A newborn male is evaluated one minute after birth. He was born at 38 weeks gestation to a 28-year-old gravida 3 via vaginal delivery. The patient’s mother received sporadic prenatal care, and the pregnancy was complicated by gestational diabetes. The amniotic fluid was clear. The patient’s pulse is 70/min, and his breathing is irregular with a slow, weak cry. He whimpers in response to a soft pinch on the thigh, and he has moderate muscle tone with some flexion of his extremities. His body is pink and his extremities are blue. The patient is dried with a warm towel and then placed on his back on a flat warmer bed. His mouth and nose are suctioned with a bulb syringe. Which of the following is the best next step in management?
ASupplemental oxygen via nasal cannula and reassessment of Apgar score at 5 minutes
BChest compressions and bag-mask ventilation
CEndotracheal intubation and mechanical ventilation
DIntravenous epinephrine and reassessment of Apgar score at 5 minutes
EPositive pressure ventilation and reassessment of Apgar score at 5 minutes
An 8-year-old boy and his 26-year-old babysitter are brought into the emergency department with severe injuries caused by a motor vehicle accident. The child is wheeled to the pediatric intensive care unit with a severe injury to his right arm, as well as other external and internal injuries. He is hemorrhaging and found to be hemodynamically unstable. He subsequently requires transfusion and surgery, and he is currently unconscious. The pediatric trauma surgeon evaluates the child’s arm and realizes it will need to be amputated at the elbow. Which of the following is the most appropriate course of action to take with regards to the amputation?
AObtain an emergency court order from a judge to obtain consent to amputate the child’s arm
BFind the child’s parents to obtain consent to amputate the child’s arm
CAmputate the child’s arm at the elbow joint
DWait for the child’s babysitter to recover from her injuries to obtain her consent to amputate the child’s arm
EWait for the child to gain consciousness to obtain his consent to amputate his arm
A 3900-g (8.6-lb) newborn is delivered at 38 weeks' gestation to a 27-year-old woman, gravida 3, para 2, via spontaneous vaginal delivery. Immediately after delivery, he spontaneously cries, grimaces, and moves all four extremities. Over the next five minutes, he becomes cyanotic, dyspneic, and tachypneic. Mask ventilation with 100% oxygen is begun, but ten minutes after delivery the baby continues to appear cyanotic. His temperature is 37.2°C (99.0°F), pulse is 155/min, respirations are 65/min, and blood pressure is 90/60 mm Hg. Pulse oximetry on 100% oxygen mask ventilation shows an oxygen saturation of 83%. Breath sounds are normal on the right and absent on the left. Heart sounds are best heard in the right midclavicular line. The abdomen appears concave. An x-ray of the chest is shown below. Which of the following is the most appropriate initial step in the management of this patient?
AIntubation and mechanical ventilation
BSurfactant administration
CChest tube placement
DExtracorporeal life support
ESurgical repair
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