Dreams and dedication are a powerful combination. -William Longgood Welcome back to Roshcast for Episode 40! After a quick detour last week to talk with Dr. Rosh, we are back at it with our regular routine. But before we get going, if you have any thoughts or feedback on last week’s episode, or even if you have any unanswered questions, make sure you send them our way to [email protected], so that we can get them answered either individually by email or on another special episode. This week, we are going to cover a few pediatric respiratory questions to parallel the EM Clerkship podcast’s most recent episode in addition to some bread and butter emergency medicine. Before we begin, let’s get warmed up with a rapid review covering environmental emergencies, since these are things we see less frequently in our day to do practice but ALWAYS appear on the in-training exam.  * Pit viper bites cause local swelling and oozing from the wound. Severe envenomations can lead to a DIC like coagulopathy and hemorrhagic bullae. * Brown recluse spider bites cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shock. * Black widow spider bites cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculations, and diaphoresis. Remember that you can identify a black widow spider by the red hourglass on their abdomen. * Frostbite should be treated with immersion in a warm water bath set at 37-39 degrees Celsius. Now onto this week’s podcast Question 1 Let’s get right into with a pediatric respiratory question: A 3-year-old girl presents to the ED with 1 hour of a barking cough and inspiratory stridor at rest. On exam, she has mild retractions but is not hypoxic. Which of the following interventions has been shown to reduce hospital length of stay in moderate to severe croup? A. Dexamethasone B. Heliox C. Humidified air D. Racemic epinephrine Teaching Image Question 2 A 33-year-old woman presents with intermittent, intense shooting pain to the left side of the face. She states that the pain begins near her ear and radiates to her chin. The pain is often brought on by chewing and brushing her teeth. Which of the following managements is most likely indicated? A. Carbamazepine B. Dental X-rays C. Mandible CT scan D. Prednisone Teaching Image Question 3 Which of the following cervical spine fractures is considered stable? A. Bilateral facet dislocation B. Flexion teardrop fracture C. Jefferson fracture D. Type I odontoid fracture Teaching Image  Question 4 You are working in a busy pediatric ED in December. During your shift you evaluate and treat 4 children with moderate croup by administering oral dexamethasone and aerosolized epinephrine. You re-evaluate each child 2 hours after the initial racemic epinephrine treatment. Which of the following children can most safely be discharged home? A. A 1-year-old boy with persistent stridor at rest B. A 2-year-old uninsured boy with clinical improvement, but no primary care physician C. A 3-month-old girl with a history of tracheomalacia who has clinical improvement D. A 4-year-old girl with retractions that have since resolved a href="https://www.roshreview.