A 10-Year-Old Boy Is Brought to the Emergency Department Due

question 191

Multiple Choice

A 10-year-old boy is brought to the emergency department due to 2 days of rhinorrhea, congestion, cough, and wheezing that worsened over the 6 hours prior to arrival.  Chest x-ray reveals hyperinflation and bronchial wall thickening.  He receives nebulized albuterol and ipratropium, intravenous corticosteroids, and intravenous magnesium sulfate.  Due to lack of significant improvement in symptoms, the patient is admitted to the intensive care unit and given continuous nebulized albuterol, intravenous terbutaline, and bilevel noninvasive positive airway pressure ventilation.  After 2 hours, pulse oximetry shows 89% on 0.6 FiO₂, and the patient becomes agitated.  Breath sounds are diminished but equal bilaterally, and no wheezing or stridor is heard.  The patient's trachea is midline.  Laboratory results are as follows: Which is the best next step in management of this patient?

• A)Continued noninvasive ventilation with close observation
• B)Endotracheal intubation
• C)Nebulized racemic epinephrine
• D)Needle thoracostomy
• E)Tracheostomy

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Definitions:

Collective Unconscious

A term coined by Carl Jung, referring to structures of the unconscious mind shared among beings of the same species.

Latent Memory Traces

Hidden or inactive records of past experiences that can potentially be recalled.

Strive

To make great efforts to achieve or obtain a specific objective.

Inferiority

A feeling of lower status or quality compared to others, often associated with low self-esteem or lack of confidence.