emrap board评论an年6月第15卷6期melherbert医学执行.pdfVIP

EM:RAP Monthly Audio Program: Board Review Answers EM:RAP Monthly Audio Program: Board Review Answers Challenging ABEM style questions for enhanced learning and deeper understanding of the EM: RAP program June 2015: Volume 15, Issue 6 Editor- hief: Mel Herbert, MD Executive Editor: Paul Jhun, MD Associate Editor: Dan Joseph, MD Answer #1 The correct answer is apnea. Starting an IV in these patients can agitate them, causing them to hold their breath and decrease their respiratory rate. This can be catastrophic in the sick croup patient. An IV needs to be started eventually to give IV steroids, however ideally the child would receive some treatments first luding racemic epinephr o try and improve their respiratory distress. 1. Apnea 2. Bradycardia 3. Hypotension 4. reased respiratory rate Answer #2 The correct answer is bag-valve-mask with a PEEP valve. The segment makes the point that these children have a fixed obstruction and high pressure is needed to overcome it. An LMA only helps you generate about 35-40 cm of water pres- sure. The BVM can generate up to 120 cm of water pressure. Cricothyrotomy is contraindicated in a two year old (they would require a tracheostomy). Needle cric can be used but will only last for 20 -30 minutes. 1. Bag-valve-mask with a PEEP valve