Rapid onset cardiac tamponade may also appear similar to pleural effusions, shock, pulmonary embolism, and tension pneumothorax.If symptoms appeared more gradually, the differential diagnosis includes acute heart failure.In a person with trauma presenting with pulseless electrical activity in the absence of hypovolemia and tension pneumothorax, the most likely diagnosis is cardiac tamponade.In addition to the diagnostic complications afforded by the wide-ranging differential diagnosis for chest pain, diagnosis can be additionally complicated by the fact that people will often be weak or faint at presentation. For instance, a fast rate of breathing and difficulty breathing on exertion that progresses to air hunger at rest can be a key diagnostic symptom, but it may not be possible to obtain such information from people who are unconscious or who have convulsions at presentation. Treatment
Pre-hospital care
Initial treatment given will usually be supportive in nature, for example administration of oxygen, and monitoring. There is little care that can be provided pre-hospital other than general treatment for shock. Some teams have performed an emergency thoracotomy to release clotting in the pericardium caused by a penetrating chest injury.Prompt diagnosis and treatment is the key to survival with tamponade. Some pre-hospital providers will have facilities to provide pericardiocentesis, which can be life-saving. If the person has already suffered a cardiac arrest, pericardiocentesis alone cannot ensure survival, and so rapid evacuation to a hospital is usually the more appropriate course of action. Hospital management
Initial management in hospital is by pericardiocentesis.
Neorickettsia helminthoeca is a bacterium in the Neorickettsia genus that causes Salmon poisoning disease. Salmon poisoning disease
Salmon poisoning disease (SPD) is a fatal disease of dogs and other canids caused by a rickettsial bacterium, Neorickettsia helminthoeca. It results from eating raw salmon, trout, or salamander and is common in the Pacific Northwest. These fish and amphibians are infected with the larvae of a fluke, Nanophyetus salmincola through an intermediate host, the snail Oxytrema plicifer. The larvae attaches to the intestine of the dog and the rickettsial bacteria are released, causing severe gastrointestinal disease and systemic infection. Neorickettsia elokominica, carried by the same fluke, causes a similar disease known as Elokomin fluke fever (EFF) in canids, bears, raccoons, and ferrets. Symptoms
Symptoms of SPD begin about one week after eating the salmon and include vomiting, diarrhea, loss of appetite, depression, high fever, and enlarged lymph nodes. Untreated, mortality reaches 90 percent. Death occurs seven to ten days after symptoms begin.EFF has less severe symptoms than SPD, with less gastrointestinal signs and more lymph node involvement. The mortality in untreated cases is about 10 percent.A similar disease has been identified in Brazil. Diagnosis
Diagnosis is through finding the fluke eggs microscopically in a stool sample. A needle aspiration biopsy of an enlarged lymph node will reveal rickettsial organisms within macrophages in many cases. The rickettsial infection can be successfully treated with tetracycline, and the fluke infection can be treated with fenbendazole. == References ==