Approach to shock (pediatrics) Quiz: Ace Your Exams
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A 12-year-old boy is brought to the emergency department by his parents for evaluation of chest pain, weakness, and fatigue for two days. The patient's chest pain is not related to exercise and is associated with shortness of breath. Parents report he had a fever and cough one week ago. Past medical and surgical history are non-contributory. Temperature is 37°C (98.6°F), pulse is 125/min, respirations are 35/min, blood pressure is 80/55 mmHg, and oxygen saturation is 97% on room air. Peripheral pulses are weak, and the patient's hands and feet are cool to the touch. Capillary refill time is five seconds. Pulmonary exam is notable for subcostal retractions and nasal flaring. Air entry is equal bilaterally with rales over the bilateral lung bases. On cardiac exam, an S4 gallop is auscultated. The abdomen is nontender, and the liver is palpated at 4 cm below the intercostal margin. Which of the following additional physical findings is most likely to be seen in this patient?
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