Animals
An 8-year-old boy in southern Texas presents to the ED with his mother, who reports he was bitten by a stray dog at the park. The child reports right forearm pain where he was bitten. On exam, you note a superficial macerated laceration on the dorsal surface of the distal forearm. The patient is able to freely flex and extend all joints in the right upper extremity. This is the most important next step in the care of this child, in addition to localized wound care and tetanus prophylaxis.
What is rabies immunization?
This symptom is most consistent with acute mountain sickness.
What is nausea?
A 2-year-old child presents to the emergency department after being pulled lifeless from a backyard pool. Bystander cardiopulmonary resuscitation was initiated, and the patient arrives receiving chest compressions and ventilation. Your team rapidly performs intubation, obtains IV access, and places the patient on monitors. The patient is limp, pulseless, apneic, and has fixed and dilated pupils. This of the following, if present on history or physical exam, is most likely to positively affect this patient’s outcome.
•Freshwater drowning
•Hyperglycemia
•Hypothermia
•Saltwater drowning
What is hypothermia?
An 8-year-old boy presents to the emergency department after being stung by a Portuguese man o' war. His parents brought him to the hospital due to his severe pain. This treatment is most likely to reduce his pain.
What is hot water bath?
In addition to altered mental status, this is the most sensitive sign for early recognition of high altitude cerebral edema.
What is ataxia?
A 3-year-old previously healthy boy is brought to the emergency department by emergency medical services. He has emesis covering his shirt, is obtunded, limp, and does not respond to intraosseous access. His heart rate is 182 bpm, respiratory rate is 40/min, oxygen saturation is 98% on a nonrebreather facemask, blood pressure is 86/54 mm Hg, and temperature is 43°C measured rectally. His skin is dry, lungs are clear, breathing is shallow, and pupils are normal in size and equal but sluggish to respond. There is no sign of trauma. This is the most likely mechanism for this patient's elevated temperature.
What is heat absorption greater than heat dissipation?
A 10-year-old boy presents to the emergency department an hour after being bitten by a rattlesnake on a hike with some friends in the western United States. He is mildly tachycardic but other vital signs are within normal limits for age. He has moderate swelling at the bite site on his ankle that is progressively getting worse according to his parents. This laboratory abnormality is most likely at this time in this patient.
What is thrombocytopenia?
A 10-year-old girl presents to the emergency department with a headache. She flew with her family from Florida yesterday to your location, where they are sleeping overnight before they ski tomorrow. They live at < 100 meters above sea level, your location is at 2,100 meters above sea level, the ski resort base is at 2,800 meters above sea level, and the peak is at 3,800 meters above sea level. She developed a headache and one episode of vomiting within 12 hours of arrival. She has not had any fever, difficulty breathing, or changes in her mental status. Her vital signs and exam are within normal limits for her age. This is the best initial treatment and recommendation for this patient.
What is acetaminophen, ondansetron, and allowing the ski trip after a day of rest?
An 18-month-old boy presents to the emergency department with loss of consciousness. He was found unresponsive alone in a hot vehicle. His initial vital signs show a temperature of 43.1°C, heart rate of 210 bpm, respiratory rate of 50/minute, and blood pressure of 82/34 mm Hg. An IV is placed and basic labs are obtained. His blood glucose is 152 mg/dL, pH is 7.12, carbon dioxide is 32 mEq/L, and lactate is 7.1 mmol/L. He is intubated and a bolus started. This is the best next step to treat this patient.
What is evaporative cooling?
An 11-year-old girl presents to the emergency department with severe abdominal and leg cramping. On exam, she is tachycardic, hypertensive, diaphoretic, and is noted to have an erythematous macule on her thigh. This is the most likely cause of her presentation.
What is black widow spider bite?
This illness / genetic condition is an independent risk factor for developing high-altitude pulmonary edema in a pediatric patient.
A 17-year-old boy presents to the emergency department the morning after being found stranded in the woods on a winter campout. The patient was given blankets, was in a warm vehicle en route, and has normal vital signs on arrival, including a normal core temperature. He is alert, and his exam is only remarkable for erythema and edema of the distal tips of the fingers with a small clear fluid-filled blister on the index finger. This is the best next step to rewarm this patient’s extremities.
What is immersing the frozen tissue in warm water?
A 13-year-old girl with no medical history presents with a 3 cm laceration to the left forearm secondary to a dog bite. The bite occurred 1 hour ago. The wound is superficial with no local crush injury. This management should be pursued.
What is irrigation, primary repair, and antibiotics?
An 18-year-old man with no previous medical history develops a dry cough and progressive cyanosis even at rest while climbing Mount Denali, the highest peak in North America. He is a cross-country runner at his home in Chicago, and his only medication is prophylactic acetazolamide. He is found to have a temperature of 38°C. This is the most likely underlying cause of his symptoms.
What is pulmonary capillary leakage?
An 18-year-old man is brought to the emergency department after a soccer game where he played under the hot sun for several hours. His coach is concerned that he may have heat exhaustion. This clinical feature is most suggestive of heat exhaustion.
What is nausea and vomiting?