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An 4-year-old male is brought to the urgent care in respiratory distress. The parents state symptoms began gradually over several days. The child has been otherwise healthy.
On physical exam, vital signs show blood pressure 100/70, pulse 95, temperature 100, respiratory rate 35, and oxygen saturation of 94% on room air. The patient is in moderate distress and utilizing accessory muscles of respiration. There is dullness to percussion over the lower and middle lobes of the right lung, absent breath sounds, and decreased tactile fremitus. Abdominal exam is notable for a large, hard, irregular mass palpated along the right mid-axillary line from the bottom of the liver down to the level of the umbilicus. There is no hepatosplenomegaly or tenderness to palpation.
CBC shows mild normochromic normocytic anemia. Electrolytes are significant for decreased serum calcium and increased serum phosphate levels. Creatinine and BUN are elevated. Urinalysis, cytogenetics, and coagulation studies are pending.
Chest x-ray shows a large right pleural effusion. EKG is normal.
Supplemental oxygen is given. Thoracentesis of the right pleural effusion is performed. Cytology and chemistry of the fluid is pending.
What is the best next step in management?
Greg is a 15 year old male. He injured his UCL playing baseball. Which treatment should be avoided in the early rehabilitation phase after an ulnar collateral sprain?
Loperamide is used to treat _______ and is contraindicated with/in ___________.
A 35-year-old male appears at urgent care complaining of fever, headache, and a swollen, painful left ear. The patient reports the symptoms started about five days ago and have steadily worsened. The right ear canal is painfully sore and swollen, and patient describes some slight hearing loss in that ear. The patient states he woke up today with a severe headache and blurred vision, which has not improved. The patient’s medical history is significant for a deep vein thrombosis several months prior, for which he is not on anticoagulation.
On exam, vital signs show blood pressure 100/75, pulse 85, temperature 103.1, respiratory rate 20, and oxygen saturation of 99% on room air. There is tenderness to palpation of the right ear and over the right mastoid. The auricle is protruded, and there is obliteration of the postauricular crease. The tympanic membrane is red and bulging with markedly impaired mobility on pneumatic otoscopy.
CT shows areas of signal attenuation and fluid in the right middle ear extending to and involving the mastoid air cells.
What is the best next step in management?