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EM@3AM: Laryngospasm

An 8-year-old male presents after falling onto an outstretched hand. He has an obvious dinner fork deformity to the right forearm. X-ray confirms a fracture of the distal radius and ulna. You prepare for procedural sedation with ketamine while you reduce and splint the fracture. You run through the pre-sedation assessment and exam, then gather all medications and airway supplies. Once the ketamine is pushed you hear a high-pitched stridor and see the patient’s chest rise and fall irregularly as his oxygen saturation drops. What is the diagnosis and management?

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EM@3AM: Acute Respiratory Distress Syndrome

A 66-year-old male presents via EMS in respiratory distress. For the past several days he has had worsening productive cough, chest pain, dyspnea, and fever. He appears fatigued, is sitting up in bed, and has increased work of breathing. On exam there is no JVD, 1+ edema, and crackles bilaterally. Vital signs include T 102.1 F, HR 110, RR 28, BP 94/62. Chest Xray shows bilateral infiltrates. What is the likely diagnosis?

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