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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.
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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. When is reduction required in fracture?
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
Ceftriaxone
Skin or vascular compromise
Antidote is deferoxamine chelation. Charcoal is ineffective.

2. Tricyclic antidepressants
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

3. Organophosphates antidotes
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
Antidotes are atropine sulfate and pralidoxime chloride.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

4. Ingesting Petrol. Cx?
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.
Digoxin Fab
Intubate - tracheostromy or nebulized adrenaline.
Aspiration Pneumonia

5. Signs of abuse from the history
Causes BAD constipation. Upsets fluid and electrolyte balance.
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
Discobalt edetate

6. Mx of critical asthma
Causes BAD constipation. Upsets fluid and electrolyte balance.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

7. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
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.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

8. OSCE: What are the five princples of discharging a patient with a fracture?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

9. Signs of psychological maltreatment?
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 -
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
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.

10. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

11. Sodium Bicarbonate
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Bone scan for occult fracture

12. What is the most common caUse of acute laryngeal obstruction?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
... blood sugars for hypoglycaemia
Croup.
Immobilize with plaster slab

13. Ibuprofen
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
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
Notify if abuse CONSIDERED. CONSIDERED.
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.

14. Methanol
Aspiration pneumonia even if intubated.
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.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

15. Mx of petroleum overdose
Collar and cuff. Check integrity of nerve.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Neurosurgery if trauma. Give mannitol.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

16. Management of septicaemia shock

17. What is the most important investigation in suspected alcohol poisoning in young person?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blood glucose level for hypoglycaemia!!
Skin or vascular compromise
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

18. What are the special features that must be done to correct haemorrhagic shock.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
It can cause fatal bronchioloitis obliterans
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Stomach pumping.

19. What are the early symptoms of paracetamol overdose?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Flurescence in ultraviolet light.
Nausea vomiting and anorexia.
'I WOULD CALL POISON HOTLINE'.

20. What evidence should a doctor give about parental neglect
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Objective signs of growth - tidiness - weight -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Antidote is naloxone.

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

22. Cyanide
Intubate - tracheostromy or nebulized adrenaline.
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
Discobalt edetate
Severe illness - past history of injuries - 18 months or less - inconstent story.

23. What psychiatric disease defined as childabuse?

24. 20
Digoxin Fab
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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 -

25. Salicylates
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.
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 -
Croup.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

26. Undisplaced surgical neck of humerous?
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 -
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
Sling for 3 weeks - fracture clinic at 7 days.

27. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars 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
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

28. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
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.
Notify if abuse CONSIDERED. CONSIDERED.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

29. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Croup.

30. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
CHARCOAL! except for lithium - iron - alcohol - lead.
Aspiration pneumonia even if intubated.
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.

31. Which is better - activated charcoal or gastric lavage.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
CHARCOAL! except for lithium - iron - alcohol - lead.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.

32. How do snake bites damage?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Digoxin Fab
Abdo XRAY!!!! do it!
Neurotoxins - procagulants. Rhabdomyolysins.

33. Calcium gluconate
Aspiration pneumonia even if intubated.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

34. Management of near drowning.
Munchausen's by proxy
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and 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

35. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Notify if abuse CONSIDERED. CONSIDERED.
Discobalt edetate
Normally treated with sling alone. Seek advice.

36. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

37. Funnel web and red back
CHARCOAL! except for lithium - iron - alcohol - lead.
Collar and cuff. Check integrity of nerve.
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.
Release NEUROTOXINS both have antivenom

38. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes decreased cholinesterase activity.
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.

39. Hydrocarbons
Aspiration pneumonia even if intubated.
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.
Objective signs of growth - tidiness - weight -
Release NEUROTOXINS both have antivenom

40. Carbon monoxide
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.
Cyanosis and irregular respiratory effort
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

41. Displaced 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 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
Normally treated with sling alone. Seek advice.
Rash bronchospasm and hypotension.

42. Sympathomimetics
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

43. Ethylene glycol
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 -
Aspiration pneumonia even if intubated.
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.
Immobilize with plaster slab

44. Carbon monoxide
Cyanosis and irregular respiratory effort
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Flumazenil
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

45. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
'I WOULD CALL POISON HOTLINE'.
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
Intubate - tracheostromy or nebulized adrenaline.

46. Acetaminophen
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Normally treated with sling alone. Seek advice.
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.

47. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Hypotension - bronchospasma and upper airway obstruction becasue of 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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

48. Opiates
Antidote is naloxone.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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

49. Organophosphates
Poisoning causes decreased cholinesterase activity.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Immobilize with plaster slab

50. Anticholinergics
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.