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"what were your indications for doing a pericardiocentesis since I am assuming they were medical codes?"
Best explanation of why a medicine guy is running around with a needle follows...
Two schools of thought on running codes:
First school: do every possible intervention in attempt to treat all possible etiologies of a code.
Second school: do everything to treat etiology of code as it reasonable applies to patient's hospitalization history.
My experiences have been part of both schools of thought. Given cardiac tamponade being on the short list of PEA etiologies, I have stuck patients in vain hopes of resurrecting the dead. No success.
However the second school of thought has led me to pericardiocentese patients as well. Common medical service etiologies (in my experience, anyways) of chronic pericardial effusions are patients with renal failure, cardiac failure, severe hypothyroidism, malignant pericardial effusions. Most of these patients are hypotensive for any number of reasons, and do not demonstrate the hallmark right atrial end diastolic collapse on ECHO, and thus clinically do not have tamponade. BUT if they code, all bets are off, and the needles come out. These guys usually have nonbloody effusions (except the malignant effusions) and thus can be drained fairly well. That's not to say that medicine patients can't develop an acute effusion as well- how about a free wall rupture post MI?
The above in addition to the fact that the on call medicine team runs all the codes in our 500 bed level one trauma center and end up coding high effusion risk folks like post cardiac surgery patients, hospitalized trauma patients, etc, explains why I at least have to entertain the idea of cardiac effusion with tamponade more often than I would like to.
As to the second question, no one that I have coded has ever survived directly as a result of percardiocentesis- not that I could tell. That's the (crappy or challenging, depending on how you look at it) thing about Medicine patients, there's never just one thing wrong- it's hard to say sometimes which intervention worked. I can say that a Medicine patient with an effusion who codes has an almost nil chance at walking out of the hospital alive given the comorbidities a chronic effusion implies.
Now I've got a Q for you- does your hospital allow the ER docs to do thoracotomies emergently?
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