A patient is receiving PRBCs. Ten minutes into the transfusion the patient reports, “I feel cold,” begins shivering, complains of back pain, and becomes short of breath.

A resident gives a verbal order for vancomycin 10 mg/kg IV. The nurse reads back ’10 mg/kg vancomycin IV.’ The resident confirms ‘Correct.’ Twenty minutes later, a pharmacy review reveals the correct dose was 15 mg/kg based on current guidelines. Which component of closed-loop communication failed?

A 15-year-old sustains a gunshot wound to the right lower abdomen. In the trauma bay: HR 108 bpm, BP 112/68 mmHg. Abdominal exam shows peritoneal penetration on local wound exploration. There is NO peritonitis on exam. CT abdomen/pelvis shows the trajectory traverses the peritoneal cavity. What is the MOST appropriate definitive management decision?

A 14-month-old is brought to the ED with a 4-hour history of intermittent severe screaming with drawing-up of his knees, separated by periods of lethargy. He has vomited twice and passed one blood-tinged mucousy stool. A sausage-shaped mass is palpable in the RUQ. What is the MOST appropriate next step?

A 10-day-old previously well male infant develops sudden onset bilious vomiting. He is now lethargic with a distended, tender abdomen and HR of 188 bpm. Abdominal X-ray shows paucity of bowel gas in the right lower quadrant. What is the MOST appropriate next step?

A 7-year-old with known biliary atresia and cirrhosis presents in hemorrhagic shock with hematemesis and hematochezia. HR 158 bpm, BP 72/40 mmHg. Exam: jaundice, massive hepatosplenomegaly, ascites, and caput medusae. Blood type is sent. PRBCs are being prepared. What pharmacologic intervention should be initiated IMMEDIATELY while endoscopy is arranged?

A 6-week-old infant presents with recurrent episodes of unresponsiveness and seizures. Repeated bedside glucose values during episodes are 22–35 mg/dL. He requires a glucose infusion rate (GIR) of 13 mg/kg/min to maintain glucose >50 mg/dL. Critical sample during hypoglycemia shows: insulin 9.8 uU/mL, C-peptide elevated, beta-hydroxybutyrate 0.3 mmol/L, free fatty acids low, cortisol 22 mcg/dL, GH 15 ng/mL. What is the MOST appropriate initial pharmacotherapy?

A 2-day-old male neonate has not passed meconium since birth. He has progressive abdominal distension. On physical examination, the abdomen is tense and tympanitic. Digital rectal examination reveals a tight anal canal with an explosive release of gas and liquid stool upon finger withdrawal. Abdominal X-ray shows marked dilation of the colon. What is the MOST appropriate next step to confirm the diagnosis?

A 16-year-old with ulcerative colitis presents with 10–12 bloody stools per day, fever of 39.0°C, HR 128 bpm, CRP 96 mg/L, albumin 2.0 g/dL, Hgb 8.1 g/dL. Plain abdominal X-ray shows the transverse colon measuring 7.2 cm. She is admitted and started on IV methylprednisolone 1 mg/kg/day. At 72 hours, she remains febrile with 11 stools today. What is the MOST appropriate next step?

A post-Fontan patient’s ECG shows a regular atrial rate of approximately 300 bpm with sawtooth-appearing waves in the inferior leads and a ventricular rate of 150 bpm. What is the most likely diagnosis?