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