QUIZ10thMay2017(answersbelow)

1. WhatarethedifferencesinpaediatricALScomparedtoadultALS?

2. WhatdoestheambulancehandovermnemonicIMIST-AMBOrepresent?

3. WhatistheYoungandBurgessclassificationofpelvicringfractures?

4. WhatECGchangescanbefoundinacutepulmonaryembolus?

5. DescribeandinterpretthefollowingECG.

QUIZanswers10thMay2017

1. WhatarethedifferencesinpaediatricALScomparedtoadultALS?

ThepaediatricALSalgorithmfollowsthesamepatternastheadultALSalgorithmoftwominutelycycleswithrhythmcheck/pulseassessment,adrenalineevery2ndcycle,amiodaroneforrefractoryVF/VTandworkingthroughthereversiblecauses.TheonlydifferencesthatIcouldthinkofare;

a) Thecauseofcardiacarrestinpaediatricsisoverwhelminglysecondaryto

hypoxiaand/orhypovolaemia,ratherthanaprimarycardiaccause.Oxygenatedbreathsarestartedimmediatelyandtheventilationtochestcompressionratiois15:2ratherthan30:2.

b) Airwayopeninginaninfantrequiresaneutralpositionduetoasoftandsmall

airwaythatcankinkwithflexionorextension.Whensupine,theinfant’srelativelylargeocciputresultsinneckflexion,requiringslightshoulderelevationtoobtaintheneutralposition.

c) Infantsandchildrenaresmalleranddrugdosesandjoulesareweightbased

ratherthanflatdoses.

d) Thereisalmostalwaysaparentorcarerpresent.

2. WhatdoestheambulancehandovermnemonicIMIST-AMBOrepresent?

I IdentificationM Mechanismofinjury/MedicalcomplaintI Injuries/InformationrelatedtothecomplaintS SignsT TreatmentandTrendsA AllergiesM MedicationB BackgroundhistoryO Otherinformation

3. WhatistheYoungandBurgessclassificationofpelvicringfractures?

AnteriorPosteriorCompression(APC)ResultsindiastasisofthepubicsymphysisorverticalpubicramifracturePubicsymphysiswideningmayhavealreadybeenpartlycorrectedbypelvicbinding

LateralCompression(LC)FracturesmorecommoninLCthanAPCResultsinhorizontalorcoronalfractureofpubicrami

VerticalShear(VS)

CombinedorComplexMechanism(CM)Massiveunstableinjurythatdoesn’tclearlyfittheothercategories

APCTypeI<2.5cmsymphysiswideningispossiblewithnoposteriordisruption

APCTypeII>2.5cmsymphysiswideningrequiresthedisruptionofthesacrospinous,sacrotuberousandanteriorsacroiliacligamentcomplex

APCIII Completeposteriorligamentdisruption

LCTypeICompressionattheSIjointwithoutligamentdisruption

LCTypeIIInternalrotationofhemipelvisdisruptingposteriorSIjointandfurtherfractures

LCTypeIIIFurtherinternalrotationwithcontralateraldisruptionandfractures

Thesacrumisdrivendownrelativetoiliacwingresultingincompletedisruption

4. WhatECGchangescanbefoundinacutepulmonaryembolus?

• Sinustachycardia• RVstrainpattern

Twaveinversioninferiorlyandrightprecordialleads(V1-4)• RBBB–completeorincomplete• Rightaxisdeviation• DominantRwaveinV1withclockwiserotation• S1Q3T3sign• Atrialarrhythmias–atrialfibrillation,atrialflutter• Non-specificST-Twavechanges

5. DescribeandinterpretthefollowingECG.

Regulartachycardia125/minPwavesuprightinIIsolikelysinusinoriginQRS Narrow

Normalaxisat60degrees WideSwavesinprecordialleads,persistingtoV6(RVdilatation)

STsegmentsnotsignificantlychangedTwaveinversioninferiorly(II,IIIandaVF)Twaveinversionrightprecordialleads(V1-3) =RVstrainpatternQTc–calculatedmanuallyIget460msec,not577msec

! SinustachycardiawithRVstrain

(ThispatienthadamassivePEwithhypotension)