New to EM cases, it's my pleasure to welcome Dr. Max Benyakov, assistant professor at the

University of Toronto, pediatric emergency physician who works both at pediatric and adult eds in

Toronto. And Dr. Benyakov has the case of his career to tell us about. So welcome Max to

EM cases. Thank you, Anton. It's a pleasure to be here.

And I've been a long-time listener of your program and the best case ever.

And this case had such an impact on me that I wanted to share it with your listeners.

So the case happened while I was working one of my evening shifts on the acute side of the emergency department.

I was called overhead by one of a triage nurses

to the recess room, and as soon as I walked into a room, I see this gray, blue baby that looked

quite irritable and unwell. And all I gathered from the triage note that this was an eight-week-old

with some heart condition, and the vital signs that looked quite abnormal strikingly the sats were 43 percent high

trade anywhere between 160 and 180 on the monitor blood pressure that was normal for this baby's age

a low grade temp of 381 and the respite of anywhere between 16 and 70 on a monitor so we were working

on getting the ABC secured and our nurses by some miracle of luck were able to get an IV access on the first try.

So we applied oxygen via non-rebeater. We were trying to reposition the baby and reduce the baby's work of breathing a little bit.

And the baby looked quite dry and malperfused, the cap refill of anywhere between four and five seconds,

so we decided to go ahead and give the baby a bolus of fluids. Now you got to remember that this is a

heart patient, i.e. they had a congenital heart disease. So I knew that I was working with a patient

with congenital heart disease. I didn't know what it was, but we decided to go ahead and give the baby a bolus of fluid. These patients can be quite sensitive

to fluid shifts and dehydration and overzealous fluid administration. And so we decided to go

ahead with a smaller bolus of 10mels per kilo as opposed to your usual 20mels per kilo.

So at this point, we knew that we needed more information.

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