![]() ![]() His lungs are clear to auscultation and the heart sounds are normal. His pupils are round, equal, and show a poor response to light. The examination shows a depressed fracture of the left temporal bone and ecchymoses and scratches over his abdomen and extremities. His blood pressure is 150/90 mm Hg, heart rate is 56/min, respiratory rate is 14/min, temperature is 37.5℃ (99.5℉), and SpO 2 is 94% on room air. On admission, he opened his eyes to painful stimuli, was not responsive to verbal commands, his arms were flexed and the legs were straight with no reaction to pain. On primary assessment by paramedics, he was unresponsive. Which of the following methods of treatment is indicated for this patient?Ī 31-year-old unresponsive man is admitted to the emergency department after a single-vehicle roll-over accident. MRI of the orbits shows a retina-derived tumor in the left eye with an initial spread along the intrabulbar part of the optic nerve and vitreous seeding. On testing, visual evoked potential cannot be elicited from the left retina but is normal from the right retina. Fundal examination reveals are shown in the picture. The pupillary reflex cannot be elicited from an illumination of the left eye. The eye examination shows left eye converging strabismus. He is up to date on all vaccines and is meeting all developmental milestones. ![]() The boy was born at 39 weeks gestation via spontaneous vaginal delivery. The patient is the first child in the family born to a 31-year-old woman. ![]() The patient’s mother is concerned about a slight deviation of his left eye and she also notes that her child’s left eye looks strange on the photos, especially if there is a flash. What is the next best step in management?ĭ. Immediate transfer to the operating roomĪ 3-year-old boy is brought to his pediatrician for a regular checkup by his mother. The patient is intubated, and aggressive fluid resuscitation is initiated. An emergency transthoracic echocardiography shows a left ventricular wall motion abnormality along with a significant pericardial effusion. ECG is significant for ST elevations in the precordial leads (V2-V4) and low-voltage QRS complexes. Her chest X-ray shows cardiomegaly with clear lung fields. A cardiac exam reveals tachycardia and a pronounced holosystolic murmur loudest at the apex and radiates to the back. On physical examination, the patient is pale and unresponsive. The patient’s temperature is 37℃ (98.6℉), blood pressure is 80/50 mm Hg, pulse is 125/min, respiratory rate is 12/min, and oxygen saturation is 92% on room air.
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