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[yop_poll id="289"]
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[yop_poll id="286"]
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You are seeing a 5 year old child with known adrenal insufficiency with fluid and pressor-resistant hypotension. You wish to give stress-dose steroids.
[yop_poll id="285"]
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[yop_poll id="287"]
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[yop_poll id="278"]
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You are told that you will be receiving a 12 month old child in full arrest. CPR is in progress by the paramedics. Your EMS agency does not have pre-hospital providers intubate children. Which of the following is true as you prepare your equipment and medications?
[yop_poll id="239"]
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A 16 year old girl arrives to the ED by ambulance and promptly delivers a 34 weeks by dates neonate. The infant is unresponsive, apneic, and you cannot palpate a pulse. After initial steps of drying, warming, and stimulating, the baby is still apneic with a heart rate < 100. You initiate positive pressure ventilation for 15 seconds but still do not hear the heart rate rising. Which of the following is not a part of the MR SOPA ventilation corrective steps recommended to try next?
[yop_poll id="227"]
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[yop_poll id="222"]
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You are managing a 1yo patient with submersion injury who has respiratory distress and falling O2 saturation. You begin bag-valve-mask ventilation as you prepare to intubate the patient, using a 450mL self-inflating bag with oxygen at 10 L/minute, bagging at a rate of 20 breaths/minute. You note that the patient is not improving and there is poor chest rise, so you insert a correctly sized and placed nasopharyngeal airway. The patient is still not improving and has poor chest rise - after repositioning, which is the best intervention?
[yop_poll id="178"]
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EMS is bringing you a 10yo patient that has been actively seizing for 20 minutes. They are unable to obtain IV access.
[yop_poll id="177"]
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A 2yo girl is brought in by ambulance after a seizure lasting 1 minute. She has had 2 days of fever, vomiting, and diarrhea. Her temperature is 39.1, HR 202, BP 129/61. Despite antipyretics, calming down, and volume resuscitation, she remained febrile and tachycardic. On exam, a midline neck mass is palpable, and the mother gives a history of several months of sweating and poor weight gain. A lab test confirms her diagnosis.
[yop_poll id="164"]
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A 3 week old infant that is positive for RSV has had several prolonged episodes of apnea requiring BVM ventilation. The decision is made to intubate the baby. It is a difficult intubation, although the tube is finally observed to pass through the cords on video laryngoscopy. A 3.5 uncuffed tube has been placed and taped at 12cm at the lip. After several positive pressure breaths on 100% FiO2, the pulse oximetry has fallen to 85% and fails to rise. The ETCO2 waveform is normal and reading 46 mm Hg. Heart rate is 170, BP is 62/30. On auscultation breath sounds are decreased on the left side. Trachea is midline.
[yop_poll id="160"]
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[yop_poll id="133"]
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For which of the following pediatric patients is it most important to have the clinician with the most experience in advanced airway management and endotracheal intubation perform rapid sequence medication-assisted intubation?
[yop_poll id="125"]
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A new edition of ATLS (10th edition) was recently released. Which of the following is not a recommendation of the 10thedition of ATLS regarding the trauma patient in shock?
[yop_poll id="75"]
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A previously healthy 5 year old boy with PMH of ADHD presents with 9 days of lethargy, fever, vomiting, diarrhea, and weight loss. He recently was diagnosed with strep pharyngitis and treated with amoxicillin for 3 days. His vital signs are: temp 39 C, HR 140, RR 24, BP 154/99, O2 sat 99% on room air. His exam is significant for agitation and restlessness, and tachycardia with bounding pulses and a hyperdynamic PMI. His mother feels that his anterior neck looks swollen.
