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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
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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. Mx raised intracranial pressure.
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
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.
Neurosurgery if trauma. Give mannitol.
Ceftriaxone

2. Beta-blocker overdose antidote
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Digoxin Fab
Glucagon prefered - otherwise massive dose of adrenaline.

3. What psychiatric disease defined as childabuse?

4. Signs of psychological maltreatment?
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
'I WOULD CALL POISON HOTLINE'.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

5. Ethylene glycol
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Flurescence in ultraviolet light.
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.
Rash bronchospasm and hypotension.

6. How may you detect semen?
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Class of drugs encompassing decongestants - amphetamines - cocaine.
Flurescence in ultraviolet light.

7. Signs of abuse from the history
Croup.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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 -
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

8. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
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.
Calcium chloride

9. Management of near drowning.
Munchausen's by proxy
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidote is deferoxamine chelation. Charcoal is ineffective.

10. 45; 70
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
... blood sugars for hypoglycaemia
Discobalt edetate

11. Undisplaced radial shaft fracture
Calcium chloride
Collar and cuff. Check integrity of nerve.
Immobilize with plaster slab
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.

12. Benzodiazepine overdose antidote
Ceftriaxone
Flumazenil
Neurosurgery if trauma. Give mannitol.
Glucagon prefered - otherwise massive dose of adrenaline.

13. You must consider abuse in
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.
Collar and cuff. Check integrity of nerve.
Bone scan for occult fracture
Severe illness - past history of injuries - 18 months or less - inconstent story.

14. Middle Clavicle fracture management?
Flurescence in ultraviolet light.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Munchausen's by proxy

15. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

16. Organophosphates
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 -
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 decreased cholinesterase activity.
Glucagon prefered - otherwise massive dose of adrenaline.

17. Organophosphates antidotes
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Skin or vascular compromise
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
Antidotes are atropine sulfate and pralidoxime chloride.

18. Amphetamine antidote
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Objective signs of growth - tidiness - weight -
Esmolol
Poisoning causes decreased cholinesterase activity.

19. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Normally treated with sling alone. Seek advice.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Antidote is naloxone.

20. How do snake bites damage?
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Neurotoxins - procagulants. Rhabdomyolysins.

21. Carbon monoxide
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

22. What is gastric lavage?
Stomach pumping.
... blood sugars for hypoglycaemia
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.
Glucagon prefered - otherwise massive dose of adrenaline.

23. Acetaminophen
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Flurescence in ultraviolet light.
Flumazenil
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

24. When is gastric lavage indicated and contraindicated?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
It can cause fatal bronchioloitis obliterans
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

25. Acetaminophen
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

26. Adenosine
Aspiration Pneumonia
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Rash bronchospasm and hypotension.

27. Anticholinergics
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 3 weeks - fracture clinic at 7 days.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

28. A child has swallowed a battery. Mx
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
It can cause fatal bronchioloitis obliterans

29. 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.
... blood sugars for hypoglycaemia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidote is deferoxamine chelation. Charcoal is ineffective.

30. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Aspiration pneumonia even if intubated.

31. Mx of snake bit
Esmolol
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

32. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
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.
Munchausen's by proxy
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

33. What is the antibiotic for Epiglottitis?
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.
Ceftriaxone
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Flurescence in ultraviolet light.

34. What is the most common caUse of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Croup.

35. What is the most important investigation in suspected alcohol poisoning in young person?
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 temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blood glucose level for hypoglycaemia!!

36. Procainamide
Release NEUROTOXINS both have antivenom
Croup.
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.
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

37. Management of septicaemia shock

38. Ethylene glycol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Blood glucose level for hypoglycaemia!!

39. Legal requirement in childabuse
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
Severe illness - past history of injuries - 18 months or less - inconstent story.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Notify if abuse CONSIDERED. CONSIDERED.

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

41. Epinephrine
Give IM adrenaline - steroids - salbutamol - antihistamine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

42. What is an important point to note about anaphylaxis?
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 -
Munchausen's by proxy

43. What happens if charcoal is aspirated?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
It can cause fatal bronchioloitis obliterans
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Before a child can be examined for child abuse - a parent or legal guardian must give consent

44. Tricyclic antidepressants overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Croup.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

45. Carbon monoxide
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Release NEUROTOXINS both have antivenom
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Severe illness - past history of injuries - 18 months or less - inconstent story.

46. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Skin or vascular compromise
Aspiration Pneumonia

47. OSCE: how can i prevent accidents in my children
Immobilize with plaster slab
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

48. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Esmolol

49. Which is better - activated charcoal or gastric lavage.
Skin or vascular compromise
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
CHARCOAL! except for lithium - iron - alcohol - lead.

50. Opiates
Collar and cuff. Check integrity of nerve.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Esmolol
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.