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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Opiates
Wrap upwards (even though some venom seap up still more painful and lasts longer) Premedicate w/ adrenaline. We give specifically both brown and tigersnake antivenom in victoria. Other states need to use polyvalent because other species too.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Class of drugs encompassing decongestants - amphetamines - cocaine.

2. Adenosine
Skin or vascular compromise
Antidote is deferoxamine chelation. Charcoal is ineffective.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Bone scan for occult fracture

3. Calcium gluconate
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are atropine sulfate and pralidoxime chloride.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

4. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

5. Amphetamine antidote
Persitantly angry. Anxiously attached or ambivalent towards parents. Limited ability to enjoy things. Low self esteem - depressed or unresponsive. Poor social skills and developmental inhibition.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Esmolol

6. Sympathomimetics
Causes BAD constipation. Upsets fluid and electrolyte balance.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
1) Mechanical ventilation 2) Stomach decompression 3) Saline and dopamine 4) cerebral oedema w/ mannitol 5) monitor for hypokaelamia (common) 6) give benpen if ventilation required to prevent pneumoccal pneumonia complication. Induce controlled hypot

7. Calcium channel blocker overdose antidote
Calcium chloride
Neurosurgery if trauma. Give mannitol.
Skin or vascular compromise
Esmolol

8. Epinephrine
Immobilize with plaster slab
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Blood glucose level for hypoglycaemia!!
Glucagon prefered - otherwise massive dose of adrenaline.

9. What must you do before sending fracture to radiology?
Flurescence in ultraviolet light.
Poisoning causes anticholinergic effects as well as prolonged PR interval - widened QRS complex - QT prolongation - and AV block due to blockage of sodium channels. Hypotension. Pulmonary oedema
Objective signs of growth - tidiness - weight -
Immobilize with plaster slab

10. Ethanol
Class of drugs encompassing decongestants - amphetamines - cocaine.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Normally treated with sling alone. Seek advice.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

11. Anticholinergics
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Esmolol
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

12. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurosurgery if trauma. Give mannitol.
Digoxin Fab
It can cause fatal bronchioloitis obliterans

13. Digoxin antedote
Neurotoxins - procagulants. Rhabdomyolysins.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Digoxin Fab

14. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Blood glucose level for hypoglycaemia!!
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

15. Signs of abuse from the history
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Notify if abuse CONSIDERED. CONSIDERED.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

16. Anticholinergics
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
'I WOULD CALL POISON HOTLINE'.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

17. What are the terminal signs of acute laryngeal obstruction?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Aspiration Pneumonia
Cyanosis and irregular respiratory effort
Flumazenil

18. Lead
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Skin or vascular compromise
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

19. What is the general management of poisoning?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Causes tachypnea - coughing - respiratory distress - cyanosis - N/V - GI discomfort - and mental status changes. Gastric emptying should be avoided. Charcoal is ineffective. Patients should be monitored closely for aspiration.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Munchausen's by proxy

20. Carbon monoxide
Normally treated with sling alone. Seek advice.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Calcium chloride
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

21. Management of septicaemia shock

22. Funnel web and red back
'I WOULD CALL POISON HOTLINE'.
Release NEUROTOXINS both have antivenom
The most common accident in children in from car crashes 50% always make sure your child has an approptiate seat beat - that they are not sitting in the front seat before 12 and that if possible the car has airbags for the child. Always supervise chi
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

23. What is gastric lavage?
Calcium chloride
Stomach pumping.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

24. What are the special features that must be done to correct haemorrhagic shock.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Class of drugs encompassing decongestants - amphetamines - cocaine.

25. what makes you suspicious of non-accidental injury.
Blocks open sodium channels and prolongs the action potential. Prolongs refractory period of atria and ventricles and decreases conduction. Used to treat SVT - stable VT with pulses.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Skin or vascular compromise

26. What psychiatric disease defined as childabuse?

27. Lidocaine
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

28. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Flurescence in ultraviolet light.

29. What are the early symptoms of paracetamol overdose?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Nausea vomiting and anorexia.
Calcium chloride
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

30. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

31. When and how would you do whole bowel irrigation?
Immobilize with plaster slab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

32. Organophosphates antidotes
Objective signs of growth - tidiness - weight -
Rash bronchospasm and hypotension.
Wrap upwards (even though some venom seap up still more painful and lasts longer) Premedicate w/ adrenaline. We give specifically both brown and tigersnake antivenom in victoria. Other states need to use polyvalent because other species too.
Antidotes are atropine sulfate and pralidoxime chloride.

33. Amiodarone
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Blocks Na - K - Ca channels and beta-receptors in the myocardium. Also blocks alpha and beta-receptors in the periphery. Slows AV conduction and ventricular conduction. Used to treat hemodynamically stable VT - refractory VF - pulseless VT - and SVT.
Blocks open sodium channels and prolongs the action potential. Prolongs refractory period of atria and ventricles and decreases conduction. Used to treat SVT - stable VT with pulses.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

34. What is an important point to note about anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Cyanosis and irregular respiratory effort
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
It can be biphasic. You treat them - they get better - then a few hours later it HAPPENS AGAIN! Within 48 hours. So give 3 day coUse of pred - ranitidine -

35. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blocks Na - K - Ca channels and beta-receptors in the myocardium. Also blocks alpha and beta-receptors in the periphery. Slows AV conduction and ventricular conduction. Used to treat hemodynamically stable VT - refractory VF - pulseless VT - and SVT.
Normally treated with sling alone. Seek advice.

36. OSCE: what must you say you would do if someone is poisoned?

37. Tricyclic antidepressants
'I WOULD CALL POISON HOTLINE'.
Poisoning causes anticholinergic effects as well as prolonged PR interval - widened QRS complex - QT prolongation - and AV block due to blockage of sodium channels. Hypotension. Pulmonary oedema
Calcium chloride
The most common accident in children in from car crashes 50% always make sure your child has an approptiate seat beat - that they are not sitting in the front seat before 12 and that if possible the car has airbags for the child. Always supervise chi

38. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Discobalt edetate
Release NEUROTOXINS both have antivenom
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

39. 20
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Stomach pumping.

40. What investigations should you do in suspected child abuse
Stomach pumping.
Bone scan for occult fracture
Rash bronchospasm and hypotension.
Class of drugs encompassing decongestants - amphetamines - cocaine.

41. 45; 70
Aspiration pneumonia even if intubated.
Poisoning causes decreased cholinesterase activity.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat

42. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

43. Indications of non-accidental injury
Poisoning causes anorexia - vomiting - lethargy - respiratory/CV collapse. Lab studes show metabolic acidosis with elevated anion gap - elevated serum ammonia - hypocalcemia - kidney failure - and calcium oxalate crystals on urinalysis.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Neurotoxins - procagulants. Rhabdomyolysins.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

44. Iron
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat
Antidote is deferoxamine chelation. Charcoal is ineffective.

45. Management of near drowning.
Give steroids for management of serum sickness. Must do coagulation screen!!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
1) Mechanical ventilation 2) Stomach decompression 3) Saline and dopamine 4) cerebral oedema w/ mannitol 5) monitor for hypokaelamia (common) 6) give benpen if ventilation required to prevent pneumoccal pneumonia complication. Induce controlled hypot
Poisoning causes N/V - diarrhea - GI bleeding - acute liver failure - seizures - shock - and coma. Lab studies show elevated serum levels 3-5 hours after ingestion - metabolic acidosis - hyperglycemia - increased bilirubin and LFTs - prolonged PT - i

46. Legal requirement in childabuse
Neurotoxins - procagulants. Rhabdomyolysins.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Notify if abuse CONSIDERED. CONSIDERED.
Causes tachypnea - coughing - respiratory distress - cyanosis - N/V - GI discomfort - and mental status changes. Gastric emptying should be avoided. Charcoal is ineffective. Patients should be monitored closely for aspiration.

47. Ibuprofen
Blocks Na - K - Ca channels and beta-receptors in the myocardium. Also blocks alpha and beta-receptors in the periphery. Slows AV conduction and ventricular conduction. Used to treat hemodynamically stable VT - refractory VF - pulseless VT - and SVT.
Poisoning causes N/V - anorexia - stomach pain - GI bleeding - mental status changes/coma/seizures if massive ingestion. Lab studies will show elevated serum levels 4 hours after ingestion - along with elevated transaminases - elevated alkaline phosp
Aspiration pneumonia even if intubated.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

48. Salicylates
Flumazenil
... blood sugars for hypoglycaemia
Collar and cuff. Check integrity of nerve.
Poisoning causes hyperpnea and tachypnea - mixed respiratory alkalosis and metabolic acidosis - fever - N/V - dehydration - tinnitus - agitation - and seizures. Lab studies show hyperglycemia - hypokalemia - prolonged PT/PTT.

49. Beta-blocker overdose antidote
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Glucagon prefered - otherwise massive dose of adrenaline.

50. Mx of critical asthma
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.