Professor’s Pearls
Section VI: The Pediatric Intensive Care Unit
1 Case: A 3-week-old infant was transferred to the pediatric critical care unit because of a gradual onset of tachypnea and difficulty feeding. The infant has good symmetric breath sounds, no cardiac murmur, a soft abdomen with the liver palpated 3 cm below the costal margin, and warm hands and feet. What further information do you need to help you make a diagnosis? What would be the next step in management?
2 Case: A 13-year-old boy is admitted to the hospital with weakness 2 weeks after receiving an influenza vaccine. He initially had difficulty walking and is now unable to stand without support. He has a history of asthma. On examination, there is marked weakness of his lower extremities with absent ankle and knee deep tendon reflexes (DTRs). What is his likely diagnosis? At what point would you place this patient in an intensive care unit for closer monitoring and support?
3 Case: A previously healthy 4-year-old child is admitted to the intensive care unit after presenting to the emergency department with a seizure. The child developed a high fever, cough, and poor urine output over the previous day. The chest radiograph demonstrated right lower lobe consolidation. The child does not appear dehydrated. What are the possible diagnoses? What complication should you be concerned about?
4 Case: A previously healthy 6-week-old male infant is admitted with diarrhea and assessed to be 10% dehydrated. The baby’s birth weight was 3.4 kg. His weight 1 week ago during a well child visit was 4.2 kg. Despite adequate fluid resuscitation, the child remains acidotic and has an ashen color but has begun to make urine. Why is the child still acidotic?
5 Case: A previously healthy 19-year-old presents to the emergency department with a chief complaint of light-headedness and concern for the way she is breathing. Her vital signs are temperature of 39° C (102.2° F), heart rate of 154 beats per minute, respiratory rate of 40 breaths per minute, and a blood pressure of 80/30 mm Hg. Her skin is erythematous. What are the most likely diagnoses? What should be her initial management?
6 Case: A 3-week-old infant is admitted to the intensive care unit for management of abdominal distention and respiratory compromise. The baby was born at home, has been poorly feeding over the last few days, and did not pass meconium until the third day of life. What is the baby’s most likely diagnosis? What is the most concerning complication? What should be the best management for this young infant?
7 Case: A 16-year-old is admitted to the hospital with a history of a sore throat on treatment with penicillin. She now has neck pain, cervical swelling and tenderness, and continued high fever, and she has developed tachypnea. Chest radiograph demonstrates bilateral “cannonball” infiltrates. What is her diagnosis? Which imaging study might confirm the diagnosis? How should this patient be managed?
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