A 7-year-old girl is in the postanesthesia care unit after undergoing a strabismus correction surgery under general anesthesia with sevoflurane. She is agitated, disoriented, and inconsolable, thrashing in bed despite having no significant pain on assessment. Her vital signs are stable. Which of the following is the most likely cause of her symptoms?
A 4-year-old with pneumonia develops severe hypoxemia and is intubated for acute respiratory distress syndrome (ARDS). On the ventilator, her PaO2 is 58 mmHg with an FiO2 of 0.8. The pediatric resident wants to calculate the patient’s Oxygenation Index to stratify the severity of her ARDS. In addition to the PaO2 and FiO2, what other value is essential for this calculation?
A 16-year-old female with a history of depression presents after an intentional overdose of her amitriptyline. Her initial electrocardiogram shows a heart rate of 120 beats/min, QRS duration of 140 msec, and a prominent R wave in lead aVR. She is becoming increasingly drowsy. What is the most critical initial pharmacologic intervention?
A 10-year-old boy with a history of a previously repaired large ventricular septal defect travels to a high-altitude camp. Two days after arrival, he develops a non-productive cough, dyspnea at rest, and central cyanosis. His oxygen saturation is 70% on room air. What is the most likely primary pathophysiologic mechanism responsible for his presumed diagnosis?
A 14-year-old presents with a one-week history of severe, burning pain and skin color changes in her left foot after a minor ankle sprain. On exam, the foot is cool, dusky, and exquisitely tender to light touch. You suspect Complex Regional Pain Syndrome (CRPS). What is the mainstay of treatment for this condition?
A 4-year-old child is pulled from a swimming pool and emergency medical services are called. They report the submersion time was estimated to be 6 minutes. Cardiopulmonary resuscitation was initiated by bystanders. In the emergency department, the child is comatose with fixed, dilated pupils and has received 25 minutes of continuous CPR without return of spontaneous circulation. Which factor is the strongest predictor of a poor outcome?
A 3-month-old infant is undergoing repair of a complex congenital heart defect. The anesthesiologist chooses to use sevoflurane for maintenance of anesthesia. Compared to a 5-year-old child, how would the minimum alveolar concentration (MAC) of sevoflurane required for this infant differ?
A 17-year-old boy was brought to the emergency department after making contact with a high-voltage electrical wire. He has entrance wounds on his hands and exit wounds on his feet. He is tachycardic, and his urine is noted to be dark brown. In addition to aggressive fluid resuscitation, which intervention is critical to specifically prevent acute kidney injury in this patient?
A 1-year-old child is brought to the emergency department with lethargy and bradycardia after her grandfather accidentally gave her a dose of his clonidine. On exam, her heart rate is 50 beats/min and blood pressure is 70/40 mmHg. After supportive care, the administration of which medication has shown variable efficacy in treating toxicity from this agent?
A 17-year-old is brought to the emergency department after being rescued from a backcountry snowboarding accident where he was exposed to freezing temperatures for several hours. His right foot is pale, hard, and numb. After rapid rewarming in a 38°C (100.4°F) water bath, the foot becomes edematous and develops hemorrhagic blisters, consistent with third-degree frostbite. The injury occurred within the last 12 hours. Which advanced therapy has been shown to be most effective in preserving tissue when administered early?