[yop_poll id="23"]
You are caring for a 6yo oncology patient presenting in septic shock. Although he is oxygenating and ventilating well at this time, you plan to intubate him to reduce his metabolic work. The most important pre- treatment before rapid sequence intubation (RSI) is:
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[yop_poll id="13"]
A 12yo girl presents to the ED in December with fever for 4 days, malaise, and pain in the right thigh gradually leading to her having difficulty walking. There is no history of trauma, although she did play a lot of basketball 1 week ago. She is alert and oriented. Physical exam of her leg is unremarkable except for diffuse pain. She has no rash nor joint swelling or erythema. Her vital signs are: temp 39.1, HR 165, RR 22, BP 85/44. Labs show an elevated WBC count with a bandemia, a BUN of 20 with a creatinine of 2.2, and mildly elevated transaminases with a bilirubin of 2.4.
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[yop_poll id="9"]
A 36-week infant is born precipitously NSVD to a 17yo G2P1 mother in the ED after the mother presented with the chief complaint of intermittent abdominal pain. Apgars are 8 and 9 at 1 and 5 minutes, with -1 for color at both times and -1 for reflex irritability at 1 minute. The O2 sat in the left upper extremity is 82% at 5 minutes. The baby is crying intermittently, is not pale or plethoric, and is in no respiratory distress. Lung sounds are equal and clear bilaterally, and cardiac exam is normal. The next best intervention is:
A. Intubate and mechanically ventilate
B. Suction and apply 100% O2
C. Suction and apply nasal canula O2 at 5 L/min
D. Transilluminate the chest to r/o pneumothorax
E. Continue to observe the infant
Check back in a few days for my answer and others' comments
Also, if you're interested in the Peds ID Question of the Week, you can find it
hereA 20kg child sustains a 15% body surface area burn. The best answer for the rate of IV fluids that should be administered over the first 8 hours is:
A. 60 cc/hr
B. 75 cc/hr
C. 120 cc/hr
D. 135 cc/hr
E. 150 cc/hr
A 12yo boy with very high risk ALL, recent chemotherapy 4 days prior, presents to the ED with fever and lethargy. Temperature is 39C, HR 180, RR 24, BP 80/50. The patient is lethargic, has no nuchal rigidity, lungs are clear to auscultation, heart is tachycardic but regular rate and rhythm, abdominal exam is benign, and there is no rash. Pulses are bounding, there is flash capillary refill, skin is warm and dry. After adequate fluid resuscitation, cultures, and empiric antibiotics, the patient remains hypotensive. The next best treatment is:
A. Dopamine IV at 5 mcg/kg/min
B. Epinephrine IV at 0.1 mcg/kg/min
C. Norepinephrine IV at 0.1 mcg/kg/min
D. Dobutamine IV at 5 mcg/kg/min
E. Hydrocortisone 1 mg/kg IV
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A full term infant born out of asepsis (BOA) at home is brought in by ambulance to your PED. No neonatologist or pediatrician is in house. The baby's venous blood gas shows a pH of 6.9, PCO2 80. The baby has inadequate respirations. Which do you decide to do?
[poll id="57"]
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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 29 day old afebrile former 35 weeker brought in by ambulance. The patient was given a few sips of "gripe water" for runny nose, appeared to choke and gasp for air, turned blue briefly, then recovered. The entire episode was about a minute. There was no tone change. The baby has no birth complications. The baby's vital signs and physical exam are normal in the ED, pulse ox is 100% on room air, RSV testing is negative. What would be your management?
[poll id="33"]
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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
It's the day after Thanksgiving, and your patient just ate a bunch of leftovers before getting into an automobile accident. You are intubating, and hoping the patient doesn't aspirate during the procedure. A medical student asks whether he should apply cricoid pressure for you.
[poll id="31"]
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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 19 year old with a history of illicit drug use brought in with sudden onset cardiac arrest. He received bystander CPR immediately after the arrest, and is in a ventricular fibrillation rhythm that has persisted despite 5 shocks, epinephrine, and amiodarone following the ACLS algorithm.
[poll id="30"]
(Click the link to comment and to vote - voting not working through email, sorry!)
Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 3 year old with 2nd lifetime episode of SVT. The patient has no other prior PMH, was not on any medications, was healthy prior, and does not have WPW. After 2 doses of properly administered adenosine, the patient is still in SVT. She is alert, not toxic, has good perfusion, and is not hypotensive.
[poll id="29"]