ENPC ENPC Cardiovascular Emergencies 1 — Questions and Answers
Question 1: A 3-month-old presents with poor feeding, pallor, and mottling. The ECG shows a narrow complex tachycardia with HR of 235 bpm. What is the most likely diagnosis?
- Sinus tachycardia
- Supraventricular tachycardia (SVT) (Correct answer)
- Ventricular tachycardia
- Atrial flutter
Correct answer: Supraventricular tachycardia (SVT)
SVT in infants typically presents with heart rates above 220 bpm, narrow QRS complexes, and signs of poor perfusion.
Question 2: Initial management for a hemodynamically STABLE infant with SVT includes:
- Synchronized cardioversion at 0.5 J/kg immediately
- IV adenosine 0.1 mg/kg bolus
- Vagal maneuvers such as ice bag application to the face (Correct answer)
- Amiodarone infusion over 20 minutes
Correct answer: Vagal maneuvers such as ice bag application to the face
Vagal maneuvers are the first-line treatment for stable SVT in infants; the diving reflex stimulated by ice water bag application to the face is particularly effective.
Question 3: What is the correct defibrillation energy dose sequence for pediatric ventricular fibrillation?
- 1 J/kg for all shocks
- 2 J/kg initially, then 4 J/kg for subsequent shocks (Correct answer)
- 5 J/kg for all shocks
- 360 J fixed dose regardless of weight
Correct answer: 2 J/kg initially, then 4 J/kg for subsequent shocks
PALS guidelines recommend 2 J/kg for the first defibrillation attempt and 4 J/kg for subsequent attempts in pediatric VF.
Question 4: A 10-year-old collapses during soccer. He is unresponsive, pulseless, and a defibrillator is immediately available showing VF. What is the PRIORITY action?
- Establish IV access and administer epinephrine first
- Perform 2 full minutes of CPR before defibrillation
- Defibrillate immediately without delay (Correct answer)
- Intubate the airway before initiating CPR
Correct answer: Defibrillate immediately without delay
In witnessed pediatric cardiac arrest with an immediately available defibrillator and shockable rhythm, early defibrillation should not be delayed.
Question 5: Which finding BEST differentiates cardiogenic shock from septic shock in a pediatric patient?
- Hypotension and tachycardia present in both
- Hepatomegaly, gallop rhythm, and jugular venous distension (Correct answer)
- Fever and elevated white blood cell count
- Prolonged capillary refill time
Correct answer: Hepatomegaly, gallop rhythm, and jugular venous distension
Hepatomegaly, gallop rhythm, and JVD are signs of cardiac failure and fluid overload, distinguishing cardiogenic from septic shock.
Question 6: A 2-week-old previously healthy neonate presents with sudden cardiovascular collapse. Which diagnosis MUST be considered?
- Dehydration from poor feeding
- Duct-dependent congenital heart disease with spontaneous ductal closure (Correct answer)
- Neonatal hypoglycemia
- Bacterial meningitis
Correct answer: Duct-dependent congenital heart disease with spontaneous ductal closure
Duct-dependent congenital heart lesions can cause sudden cardiovascular collapse as the ductus arteriosus closes in the first weeks of life.
ENPC ENPC Cardiovascular Emergencies 1
A 3-month-old presents with poor feeding, pallor, and mottling.
The ECG shows a narrow complex tachycardia with HR of 235 bpm.
What is the most likely diagnosis?