Nephrotic syndromes (pediatrics) Quiz: Ace Your Exams

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A 6-year-old boy presents to the emergency department in respiratory distress. According to the parents, the child has appeared "swollen" over the past week and developed increased work of breathing at rest earlier today. The child is otherwise healthy and does not take any daily medications. Temperature is 36.7°C (98.1°F), heart rate is 150/min, respiratory rate is 40/min, blood pressure 137/90 mmHg, and oxygen saturation is 90% on room air. The child is alert and responsive. Physical examination reveals periorbital edema and diffuse anasarca. Cardiopulmonary exam shows bilateral rales and use of accessory muscles. Intravenous (IV) access is established, and the child is placed on a cardiac monitor. Bedside ultrasound shows no cardiomegaly or reduced ejection fraction. Which of the following is the best next step in management?

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Rapid sequence intubation (RSI)

Furosemide

Bi-level positive airway pressure (BiPAP)

Milrinone

Albuterol