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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. 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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

3. What is the most important investigation in suspected alcohol poisoning in young person?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blood glucose level for hypoglycaemia!!
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

4. Opiates
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidote is naloxone.
Esmolol
Intubate - tracheostromy or nebulized adrenaline.

5. Mx of petroleum overdose
Rash bronchospasm and hypotension.
... blood sugars for hypoglycaemia
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

6. What is the most appropriate examination in a child with suspected lead ingestion?
Aspiration Pneumonia
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Abdo XRAY!!!! do it!
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

7. Theophylline
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Notify if abuse CONSIDERED. CONSIDERED.
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

8. Procainamide
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nausea vomiting and anorexia.
Poisoning causes decreased cholinesterase activity.

9. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Bone scan for occult fracture
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

10. Atropine
It can cause fatal bronchioloitis obliterans
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

11. what makes you suspicious of non-accidental injury.
Intubate - tracheostromy or nebulized adrenaline.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

12. Lidocaine
Bone scan for occult fracture
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Aspiration pneumonia even if intubated.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

13. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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
Severe illness - past history of injuries - 18 months or less - inconstent story.
Give steroids for management of serum sickness. Must do coagulation screen!!!

14. Middle Clavicle fracture management?
Poisoning causes decreased cholinesterase activity.
Normally treated with sling alone. Seek advice.
Discobalt edetate
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

15. Benzodiazepine overdose antidote
Flumazenil
Calcium chloride
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Normally treated with sling alone. Seek advice.

16. Hydrocarbons
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.
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.
Croup.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

17. Calcium gluconate
Release NEUROTOXINS both have antivenom
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

18. What are the special features that must be done to correct haemorrhagic shock.
Calcium chloride
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of drugs encompassing decongestants - amphetamines - cocaine.

19. What are the three features of anaphylaxis
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.
Release NEUROTOXINS both have antivenom
Stomach pumping.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

20. Oedema causing laryngeal obstruction?
Antidote is naloxone.
Sling for 3 weeks - fracture clinic at 7 days.
Intubate - tracheostromy or nebulized adrenaline.
Flurescence in ultraviolet light.

21. How may you detect semen?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Flurescence in ultraviolet light.
Croup.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

22. Mx raised intracranial pressure.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.

23. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

24. Carbon monoxide
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
Cyanosis and irregular respiratory effort
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

25. Organophosphates antidotes
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Neurotoxins - procagulants. Rhabdomyolysins.
Antidotes are atropine sulfate and pralidoxime chloride.
... blood sugars for hypoglycaemia

26. OSCE: how can i prevent accidents in my children
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.

27. Cyanide
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Discobalt edetate
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

28. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Discobalt edetate
Skin or vascular compromise
Antidote is naloxone.

29. Carbon monoxide
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Abdo XRAY!!!! do it!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

30. Salicylates
Antidote is deferoxamine chelation. Charcoal is ineffective.
Cyanosis and irregular respiratory effort
Discobalt edetate
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.

31. Acetaminophen
Flurescence in ultraviolet light.
Discobalt edetate
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

32. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Aspiration pneumonia even if intubated.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

33. What are the side effects of N-acety-p-benzoquinine?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Rash bronchospasm and hypotension.

34. Ethylene glycol
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Blood glucose level for hypoglycaemia!!
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

35. Ingesting Petrol. Cx?
Aspiration Pneumonia
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Glucagon prefered - otherwise massive dose of adrenaline.
Release NEUROTOXINS both have antivenom

36. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.

37. What is the first line investigation in a young child who has consumed alcohol?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Ceftriaxone
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
... blood sugars for hypoglycaemia

38. Undisplaced surgical neck of humerous?
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.
CHARCOAL! except for lithium - iron - alcohol - lead.

39. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Discobalt edetate
Normally treated with sling alone. Seek advice.

40. What is a side effect of charcoal?
Munchausen's by proxy
It can cause fatal bronchioloitis obliterans
Release NEUROTOXINS both have antivenom
Causes BAD constipation. Upsets fluid and electrolyte balance.

41. What are the other treatments for anaphylaxis?
Blood glucose level for hypoglycaemia!!
Aspiration pneumonia even if intubated.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Give IM adrenaline - steroids - salbutamol - antihistamine.

42. Beta-blocker overdose antidote
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Glucagon prefered - otherwise massive dose of adrenaline.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

43. 45; 70
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Neurotoxins - procagulants. Rhabdomyolysins.
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

44. Amiodarone
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

45. How do snake bites damage?
Croup.
Collar and cuff. Check integrity of nerve.
Neurotoxins - procagulants. Rhabdomyolysins.
CHARCOAL! except for lithium - iron - alcohol - lead.

46. Management of near drowning.
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 - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.
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.
'I WOULD CALL POISON HOTLINE'.

47. What is the most common caUse of acute laryngeal obstruction?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Croup.
Normally treated with sling alone. Seek advice.
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

48. When is reduction required in fracture?
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.
Skin or vascular compromise
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

49. Salicylates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
... blood sugars for hypoglycaemia
Digoxin Fab

50. A child has swallowed a battery. Mx
Blood glucose level for hypoglycaemia!!
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Cyanosis and irregular respiratory effort