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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. What is the most important investigation in suspected alcohol poisoning in young person?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Blood glucose level for hypoglycaemia!!
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

2. What must you do before sending fracture to radiology?
Munchausen's by proxy
Abdo XRAY!!!! do it!
Ceftriaxone
Immobilize with plaster slab

3. What is gastric lavage?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Stomach pumping.
CHARCOAL! except for lithium - iron - alcohol - lead.

4. What are the other treatments for anaphylaxis?
Esmolol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Poisoning causes decreased cholinesterase activity.
Give IM adrenaline - steroids - salbutamol - antihistamine.

5. What is the general management of poisoning?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Collar and cuff. Check integrity of nerve.

6. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Calcium chloride
Blood glucose level for hypoglycaemia!!

7. Tricyclic antidepressants
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

8. What psychiatric disease defined as childabuse?

9. What are the terminal signs of acute laryngeal obstruction?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Cyanosis and irregular respiratory effort

10. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.

11. Digoxin antedote
Digoxin Fab
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
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Bone scan for occult fracture

12. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Immobilize with plaster slab
Aspiration pneumonia even if intubated.
Blood glucose level for hypoglycaemia!!
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

13. Ethylene glycol
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
Munchausen's by proxy
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

14. Calcium channel blocker overdose antidote
Calcium chloride
Release NEUROTOXINS both have antivenom
Glucagon prefered - otherwise massive dose of adrenaline.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

15. What are the side effects of N-acety-p-benzoquinine?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Rash bronchospasm and hypotension.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

16. OSCE: how can i prevent accidents in my children
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
Bone scan for occult fracture
Munchausen's by proxy
Aspiration Pneumonia

17. What are the early symptoms of paracetamol overdose?
... blood sugars for hypoglycaemia
Nausea vomiting and anorexia.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Collar and cuff. Check integrity of nerve.

18. What is better for alcohol - charcoal or gastric lavage?

19. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Skin or vascular compromise
Collar and cuff. Check integrity of nerve.

20. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Notify if abuse CONSIDERED. CONSIDERED.

21. What is the first line investigation in a young child who has consumed alcohol?
CHARCOAL! except for lithium - iron - alcohol - lead.
Neurosurgery if trauma. Give mannitol.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
... blood sugars for hypoglycaemia

22. Benzodiazepine overdose antidote
Flumazenil
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

23. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Calcium chloride
Antidote is naloxone.

24. Organophosphates antidotes
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Digoxin Fab
Antidotes are atropine sulfate and pralidoxime chloride.
Neurotoxins - procagulants. Rhabdomyolysins.

25. What is an important point to note about anaphylaxis?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
... blood sugars for hypoglycaemia
IM adrenaline: vasopressor and bronchodilator.
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 -

26. Legal requirement in childabuse
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

27. You must consider abuse in
Antidote is naloxone.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Discobalt edetate

28. Opiates
CHARCOAL! except for lithium - iron - alcohol - lead.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidote is naloxone.

29. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Glucagon prefered - otherwise massive dose of adrenaline.
Flumazenil
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.

30. Cyanide
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Discobalt edetate

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

32. How do snake bites damage?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Ceftriaxone
Neurotoxins - procagulants. Rhabdomyolysins.
Release NEUROTOXINS both have antivenom

33. Organophosphates
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes decreased cholinesterase activity.
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
Class of drugs encompassing decongestants - amphetamines - cocaine.

34. Methanol
Give steroids for management of serum sickness. Must do coagulation screen!!!
Stomach pumping.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
... blood sugars for hypoglycaemia

35. Salicylates
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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 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.
Intubate - tracheostromy or nebulized adrenaline.

36. How may you detect semen?
Ceftriaxone
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Flurescence in ultraviolet light.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

37. Methanol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Stomach pumping.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes N/V - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.

38. Epinephrine
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Bone scan for occult fracture

39. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
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
Antidote is naloxone.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

40. Indications of non-accidental injury
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

41. What else is in the management of snake bite?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Give steroids for management of serum sickness. Must do coagulation screen!!!

42. Displaced surgical neck of humerous
Skin or vascular compromise
Antidote is naloxone.
'I WOULD CALL POISON HOTLINE'.
Normally treated with sling alone. Seek advice.

43. Sodium Bicarbonate
IM adrenaline: vasopressor and bronchodilator.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

44. 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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

45. Organophosphates
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

46. Amphetamine antidote
Croup.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Esmolol
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.

47. Signs of psychological maltreatment?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.

48. Tricyclic antidepressants overdose
Stomach pumping.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

49. Sympathomimetics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Munchausen's by proxy

50. Undisplaced surgical neck of humerous?
Calcium chloride
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Objective signs of growth - tidiness - weight -
Sling for 3 weeks - fracture clinic at 7 days.