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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. Management of septicaemia shock

2. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Nausea vomiting and anorexia.

3. How may you detect semen?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Objective signs of growth - tidiness - weight -
Flurescence in ultraviolet light.
Sling for 3 weeks - fracture clinic at 7 days.

4. Carbon monoxide
Aspiration pneumonia even if intubated.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Release NEUROTOXINS both have antivenom
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

5. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Antidotes are atropine sulfate and pralidoxime chloride.

6. What are the side effects of N-acety-p-benzoquinine?
Cyanosis and irregular respiratory effort
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Rash bronchospasm and hypotension.
Antidote is naloxone.

7. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Abdo XRAY!!!! do it!
Notify if abuse CONSIDERED. CONSIDERED.
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

8. 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 decreased cholinesterase activity.
Nausea vomiting and anorexia.
Abdo XRAY!!!! do it!

9. What is one of the technicalities of childabuse.
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
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

10. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Intubate - tracheostromy or nebulized adrenaline.
Flurescence in ultraviolet light.

11. What else is in the management of snake bite?
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 -
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Nausea vomiting and anorexia.

12. Ethylene glycol
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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

13. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

14. What are the other treatments for anaphylaxis?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

15. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of drugs encompassing decongestants - amphetamines - cocaine.

16. Signs of psychological maltreatment?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Normally treated with sling alone. Seek advice.
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.
Digoxin Fab

17. 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
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

18. Funnel web and red back
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Release NEUROTOXINS both have antivenom
Flurescence in ultraviolet light.

19. What are the special features that must be done to correct haemorrhagic shock.
Release NEUROTOXINS both have antivenom
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
'I WOULD CALL POISON HOTLINE'.

20. Adenosine
Ceftriaxone
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Digoxin Fab

21. Mx severe croup
Causes BAD constipation. Upsets fluid and electrolyte balance.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

22. Lidocaine
Give steroids for management of serum sickness. Must do coagulation screen!!!
Ceftriaxone
Discobalt edetate
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

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

24. What is gastric lavage?
Class of drugs encompassing decongestants - amphetamines - cocaine.
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
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Stomach pumping.

25. Tricyclic antidepressants overdose
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Esmolol

26. When is reduction required in fracture?
Skin or vascular compromise
Antidote is naloxone.
Ceftriaxone
Give steroids for management of serum sickness. Must do coagulation screen!!!

27. Salicylates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Normally treated with sling alone. Seek advice.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

28. When is gastric lavage indicated and contraindicated?
Release NEUROTOXINS both have antivenom
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Intubate - tracheostromy or nebulized adrenaline.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

29. Carbon monoxide
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 -
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blood glucose level for hypoglycaemia!!
Flurescence in ultraviolet light.

30. What investigations should you do in suspected child abuse
Bone scan for occult fracture
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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Nausea vomiting and anorexia.

31. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Release NEUROTOXINS both have antivenom
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.

32. You must consider abuse in
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Rash bronchospasm and hypotension.
Severe illness - past history of injuries - 18 months or less - inconstent story.

33. Theophylline
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurosurgery if trauma. Give mannitol.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

34. Opiates
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

35. Ethanol
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

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

37. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Aspiration Pneumonia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Blood glucose level for hypoglycaemia!!

38. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
CHARCOAL! except for lithium - iron - alcohol - lead.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Aspiration pneumonia even if intubated.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

39. Digoxin antedote
Digoxin Fab
Abdo XRAY!!!! do it!
Nausea vomiting and anorexia.
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.

40. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Digoxin Fab
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

41. Atropine
Poisoning causes decreased cholinesterase activity.
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 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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

42. Amiodarone
Blood glucose level for hypoglycaemia!!
... blood sugars for hypoglycaemia
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

43. Organophosphates
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Croup.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

44. What is the first line investigation in a young child who has consumed alcohol?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
... blood sugars for hypoglycaemia

45. Indications of non-accidental injury
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
It can cause fatal bronchioloitis obliterans

46. Opiates
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
Antidote is naloxone.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

47. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Stomach pumping.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Flumazenil

48. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

49. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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 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.
Immobilize with plaster slab

50. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy