386.A 5-month-old previously healthy girl presents to the ED with a 4- to
5-day history of constipation and decreased feeding. The patient is a full-
term product of an uncomplicated antenatal course and delivery. The
patient also had recent congestion and cough that resolved with adminis-
tration of tea prepared by a family friend. The mother denies any recent
fever or vomiting. On examination, the temperature is 99.9°F, HR 165 beats
per minute, and RR 22 breaths per minute. The BP was not obtained. The
patient has a weak cry, is notably flaccid and ill-appearing. You note that
patient is drooling. Her pupils are poorly responsive and she is not track-
ing to light or faces. Which of the following is the most likely cause of this
condition?
a. Type I spinal muscular atrophy
b. Brain tumor
c. Infant botulism
d. Meningitis
e. Organophosphate poisoning
387.A 6-month-old boy is brought to the ED after being found apneic and
cyanotic at home. The patient’s mother called 911 and began cardiopul-
monary resuscitation (CPR). The patient responded within seconds to min-
utes. On arrival to the ED, the patient was noted to be awake and responsive,
but slightly mottled with mild respiratory distress. Within minutes of arrival
patient becomes apneic suddenly, cyanotic, and bradycardic. Which of the
following is the most important initial response?
a. Administer epinephrine
b. Provide oxygen via non-rebreather face mask
c. Jaw thrust, chin lift, and bag-valve-mask ventilation
d. Endotracheal intubation
e. Chest compressions
410 Emergency Medicine