Tamponade

Tamponade (from French tampon — plug, tampon) is a medical term with two main meanings: a therapeutic procedure and a pathological condition. In both cases, the essence of the process is to create pressure in a specific cavity or on a specific structure.

As a therapeutic measure, tamponade is a method of stopping bleeding by tightly inserting tampons, gauze, or special balloons into a wound or body cavity. As a pathological condition, tamponade is the compression of an organ by fluid accumulated in a confined space, resulting in impairment of its function.

Tamponade as a therapeutic procedure

The main purpose of therapeutic tamponade is hemostasis (stopping bleeding). Dense filling of the cavity with pressure material creates compression on bleeding vessels, promoting thrombosis and stopping bleeding.

The main types of therapeutic tamponade:

• Nasal tamponade: one of the main methods of stopping severe nosebleeds. Depending on the localization of the source of bleeding, it is distinguished as:
  • Anterior tamponade: long gauze tubes soaked in hemostatic agent are inserted into the anterior regions of the nasal cavity.
  • Posterior tamponade: used for posterior bleeding, it involves securing a tight tampon in the nasopharynx with catheters.
• Wound tamponade: dense layer-by-layer filling of a deep wound with sterile gauze to stop diffuse bleeding and allow outflow of wound discharge.
• Uterine tamponade: insertion of a special balloon (such as a Bakri balloon) into the uterine cavity to stop massive postpartum bleeding.

Tamponade as a pathological condition

In this sense, the term describes the compression of an organ due to the accumulation of fluid in the inextensible surrounding cavity. The most prominent and life-threatening example is cardiac tamponade.

Cardiac tamponade:

• Pathophysiology: it is a critical condition in which fluid (blood, exudate) rapidly accumulates in the pericardial cavity (heart sac). The stiff fibrous pericardium cannot stretch, and fluid begins to squeeze the heart chambers.
• Consequences: the compression prevents the heart from adequately filling with blood during the diastole phase. This leads to a fall in cardiac output, the development of obstructive shock and circulatory arrest.
• Causes: penetrating chest wounds, myocardial rupture after infarction, aortic dissection, cancer, severe pericarditis.
• Clinical presentation is described by the classic Beck’s triad: 1) Hypotension (drop in blood pressure); 2) Jugular venous distension; 3) Muffled heart sounds.
• Treatment: requires immediate intervention — pericardiocentesis, that is, puncture of the pericardial cavity with aspiration of fluid to relieve compression.

Clinical Significance

It is important to clearly understand the context in which the term “tamponade” is used. As a medical manipulation, tamponing is an effective and often life-saving method of controlling bleeding. As a pathological condition (primarily cardiac tamponade), it is one of the most critical medical emergencies requiring immediate diagnosis and invasive treatment to decompress a vital organ. Common to both concepts is the principle of pressure, which in one case is used for cure and in the other case leads to disastrous consequences.