title: Making the Quick Diagnosis: A Case of Neonatal Shock.
abstract: BACKGROUND
  The work-up and initial management of a critically ill neonate is challenging and anxiety provoking for the Emergency Physician. While sepsis and critical congenital heart disease represent a large proportion of neonates presenting to the Emergency Department (ED) in shock, there are several additional etiologies to consider. Underlying metabolic, endocrinologic, gastrointestinal, neurologic, and traumatic disorders must be considered in a critically ill infant. Several potential etiologies will present with nonspecific and overlapping signs and symptoms, and the diagnosis often is not evident at the time of ED assessment.
  
  
  METHODS
  We present the case of a neonate in shock, with a variety of nonspecific signs and symptoms who was ultimately diagnosed with tachycardia-induced cardiomyopathy secondary to a resolved dysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the diagnostic and therapeutic approach to the critically ill neonate in the ED, and expands the differential diagnosis beyond sepsis and critical congenital heart disease. Knowledge of the potential life-threatening etiologies of shock in this population allows the Emergency Physician to appropriately test for, and empirically treat, several potential etiologies simultaneously. Additionally, we discuss the diagnosis and management of supraventricular tachycardia and Wolff-Parkinson-White syndrome in the neonatal and pediatric population, which is essential knowledge for an Emergency Physician.
authors.affiliation: The University of Texas at Austin, Dell Medical School, Dell Children's Medical Center of Central Texas, Austin, Texas.
authors.forename: Mike
authors.initials: M
authors.lastname: Gardiner
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Ruttan
authors.affiliation: The University of Texas at Austin, Dell Medical School, Dell Children's Medical Center of Central Texas, Austin, Texas.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kienstra
authors.affiliation: The University of Texas at Austin, Dell Medical School, Dell Children's Medical Center of Central Texas, Austin, Texas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wilkinson
mesh_terms: D000138:Acidosis / Q000209:etiology; D000212:Acyclovir / Q000494:pharmacology / Q000627:therapeutic use; D000241:Adenosine / Q000494:pharmacology / Q000627:therapeutic use; D000667:Ampicillin / Q000494:pharmacology / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications* / Q000208:ethnology*; D002439:Cefotaxime / Q000494:pharmacology / Q000627:therapeutic use; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005247:Feeding Behavior / Q000502:physiology; D005440:Fluid Therapy / Q000379:methods; D005947:Glucose / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007231:Infant, Newborn; D053609:Lethargy / Q000209:etiology; D008297:Male; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use; D012769:Shock / Q000175:diagnosis / Q000503:physiopathology*; D013610:Tachycardia / Q000150:complications; D013617:Tachycardia, Supraventricular / Q000150:complications* / Q000188:drug therapy; D014839:Vomiting / Q000209:etiology; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000175:diagnosis*
chemical_list: D000889:Anti-Arrhythmia Agents; D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D011412:Propanolamines; D000667:Ampicillin; D011433:Propranolol; D005947:Glucose; D000241:Adenosine; C036604:esmolol; D002439:Cefotaxime; D000212:Acyclovir
keywords: Wolff-Parkinson-White syndrome; cardiomyopathy; neonatal shock; resuscitation; supraventricular tachycardia