A 1-month-old infant is scheduled for elective inguinal hernia repair. According to the preoperative fasting guidelines, what is the minimum fasting time required after a feeding of breast milk?
A 15-year-old male with a history of Duchenne muscular dystrophy (DMD) is brought to the emergency department with a severe leg fracture requiring urgent open reduction and internal fixation. The anesthesiologist is planning for general anesthesia. Which of the following anesthetic agents should be strictly avoided due to the highest risk of a life-threatening complication in this specific patient population?
A 17-year-old female presents to the emergency department after ingesting a large amount of her bupropion extended-release tablets in a suicide attempt 4 hours ago. She is currently asymptomatic with a normal ECG and vital signs. What is the most appropriate management and disposition for this patient?
A 2-year-old boy is brought to the emergency department by his parents who found him unresponsive. They found an open bottle of his uncle’s Suboxone (buprenorphine/naloxone) films on the floor. On exam, he has pinpoint pupils, a respiratory rate of 6 breaths/min, and shallow breathing. After establishing an airway and providing oxygen, you administer an appropriate dose of naloxone, and he improves. What is the most appropriate disposition for this child?
A 9-year-old child with a severe head injury is intubated in the field. Upon arrival at the emergency department, you note abnormal breathing characterized by the diaphragm contracting normally to distend the abdomen, but the intercostal muscles are paralyzed, causing a lack of chest wall expansion on inspiration. What is the most likely cause of this breathing pattern?
A 6-year-old boy is receiving a continuous morphine infusion via a patient-controlled analgesia (PCA) device after major abdominal surgery. On the second postoperative day, he develops persistent itching on his chest and face, which is distressing him. His pain is well-controlled, and he is slightly drowsy but easily arousable. Which intervention is most appropriate to manage his pruritus without compromising his analgesia?
A 7-year-old child presents with lethargy and signs of poor perfusion. An electrocardiogram reveals a regular, narrow-complex tachycardia at a rate of 230 beats/min with absent P waves. Intravenous access has been established. What is the most appropriate initial pharmacologic treatment for this hemodynamically unstable arrhythmia?
An 18-month-old child ingests an unknown quantity of windshield washer fluid from the garage. He presents to the emergency department 2 hours later, appearing drowsy and inebriated. His initial labs show a significant anion gap metabolic acidosis. The hospital has fomepizole available. What is the mechanism of action of the indicated antidote?
A 15-year-old travels with his family from sea level to a ski resort at 2895 m (9,500 ft). On the second day, he develops a headache, nausea, and significant fatigue that prevent him from skiing. The family is scheduled to drive to an even higher lodge at 3350 m (11,000 ft) that evening. What is the most appropriate next step in management for this adolescent?
A 10-year-old patient with blunt abdominal trauma is hemodynamically unstable. A FAST exam performed in the emergency department is negative for free fluid. What is the most appropriate interpretation and subsequent action based on this finding?
