![]() Her vital signs in the PICU are: temperature, 38.1° C HR, 81 beats per minute RR, 20 breaths per minute SaO 2, 100% in room air and BP, 127/58 mm Hg (95th percentile for systolic and diastolic BP for a girl of her height percentile is 115/76). When you see the patient in the PICU 90 minutes after her arrival in the ED, her left pupil and eyelid are indeed normal, and as you were told, she's awake, talking appropriately, and has complete mobility. You are informed that even before the patient has left the ED for the PICU, her left pupil and eyelid have returned to normal appearance and function. Because of the frightening combination of a cranial nerve abnormality and the abnormal vital signs, which may cause an observer to worry about an intracranial emergency such as increased pressure, a tumor, or an infection, the ED physician treated her with 28 g intravenous (IV) mannitol and 1.45 g IV ceftriaxone and, 30 minutes later, with 10 mg IV dexamethasone. An irregular heartbeat might be of concern because the heart rate and rhythm may deteriorate. In addition, the ED doctor says that the girl has a slow and irregular heart rate for a child that age, along with widened QRS complexes. Repeat BP measurements were 131/85 mm Hg 19 minutes later, 128/88 mm Hg 36 minutes later, and 127/83 mm Hg 42 minutes later. The girl's vital signs on admission to the ED were: temperature, 37° C heart rate (HR), 69 beats per minute respiratory rate (RR), 16 breaths per minute blood pressure (BP), 144/74 mm Hg and oxygen saturation (SaO 2), 99% in room air. The doctor also states that the girl has a history of pseudotumor cerebri and Chiari malformation type I. The ED doctor says that the patient is awake, talking, and moving everything except her left eye and eyelid. ![]() You receive a phone call from the emergency department (ED) physician informing you that a 9-year-old girl is being admitted to the pediatric intensive care unit (PICU) because of headache and a dilated, fixed left pupil. ![]()
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