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Answers to Epilogue Questions
  1. Ravinder Parige,
  2. Simon Power
  1. Department of Neonatology, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
  1. Correspondence to Dr Ravinder Parige, 19 Old Worden Avenue, Buckshaw Village, Chorley, PR7 7DG; ravinderdoctor2004{at}yahoo.co.in

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Answers

From questions on page 72

  • Correct answer: B

This chest x-ray demonstrates bilateral pleural effusions and a widened superior mediastinum. The effusion is most apparent on the left side appearing as a rim of fluid between the left lung and the rib cage. This appearance is a consequence of the infant being supine at the time of imaging.

The endotracheal tube position is satisfactory lying above the carina at the level of the T2 vertebra. One would aim for the position to be between the levels of T1 and T2.

There is no evidence of cardiomegaly, pneumothorax or right upper lobe collapse.

  • Correct answer: D

The pleural effusions and widened mediastinum strongly suggest that there has been extravasation from the long line and the infusion through this line needs to stop immediately. The line should then be removed.

The metabolic acidosis is likely a consequence of reduced fluid input due to extravasation and therefore sodium bicarbonate is not indicated. A bolus of 0.9% sodium chloride is appropriate but not before the long line infusion has been halted.

The endotracheal tube is in a good position and does not need adjustment.

An intercostal drain is not indicated in this context as with increased ventilatory support and the removal of the line it is likely the fluid in the pleural space will be reabsorbed.

Footnotes

  • Contributors Both authors contributed equally in designing the questions and writing the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.