A 6-year-old is rescued from a house fire with heavy smoke e…
A 6-year-old is rescued from a house fire with heavy smoke exposure from burning furniture and plastics. She is tachypneic, confused, and hypotensive despite an adequate airway and supplemental oxygen with a normal SpO2 reading. A venous blood gas shows a markedly elevated lactate and, unexpectedly, a venous oxygen saturation that is much higher than typically seen in shock. What does this combination of findings suggest, and what is the underlying mechanism?
Read DetailsA 5-year-old presents with 12 days of fever, productive coug…
A 5-year-old presents with 12 days of fever, productive cough, and left-sided pleuritic chest pain not responding to outpatient amoxicillin. Exam: T 39.2°C, RR 36, SpO2 94% on RA, decreased breath sounds and dullness to percussion at the left base. Chest ultrasound reveals a large left pleural effusion with multiple internal septations (loculations). CT chest confirms complex parapneumonic effusion without lung abscess. Which management strategy is most appropriate?
Read DetailsA 10-year-old has a BB gun injury to the right eye: mild hyp…
A 10-year-old has a BB gun injury to the right eye: mild hypotony, shallow anterior chamber, teardrop-shaped pupil, and a positive Seidel test. Visual acuity is counting fingers at 3 feet. Which is the single most important immediate management step?
Read DetailsAn 8-year-old on pressure control A/C (PIP 24, PEEP 6, RR 18…
An 8-year-old on pressure control A/C (PIP 24, PEEP 6, RR 18, FiO2 0.50) has ABG: pH 7.48, PaCO2 30, PaO2 98. The team wants to correct the hyperventilation without compromising oxygenation. Which adjustment is most appropriate?
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