Quiz #34: ICU - Temporary Pacemaker

Quiz # X: ICU – Temporary Pacemaker

6 month old infant s/p AV septal defect repair. 3^rd postoperative day. Underlying rhythm was 3^rd 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)

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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?

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(Click on the image to enlarge)

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?

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(Click on the image to enlarge)

Quiz #22: ICU monitor interpretation

5 month old baby. Postoperative day 1 after closure of membranous VSD. Panel 1 and Panel 2 were recorded few minutes apart.

Questions:

1)      What is the arrhythmia in Panel 1?

2)      What type of pacing is done in Panel 2?

3)      Describe the important difference between the CVP waveform in Panel 1 and Panel 2. What is the reason for the difference?

4)      Comment about AV conduction in Panel 2.

5)   Why does arterial line trace have a “flat top”? How will you rectify this issue?

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(Click on the image to enlarge)

Quiz #17: Arterial pulse trace

Below is ICU monitor display for a teen ager.

Question 1: What is the name of the pulse for the pattern shown in the arterial line trace?

Question 2: Name 3 causes for this pattern of pulse in any patient?

Link to the answer.

(Click on the image to enlarge)

Quiz #11: CVP trace

The two snap shots were taken 1 minute apart from a postoperative patient.
What is the difference between the CVP traces in each of the panels? (Top panel - Clock time is 13:44 Hrs and Bottom panel - Clock time is 13:45 Hrs).
Click on the image to enlarge.


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Quiz #9: Where is the tip of the PA line?

This patient returned from operating room 20 minutes ago. He has a pulmonary artery line. What is the location of the PA line tip based on the CXR and the PA pressure trace?
Clue: PA line pressure trace holds the answer. CXR helps to corroborate.

(To see a larger image, click on the image)
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Quiz #4: EKG - Pacemaker

4 month old, s/p VSD repair. Postoperative day #3. Temporary pacemaker is on, for complete AV block. Set to DDD mode. What is wrong?

Click on the image to see a larger image.

Link to the answer