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