This chapter discusses the diagnosis, evaluation and management of shock. It presents special circumstances which make diagnosis and management of shock difficult in pediatric and pregnant patients. Shock should be suspected when patients present with a constellation of signs including ill-appearance, tachycardia, tachypnea, hypotension, and oliguria. The principles of shock management include specific therapy for treating the underlying cause, and general therapy to manage the shock syndrome. Recognition of shock is difficult due to variations in age-dependent vital signs, difficulty in assessing mental status, and the non-specificity of early manifestations of shock such as irritability and poor feeding. Elderly patients experience significantly more morbidity and mortality from all causes of shock due to their limited ability to augment cardiac output and maintain vascular tone. Elderly patients often have multiple comorbidities or use multiple medications that distort the diagnosis and management of shock.

This chapter discusses the diagnosis, evaluation and management of small bowel obstruction (SBO). It details the specific types of small bowel obstruction. Common causes of small bowel obstruction include hernias, neoplasms, intussusception, and others. Thorough history should be taken, with particular attention paid to prior SBOs, abdominal surgeries, hernias, cancer, and opiate use. The vital signs of SBO are: fever, tachycardia, hypotension, and tachypnea. The examination of the abdomen is performed by visually inspecting the abdomen for scars and distension. Rectal examination is considered with evaluation for occult blood, although diagnostic yield may below and classically the rectal vault will be empty. In laboratory evaluation findings are not specific to bowel obstruction. Results may show evidence of dehydration, acidosis, renal failure, and leukocytosis. Antibiotics are indicated with evidence of ischemia, perforation, or severe disease, although there is no good evidence supporting or refuting the use of empiric broad-spectrum antibiotics.

This chapter discusses the diagnosis, evaluation and management of asthma. Airflow restriction may be severe, leading to asthma patients presenting in an upright or tripod position, with cyanosis, altered mental status, and respiratory arrest. Asthma exacerbations initially produce tachypnea and a resultant low carbon dioxide level; a normal or elevated carbon dioxide level may indicate fatigue and impending respiratory failure. Laboratory testing and ECG should be used to differentiate asthma exacerbations from alternative etiologies or comorbid conditions. Patients should be placed on supplemental oxygen therapy as needed to maintain adequate oxygen saturations. Patients must be monitored for signs of impending respiratory failure. Constant positive airway pressure (CPAP) and bi-level positive airway pressure (Bi-PAP) may be considered for patients with severe asthma. The goal of ventilator management in asthmatic is to oxygenate and ventilate without worsening hyperinflation, which causes barotrauma and hemodynamic instability.

This chapter describes the case of a 7.5-month-old Caucasian infant with a birthweight of 3.9 kg, born full term to a 35-year-old mother. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The patient's pediatrician suspected an upper respiratory tract infection and treated her with "Infants' Cold Formula" with no relief. A soft-tissue X-ray of her neck revealed hypertrophy of her adenoids, which were obstructing the nasal airway. There was paradoxical inward rib-cage motion during inspiration throughout much of the study. Tachypnea was present, particularly during REM sleep. The diagnosis based on the polysomnography (PSG) results was severe obstructive sleep apnea (OSA), pediatric. The patient's symptoms and O2 saturation improved immediately thereafter. A follow-up sleep study 2 months later revealed that the patient no longer demonstrated an obstructive breathing pattern or impairment in gas exchange.