Round 26 (Stridor, Vomiting, Shock)

Case Introduction You are working a shift at your local free-standing emergency room when a family of three checks in to be seen (a father and his two sons). Initial Vitals#1 (Chris, 18mo with stridor) * Temp 100.4F* HR 120* RR 40* O2 93% Critical Actions#1 (Chris, 18mo with stridor) * Check pulse oximetry (hidden)* Administer PO Steroids* Administer Racemic Epinephrine* Reassess patient after therapy* Discharge patient Initial Vitals#2 (Ronnie, 3yo with vomiting) * Temp 98.0F* HR 140* RR 38* O2 98% Critical Actions #2 (Ronnie, 3yo with vomiting) * Identify Iron overdose* Obtain abdominal XR * Obtain Iron level* Administer IVF bolus* Administer deferoxamine Initial Vitals#3 (Carson, 55yo with shock) * Temp 98.0F* HR 130* RR 28* BP 82/68* O2 92% Critical Actions#3 (Carson, 55yo with shock) * Obtain ECG* Identify pericardial tamponade* Administer IVF Bolus (tamponade is preload dependent)* Perform pericardiocentesis* Consult CT Surgery/CVICU Further Reading Life in the Fast Lane – Iron Toxicity EMDocs – Croup EMDocs – Pericardial Tamponade