Monday, July 28, 2014

Quiz #34: ICU - Temporary Pacemaker

Quiz # X: ICU – Temporary Pacemaker

6 month old infant s/p AV septal defect repair. 3rd postoperative day. Underlying rhythm was 3rd degree AV block & probable sinus node dysfunction. The rhythm strip was printed to evaluate the temporary pacemaker.

Questions:
1) What mode is being used?
2) Comment on the following:
a.       Is the pacemaker atrial pacing properly? (Yes/No)
b.      Is the pacemaker atrial sensing properly? (Yes/No)
c.       Is the pacemaker ventricular pacing properly? (Yes/No)

(Click on the image to enlarge)



Sunday, July 20, 2014

Quiz #33: ICU Arterial line traces

Quiz #33: ICU Arterial line Traces

13-year old patient who underwent repair of coarctation of aorta earlier that day has two arterial lines – right radial & left femoral. The apparent peak to peak pressure gradient across the coarctation repair site is 37 mmHg.


Question: Based on the traces in each arterial line, is the pressure gradient higher than, lower than or equal to 37 mmHg? Why?


(Click on the image to enlarge)

Tuesday, July 15, 2014

Quiz #31: RA line trace

This RA trace was recorded in cath lab, under endotracheal general anesthesia.

Question: Which wave is the taller one, a wave or v wave?

(Click on the image to enlarge)

Saturday, July 5, 2014

Quiz #30: EKG - Arrhythmia

13-year old girl was transferred to Pediatric ICU for atrial flutter. She is obtunded and has muscle tremors. Suspected to have developed encephalopathy as part of a systemic vasculitis. Figure 1 is an strip from floor with EKG and pulse oximeter trace. Figure 2 is an apical 4-chamber view with Doppler trace of mitral/aortic valve flows.

Questions:
1) What is the diagnosis?
2) How will you manage?

Link to the answer

(Click on the image to enlarge)