A 3-day-old term male infant is brought to the ED by EMS after being seen at their Family Physician’s office with a low temperature (33.1oC). The child has been feeding poorly for about 12 hours, and has vomited twice. He is lethargic on examination and poorly perfused with intermittent apneas lasting ~ 20 seconds. He requires immediate fluid resuscitation and broad-spectrum antibiotics. His perfusion will improve after IVF boluses, however the apneas will persist and necessitate intubation.
A 2-week-old neonate presents in shock requiring the learner to implement an initial broad work-up. The patient will also be hypoglycemic, and will seize if this is not promptly recognized. Physical exam and CXR findings will suggest coarctation of the aorta as the likely cause, and the learner should recognize the need for gentle fluid boluses and a prostaglandin infusion. Unless learners anticipate appropriately and intubate the patient prior to beginning the prostaglandins, the infant will become apneic after starting the infusion and require intubation.
A 30 year-old female, G1P0 at 32 weeks, presents to the ED with headache, blurred vision, nausea, and vomiting. Her arrival BP is 175/115. As the team coordinates her initial workup, the patient will begin to seize. She will not stop seizing until magnesium sulfate is given. The patient will then require intubation for respiratory depression. The patient will also remain hypertensive, requiring administration of an appropriate antihypertensive agent. The case will end post intubation when the patient has been referred to OB.