A 7-year-old boy is brought to the emergency room because of severe, acute diarrhea. He is drowsy with a dull, lethargic appearance. He has sunken eyes, poor skin turgor, and dry oral mucous membranes and tongue. He has a rapid, thready pulse with a systolic blood pressure of 60 mm Hg and his respirations are 33/min. His capillary refill time is 6 sec. He has had no urine output for the past 24 hours. Which of the following is the most appropriate next step in treatment?
AStart IV fluid resuscitation by administering colloid solutions
BProvide oral rehydration therapy to correct dehydration
CGive initial IV bolus of 2 L of Ringer’s lactate, followed by packed red cells, fresh frozen plasma, and platelets in a ratio of 1:1:1
DStart IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output
EGive antidiarrheal drugs
A 57-year-old man is admitted to the burn unit after he was brought to the emergency room following an accidental fire in his house. His past medical history is unknown due to his current clinical condition. Currently, his blood pressure is 75/40 mmHg, pulse rate is 140/min, and respiratory rate is 17/min. The patient is subsequently intubated and started on aggressive fluid resuscitation. A Swan-Ganz catheter is inserted to clarify his volume status. Which of the following hemodynamic parameters would you expect to see in this patient?
ACardiac output: ↓, systemic vascular resistance: ↔, pulmonary artery wedge pressure: ↔
BCardiac output: ↑, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↔
CCardiac output: ↑, systemic vascular resistance: ↓, pulmonary artery wedge pressure: ↔
DCardiac output: ↓, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↓
ECardiac output: ↔, systemic vascular resistance: ↔, pulmonary artery wedge pressure: ↔
A 37-year-old man presents to the emergency department for a persistent fever. The patient states he has felt unwell for the past week and has felt subjectively febrile. The patient has a past medical history of a suicide attempt and alcohol abuse. He is not currently taking any medications. The patient admits to using heroin and cocaine and drinking 5-8 alcoholic drinks per day. His temperature is 103°F (39.4°C), blood pressure is 92/59 mmHg, pulse is 110/min, respirations are 20/min, and oxygen saturation is 96% on room air. Cardiopulmonary exam is notable for a systolic murmur heard best along the left sternal border. Dermatologic exam reveals scarring in the antecubital fossa. Which of the following is the next best step in management?
ACT scan
BUltrasound
CChest radiograph
DBlood cultures
EVancomycin and gentamicin
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