A 4-Year-Old Boy Is Brought to the Emergency Department by His

question 705

Multiple Choice

A 4-year-old boy is brought to the emergency department by his mother for vomiting and diarrhea.  His mother says, "He started complaining of a stomachache after playing at the neighbor's farm, but I thought he was just hungry after playing outside all afternoon."  The child subsequently had several episodes of emesis and diarrhea.  His mother has also noticed that he seems to be sweating excessively and drooling.  He has no medical conditions and takes no daily medications.  The patient lives with his parents and uncle.  His uncle has sickle cell disease, for which he takes ibuprofen and oxycodone as needed for pain crises.  Temperature is 37.2 C (99 F) , blood pressure is 90/60 mm Hg, pulse is 50/min, and respirations are 36/min.  Pulse oximetry is 94% on room air.  Physical examination shows an ill-appearing child moaning on the stretcher and clutching his abdomen.  Significant diaphoresis and bilateral tearing are noted, and his pupils are constricted.  Cardiac examination reveals a regular rhythm with bradycardia and no murmurs, and respiratory exam is notable for tachypnea, bilateral wheezing, and mild subcostal retractions.  Oxygen via facemask is administered.  Which of the following medications should also be administered?

• A)Atropine
• B)Naloxone
• C)Pyridostigmine
• D)Pyridoxine
• E)Succinylcholine

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Definitions:

Normal Balance

The side of an account (debit or credit) where increases in the account are recorded, reflecting the nature of the account.

Financial Statement

A formal record of the financial activities and position of a business, person, or other entity, typically including income statement, balance sheet, and cash flow statement.

Permanent/Temporary

Terms used to differentiate between accounts that remain open over fiscal periods (permanent) and those closed at the end of a period (temporary).

Normal Balance

The side of an account (debit or credit) on which increases in the account are recorded, depending on the account type.