Читать книгу Emergency Medical Services - Группа авторов - Страница 481

Inflammation of the pericardium with or without effusion is a known complication for dialysis patients. Uremic pericarditis is defined as development of pericarditis before or within 8 weeks of initiating dialysis, while dialysis‐associated pericarditis is thought to occur after the 8‐week mark of dialysis treatment. More classic etiologies such as infectious, postmyocardial infarction, and constrictive are also possible [17].

A patient with both uremic and dialysis‐associated pericarditis may present similarly with fever, chest pain that can be positional in nature, and a friction rub heard on cardiac exam. Classic ECG findings may not be present, as the inflammatory cells associated with noninfectious ESRD pericarditis do not involve the epicardium. The ultimate treatment for ESRD pericarditis is dialysis [4, 17].

Cardiac tamponade is a realistic possibility, and it should be considered in the hypotensive, dyspneic ESRD patient with distant heart sounds, elevated jugular venous pressure, pulsus paradoxus, or electrical alternans on ECG [17]. Focused point of care ultrasound may be used to aid in this diagnosis in the prehospital setting.