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Post-Cardiac Surgery Tamponade Early Signs — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaPost-Cardiac Surgery Tamponade Early SignsFRCA Final

A 60-year-old man undergoes emergency CABG surgery. Post-operatively in ICU he develops cardiac tamponade from mediastinal bleeding. Which clinical sign is the EARLIEST indicator of post-cardiac surgery tamponade?

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Correct answer: B — Pulsus paradoxus on the arterial line

Post-cardiac surgery tamponade is a surgical emergency. The EARLIEST sign is often a sudden reduction in chest drain output (indicating the blood is no longer draining but accumulating in the pericardium), followed by haemodynamic deterioration (rising CVP, falling BP, falling CO, equalisation of diastolic filling pressures). Pulsus paradoxus may be present. Beck's triad is a LATE sign. Echocardiography confirms the diagnosis. Management: immediate return to theatre for re-exploration and evacuation of the haematoma. Temporary measures: fluid loading, vasopressors, and in extremis, bedside resternotomy.

Reference: RCOA – 2023 – Cardiothoracic ICU; EACTS/STS – 2019 – Post-cardiac surgery complications