Quiz #17 Answer: Arterial line trace

Below is the image of ICU monitor of a teen ager.

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

Answer: Pulsus paradoxus

Question 1: What are the 3 cause of such pulse pattern in any patient?

Answer: Pericardial tamponade, Severe asthma (Status asthmasticus) and Hypovolemia.

(Click on the image to enlarge)

Quiz #16: Answer (Echocardiogram - Pericardial effusion - M-mode)

Question: Image below is a parasternal short axis view recorded in a patient who presented with pericardial effusion. What ominous sign is being demonstrated?

Answer: Diastolic collapse of the RV free wall (Arrows. But, not seen in every beat due to movement artifacts). This is an echocardiographic sign of cardiac tamponade.

Quiz #15: 12-lead EKG - Inverted P in Lead I

Answer: There is P wave inversion in lead I and aVL. However, R wave progression in chest leads is normal. Therefore, this is misplacement of limb leads. Compare the corrected EKG when the same baby was 3 days old with normal lead placements.(Click on the images to enlarge)

Quiz #14 Answer: EKG - Inverted P wave in lead I.

Question 1: What is the diagnosis?

Answer: Dextrocardia

Question 2: Provide 2 salient findings that support the diagnosis:

Answer: (i) Inverted P wave in leads I & aVL. (ii) Lack of R wave progression in chest leads (V1-V6)

Compare this EKG with that in Quiz #15.

Click on the image to enlarge.