Pediatric Emergency Medicine is a tough, tough exam. This week we have a lot of missed prep questions. Several with a correct answer rate less than 65%. This question doesn’t have any tricky test-taking bits to it - just clinical next actions.
The right answer here is (b). Most of the incorrect answers were (d) IV labetalol and (c) IV furosemide, focusing on the hypertensive emergency that is being presented. But safety before treatment - starting antihypertensive medications before ruling out intracranial bleeding can be dangerous because lowering blood pressure rapidly in the context of a bleed is likely to worsen cerebral perfusion.
What the test-taker is supposed to pick up on is that you have both a cardiac and neurological emergency.
IV labetalol is indicated only after intracranial hemorrhage is ruled out.
Addressing the pulmonary edema with furosemide or an echocardiogram missed the need to evaluate the brain.
Relying on the patients stable appearance aside from the altered mental state and headache may delay a head CT. Always correlate neurological symptoms with hypertensive emergences, even subtle changes in consciousness are red flags.
This question appears in Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME
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