PEM Source

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All posts with tag: "fen"

PEM Questions

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You are seeing a 15 year old girl who presents with acute bilateral lower leg weakness / near-paralysis. She is found to be hypokalemic, which led to her weakness and paralysis. She also has a hyperchloremic (non anion gap) metabolic acidosis. She was previously healthy and denies ingestion of any substances. She has not been having diarrhea. Her urine pH is 6.0. 

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Last week’s 10 day old patient presented with seizures and jitteriness due to hypocalcemia. In the ED, he has a peripheral 22 gauge IV placed. 

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(Click the link to comment and to vote - voting not working through email, sorry!) You are caring for a 12 year old known diabetic who presents in diabetic ketoacidosis. Temperature is 37.5, HR 100, RR 24, BP 96/36, O2 sat 98% on room air. Labs show glucose 550, Na – 132, K – 2.8, pH 7.09. An initial bolus of normal saline 20 mL/kg has been given. [yop_poll id="162"]
(Click the link to comment and to vote - voting not working through email, sorry!) An 18 month old with history of pseudohypoaldosteronism presents with a K+ level of 9.0 and peaked T waves with mild QRS widening on the electrocardiogram, and blood pressure of 70/40. [yop_poll id="159"]
(Click the link to comment and to vote - voting not working through email, sorry!) [yop_poll id="130"]
(Click the link to comment and to vote - voting not working through email, sorry!) You are asked to evaluate a 3 day old male with severe lethargy and hypotonia. He is mildly tachypneic. He is afebrile. As part of your work-up, you evaluate him for inborn errors of metabolism. Which of the following is false about urea cycle disorder as a diagnosis for his findings? [yop_poll id="127"]
(Click the link to comment and to vote - voting not working through email, sorry!) You have diagnosed a 14 year old boy with likely nephrolithiasis, as evidenced by his colicky flank pain, hematuria, and ultrasound showing mild hydronephrosis. [yop_poll id="115"]
(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 4 week old brought in for vomiting with every feed. The vomitus is non-bilious, non-projectile, and non-bloody. The baby is making 5 wet diapers per day and weighs 10 lbs, and has gained 30 gm per day since regaining birth weight at 10 days of age. The baby is formula feeding, taking 5 ounces every 2-3 hours. [yop_poll id="87"]
(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 16 year old obese teen with no previous history of diabetes who presents with recent viral URI symptoms and increasing altered mental status over the last 8 hours. Her temperature is 37.9, heart rate 140, resp rate 22, and BP 90/35.  Blood glucose is 950, Na 130, K 3.4, and urine negative for ketones. The teen is confused and has a GCS of 13. [yop_poll id="66"]
(Click the link to comment and to vote - voting not working through email, sorry!) D5 ¼ NS is no longer recommended for maintenance fluids in hospitalized young infants. Why not? [yop_poll id="45"]

Tips and Tricks

Iron deficiency anemia can be seen in toddlers that have switched to cow's milk (typically at age 1 yr) from formula. If the child's diet is nearly exclusively cow's milk, a severe anemia can slowly develop due to iron deficiency and chronic subclinical GI blood loss. Toddlers should not drink > 20 oz milk / day; their diet must contain a variety of foods. Only severe cow's milk-associated anemia (Hgb < 5 g/dL) requires transfusion; otherwise diet modification and iron supplementation suffices. When transfusing hemodynamically stable patients who developed their anemia chronically, transfusion aliquots should be smaller and slower to avoid TACO (transfusion-associated circulatory overload). A good rule of thumb is: transfusion aliquot = Hemoglobin amount in mL/kg over 3-4 hours, so a child with a hemoglobin of 2.5 would receive 2.5 mL/kg PRBCs over 3-4 hours (instead of the typical pediatric transfusion aliquot of 10 mL/kg).

It's July, so good time to review the basics. For pediatric resuscitations of any type, the mnemonic ABCDEFG is great - Airway, Breathing, Circulation, Don't Ever Forget Glucose. Children have lower reserves and become hypoglycemic more easily than adults when stressed. This mnemonic also came from a fantastic quick review of pediatric congenital heart disease presentations from the awesome folks at emergencymedicinecases.com

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