Question 1
What ECG characteristic is typically seen in a healthy 2 year old?
A: Low QRS voltages
B: Deep Q-wave in V1
C: T-wave inversion in V1-V3
D: QT-prolongation
The correct answer is C
Low QRS voltages can be seen in Pericarditis, Myocarditis and Hypothyroidism (and in normal newborns)
Deep Q-waves in V1 suggest severe right ventricular hypertrophy.
T-wave inversion in V1-V3 are called juvenile T-waves. They are typically seen in young infants although they can persist into early adulthood.
QT-prolongation can be drug induced, hereditary, myocarditis etc. etc.
Life In The Fast Lane posted a really useful summary of pediatric ECG interpretation.
Question 2
Your patient presents with loss of consciousness, apnea and pinpoint pupils. She responds to 0,4 mg Naloxone, but relapses 60 minutes later. Another 0,4 mg is given, but 60 minutes later your patient again becomes unresponsive. What would be an appropriate dose for a Naloxone infusion for this patient?
A: 0,04 mg per hour
B: 0,13 mg per hour
C: 0,8 mg per hour
D: 4 mg per hour
The correct answer is B
An appropriate starting dose of Naloxone infusion would be ⅓ of the effective dose, run over 1 hour.
In this Emergency Medicine Cases podcast opiate related Emergency Care presentations are discussed in detail.
In the Netherlands we fortunately are not (yet) overwhelmed by the opioid epidemic. We hope we (Dutch physicians) learn from other countries and turn the tide.
Question 3
Your 6 year old patient presents with anorexia, nausea and abdominal pain in de right lower quadrant. You suspect a appendicitis and order an abdominal ultrasound. The ultrasound is suspect for ………. Epiploic appendagitis. What is true about this condition?
A: Management includes treatment with broad spectrum antibiotics
B: It is very common in children
C: Most commonly affects the descending colon in children
D: Symptoms improve in 72 hours and resolve in 3 weeks
The correct answer is D
Epiploic appendages are fat filled structures on the outside of the colon. Inflammation is uncommon in children. It most commonly affects the cecum in children.
It is self limiting in the vast majority of cases and antibiotics are not indicated.
Pediatric EM Morsels discuss this rather uncommon disease.
What statement is true about the management of the patient with a painful wrist and this X-ray?
A: Put on a cast and follow up in one week
B: Reduction in the ED and follow up in one week
C: Reduction in the ED if surgery is not an option immediately, otherwise straight to the operating room.
The correct answer is C
Perilunate dislocations need surgery (open reduction, ligament repair and fixation) as soon as possible. However, if surgical intervention is not an option, closed reduction should be attempted in the Emergency Department.
emDocs posted an overview of common injuries requiring orthopedic consultation.
Question 5
An infant presents with a AV Nodal Reentry Tachycardia to your ED. Vagal manoeuvres and adenosine do not terminate the SVT. Your colleague asks if verapamil would be a good next treatment option. What is the correct response?
A: Hell no! Only as a last resort
B: Yes, good plan! Let’s try verapamil intravenously
Answer A is correct
Infants have immature myocardial regulating system and have difficulty storing and releasing calcium for myocyte contraction.
Newborns and infants can become highly dependent on extracellular calcium for myocardial contractility.
R.E.B.E.L. EM has this great post about the child with shock.
Thanks for joining us. We hope to see you next week!
Eefje and Rick
Good questions! Very practical for immediate use in the ED (or future references)