Recall Quiz Demo

Diagnosis:

• Mostly clinical diagnosis
• Normal compartment pressure: < 10 mm Hg
• An intra-compartmental pressure greater than 30 mmHg indicates compartment syndrome
  and a need for fasciotomy
• Use “delta pressure”: Diastolic BP – compartment pressure
• Delta pressure less than or equal to 30 mm Hg = compartment syndrome (Need Fasciotomy)
• If asked delta pressure less than or equal to 30 indicates compartment syndrome

Unstable Primary tachycardia in Children:

• In children with decompensated circulatory failure due to either supraventricular (SVT), ventricular tachycardia (VT) or other trachyarthmia the first choice for treatment is immediate synchronised electrical cardioversion at a starting energy of 1 J/kg body weight. Double the energy for each subsequent attempt up to a maximum of 4 J/kg. If possible, this should be guided by expert help. For children who are not yet unconscious, use adequate analgosedation according to local protocol. Check for signs of life after each attempt.
• Using 1j/kg initial shock would be 28 joules, as 28 joules not in options, best here would be 30 joules.

• Antibiotic Strategy
• Special Groups (Consider Back-up OR Immediate Antibiotics)
• Children with otorrhoea (discharge after tympanic perforation)
• Children under 2 years with bilateral otitis media
• Amoxicillin is 1st line; if allergic, use Clarithromycin
• High-Risk Groups (Immediate Antibiotics – Amoxicillin)
• Systemically unwell
• Signs of serious illness
• High-risk comorbidities
• Penicillin Allergy: Clarithromycin recommended; Erythromycin if pregnant
• Second choice: If worsening after 2–3 days of 1st choice, use Co-amoxiclav

Brugada Syndrome

Definition

Autosomal dominant genetic disorder, with a male preponderance, characterized by abnormal findings on the electrocardiogram (ECG) along with an increased risk of ventricular tachyarrhythmias and sudden cardiac death

Diagnostic Criteria

Brugada Syndrome: Typical ECG abnormalities AND one of the following clinical criteria:

1. Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT)
2. Family history of sudden cardiac death at <45 years old
3. Coved-type ECGs in family members
4. Inducibility of VT with programmed electrical stimulation
5. Syncope
6. Nocturnal agonal respiration

Brugada Pattern: Typical ECG abnormalities without any clinical criteria

Brugada Pattern Types & ECG Features

• Type 1: Coved ST elevation ≥2mm in V1/V2 (most diagnostic)
• Type 2: Saddleback pattern with high take-off ST elevation at least 1mm with a positive or biphasic T wave
• Type 3: Saddleback or coved pattern with ST elevation <1mm
• ST-segment elevation in V1 and/or V2 with a coved ST-segment, sometimes described as a pseudo right bundle branch block

Key Investigations

• 12-lead ECG (higher precordial leads if needed)
• Electrolytes (hypokalemia increases risk)
• Provocation testing with sodium channel blockers (flecainide/procainamide)
• Echo/cardiac MRI to exclude structural disease

Management

Brugada Syndrome (ECG + symptoms):

• Continuous cardiac monitoring
• Admit with telemetry
• ICD implantation for cardiac arrest survivors or sustained VT

Brugada Pattern only (no symptoms):

• Cardiology consultation for outpatient management/provocative testing