A 3-year-old is brought to the emergency department after being found in his family’s backyard pool. He is now awake and alert but has a persistent cough and an initial oxygen saturation of 92% on room air, which improves with supplemental oxygen. The chest x-ray is clear. What is the minimum recommended observation period in a hospital setting to monitor for delayed respiratory deterioration?
An 11-year-old child is being treated for refractory intracranial hypertension following a severe traumatic brain injury (TBI). First-tier therapies, including cerebrospinal fluid drainage and osmotic agents, have failed to control the intracranial pressure. Which of the following represents an appropriate second-tier therapy option?
A 10-year-old is rescued from a cold lake with a water temperature of 10°C (50°F). He is unresponsive and apneic upon rescue. Which of the following pathophysiologic events is the primary cause of the anoxic-ischemic injury in a drowning victim?
A 17-year-old female with newly diagnosed postural orthostatic tachycardia syndrome fails to improve with exercise and increased salt/fluid intake. She also reports suffering from chronic constipation. Which first-line medication would be most beneficial for addressing both her orthostatic intolerance and her gastrointestinal complaint?
A 3-year-old presents with a circumferential, leathery, white burn to his right forearm after a house fire. On examination, the extremity is tense and swollen, and you are unable to palpate a radial pulse. A Doppler assessment confirms the absence of arterial flow. What is the most appropriate and urgent intervention?
A 9-year-old boy is in the intensive care unit with persistent heart rate of 55 beats/min and hypotension that has not responded to ensuring adequate oxygenation and ventilation. An intravenous line is in place. According to pediatric advanced life support algorithms, which medication should be administered first?
A 16-year-old hiker is found confused and ataxic by a rescue team. His core temperature is measured at 30°C (86°F), and he is no longer shivering. An ECG in the field shows atrial fibrillation. What is the most appropriate classification and initial field management for his hypothermia?
An 18-month-old child presents to the emergency department with a several-day history of cough and fever. The parents note a prominent barking cough, and on examination, you observe inspiratory stridor and suprasternal retractions that worsen when the child is agitated. These signs are most useful in localizing the pathology to which area?
A non-verbal 4-year-old child with severe cognitive impairment is recovering from orthopedic surgery. You need to assess his postoperative pain level. He is lying quietly, has an occasional grimace, and his legs are tense. He whimpers intermittently and requires occasional consoling touch. Which pain assessment tool is most appropriate for this patient?
A 5-year-old boy is in the pediatric intensive care unit for septic shock. Despite receiving 60 mL/kg of crystalloid fluids, he remains hypotensive with a mean arterial pressure of 40 mmHg. He is subsequently started on an epinephrine infusion. According to the Phoenix Sepsis Score criteria, what is the minimum cardiovascular score for this patient?
