First step in the management of peds respiratory distress? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-09-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Pediatrics First step in the management of peds respiratory distress?

A 6-month-old boy presents to the Emergency Department with a three-day history of cough, congestion and low grade fever. The mother states that the baby has not been feeding well and has used only two diapers over the past 24 hours. Physical examination reveals a pale infant with a temperature of 37.8 C (100.1 F), pulse of 170/min, respirations of 60/min and oxygen saturation of 88% on room air. The patient exhibits nasal flaring, subcostal and intercostal retractions. Lung examination reveals diffuse wheezing. Cardiac examination reveals a regular but tachycardic rhythm with no murmur. Central capillary refill is four seconds. The remainder of the examination is normal. Which of the following is the most appropriate initial step in management?

A. Chest x-ray film
B. Albuterol nebulizer treatment
C. Bolus of intravenous fluids
D. Oxygen therapy
E. Intravenous steroids
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (09-12-2012)



  #2  
Old 09-09-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

Answer

D. Oxygen therapy

As Child is in shock...follow ABC..Then fluid bolus...
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (09-09-2012)
  #3  
Old 09-09-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 790
Threads: 76
Thanked 672 Times in 316 Posts
Reputation: 690
Default

considering low saturation....definitely oxygen therapy

i guess the case is bronchiolitis by RSV
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Matched!!!
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (09-09-2012)
  #4  
Old 09-12-2012
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

C.I think the Baby is in Shock[Pale Baby,Tachycardia,Only 2 Diapers,DELAYED CAPILLARY REFILL] hence i think the answer is IV Fluids 1st as O2 Saturation is Alarming if its below 87% which is not the case here.But as the case is RDS[due to Infection]it can also be O2 Therapy 1st.Please give correct asnwer.
Reply With Quote Quick reply to this message
  #5  
Old 09-12-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Quote:
Originally Posted by Dr.Avinash View Post
C.I think the Baby is in Shock[Pale Baby,Tachycardia,Only 2 Diapers,DELAYED CAPILLARY REFILL] hence i think the answer is IV Fluids 1st as O2 Saturation is Alarming if its below 87% which is not the case here.But as the case is RDS[due to Infection]it can also be O2 Therapy 1st.Please give correct asnwer.

yes the pt needs iv fluids but if we follow ABC , we need to provide o2 first then iv fluids but seeing capillary refill time and around ok o2 sat may be we should give iv fluids first ...... so would go with C.......
Reply With Quote Quick reply to this message
  #6  
Old 09-12-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

The correct answer is
D. Always remember your ABCs. A saturation of 90% corresponds to an oxygen partial pressure of around 60 mm Hg. Therefore, this patient is hypoxic and needs oxygen to help decrease his work of breathing. A chest x-ray film (choice A) is certainly indicated, but not a priority. Albuterol nebulizer treatments (choice B) are indicated as an initial trial. If benefits are seen, they can be continued. Some studies have shown racemic epinephrine to be more effective than albuterol in viral respiratory infections. They too should follow initial oxygen therapy. Delayed capillary refill is an indication for a bolus of IV fluid (choice C). This however, is the C in ABCs. Central refill, or the time it takes for the color to return to the skin after pressure is applied with one's finger, is usually less than 3 seconds. Steroids (choice E) are not indicated in viral upper respiratory infections. In patients with suspected asthma, steroids are important, but are not the primary intervention.
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (09-12-2012)



Reply

Tags
Emergency-Medicine, Pediatrics-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
peds and Obs/gyn zak-hindi USMLE Step 2 CK Forum 3 08-28-2012 03:58 PM
Should I apply for peds or IM? dockrishna IMG Residency Match Forum 7 06-19-2012 05:57 PM
Can I macth into peds in 2013 heman466s IMG Residency Match Forum 2 03-15-2012 09:56 AM
Peds X rays iron USMLE Step 2 CK Forum 3 08-09-2011 08:41 AM
Hematology Peds Question aksyonez USMLE Step 2 CK Forum 6 07-07-2011 06:05 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)