count that is why 2 packs of RBC was started. I was able to finish the first unit and endorsed the ongoing transfusion of the second pack.
Her attending made his rounds on her and informed her relatives that due to the patient’s age, they will do the conservative approach in draining the fluids off her lungs.
Blood pressure was stable at 150ss and she had her highest in my shft at 180.
I was able to endorse the patient in stable condition that it why I was surprised to learn that she expired early morning.
She had 80 palpatory BP and oxygen saturation was very poor that they had to conduct emergency Echocardiographically guided pericardiocentesis in the cardiac catheterization laboratory around 1:00 am. However, around 4:00 am the code was called because she was not able to recover. She expired.
According to medline plus online:

Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart).
In this condition, blood or fluid collects within the pericardium. This prevents the ventricles from expanding fully. They cannot fill enough or pump blood.

Cardiac tamponade can occur due to:

* Dissecting aortic aneurysm (thoracic)
* End-stage lung cancer
* Heart attack (acute MI)
* Heart surgery
* Pericarditis caused by bacterial or viral infections
* Wounds to the heart

In Mrs M’s case, hers was caused by pericarditis