CRITICAL CARE Flashcards
Child sustained blunt trauma to the abdomen, all vital signs are normal, and the abdominal ultrasound (US) is positive for splenic rupture. What is the best management?
For hemodynamically stable grades I–III,
conservative management with monitoring of vital signs, surgical consult, serial hemoglobin, and hematocrit measurements
Child sustained blunt trauma to the abdomen, low blood pressure, tachycardia, cold, clammy skin,
and abdominal US is positive for splenic rupture. What is the best management?
Abdominal exploration
Child presents with nausea, vomiting, and malaise. O/E: the liver is slightly enlarged. Laboratory findings include elevated liver enzymes, high direct bilirubin, hypoglycemia, and prolonged
prothrombin time. What is the most likely diagnosis?
Acute hepatic failure
Child presents to the ED with rapid breathing, low blood pressure, and normal oxygen saturation. O/E: tachypnea, tachycardia, clear lungs, and
muffled heart sounds and widened pulse pressure. What is the most likely diagnosis?
Cardiac tamponade
A 12-year-old girl was transferred to the ED after a car accident. She is complaining of chest pain on the left side and difficulty breathing. O/E: vital
signs are normal; however, she has fast and shallow breathing, a segment of the left chest moves inward upon inspiration and outward upon expiration. What is the most likely diagnosis?
Flail chest
What is the next best step in the previous case of flail chest?
Pain control, pulmonary toilet. Ensure adequate ventilation and oxygenation
A 5-year-old boy with 2 days history of severe vomiting and diarrhea. He is lethargic and not able to drink by mouth. O/E: awake but minimally interactive, low-grade fever, tachypnea,
tachycardia, low blood pressure, delayed capillary refill time, cold skin, dry mucous membranes, skin tenting, and diminished peripheral pulses. What is the most likely diagnosis?
Hypovolemic shock (low intravascular volume
What is the next step in the previous case?
Aggressive fluid resuscitation: 20 ml/kg bolus of normal saline or Ringer’s lactate over 5–10 min, additional boluses may be required based on clinical assessment and ongoing losses
A 2-month-old with a history of congenital heart disease presents with hepatomegaly, and cardiomegaly, 20 ml/kg of normal saline leads to new crackles, worsening hypotension, and
tachycardia. What type of shock is this?
Cardiogenic shock
Type of shock that is associated with bradycardia, hypotension, and is often associated with spinal cord injury?
Neurogenic shock
A 5-year-old boy with high fever 104 °F for 2 days. He is lethargic and not able to drink by mouth. O/E: awake but minimally interactive, temperature 104.9 °F, ill-looking, tachypnea, tachycardia, low blood pressure, delayed capillary refill time, diminished peripheral pulses. WBC count is 29,000. What is the most likely diagnosis?
Septic shock (cold shock)
The patient in the previous example continues to have low blood pressure, refractory to fluid resuscitation and antibiotics in the first 15 min. What is the next best step?
Start epinephrine infusion
A 5-year-old boy stung by a bee rapidly developed hives, pruritus, facial swelling, wheezing, difficulty breathing. His blood pressure is low. What is the next best step?
Epinephrine IM immediately
A 3-year-old girl arrived in PICU with prolonged cardiac arrest after choking on a hot dog. Her pupils are dilated and fixed, absent gag reflex, absence of spontaneous eye movements during
oculovestibular and oculocephalic testing. No spontaneous movement. Lack of any respiratory effort without ventilatory support. What is the next
best step to confirm brain death?
Neurological exam followed by apnea test (after 24 h of supportive care)
Child presents with no pulse; the EKG shows ventricular tachycardia. What would be the next step in the management of the arrhythmia?
Defibrillate 2 J/kg
