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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Nausea vomiting and anorexia.
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
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.

2. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

3. Adenosine
Normally treated with sling alone. Seek advice.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

4. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Neurotoxins - procagulants. Rhabdomyolysins.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Blood glucose level for hypoglycaemia!!

5. What psychiatric disease defined as childabuse?

6. Funnel web and red back
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Release NEUROTOXINS both have antivenom
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Neurotoxins - procagulants. Rhabdomyolysins.

7. Cyanide
Blood glucose level for hypoglycaemia!!
... blood sugars for hypoglycaemia
Discobalt edetate
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. Ethylene glycol
Flumazenil
Causes BAD constipation. Upsets fluid and electrolyte balance.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

9. What is the most appropriate examination in a child with suspected lead ingestion?
Severe illness - past history of injuries - 18 months or less - inconstent story.
Abdo XRAY!!!! do it!
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

10. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Rash bronchospasm and hypotension.
Croup.

11. Amiodarone
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.
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 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.

12. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Calcium chloride
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.

13. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!
Ceftriaxone
Immobilize with plaster slab

14. A child has swallowed a battery. Mx
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
... blood sugars for hypoglycaemia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Causes BAD constipation. Upsets fluid and electrolyte balance.

15. Acetaminophen
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 causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
... blood sugars for hypoglycaemia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

16. Mx of petroleum overdose
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
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

17. Ethanol
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Ceftriaxone
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Neurotoxins - procagulants. Rhabdomyolysins.

18. Oedema causing laryngeal obstruction?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Intubate - tracheostromy or nebulized adrenaline.
Objective signs of growth - tidiness - weight -
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

19. what makes you suspicious of non-accidental injury.
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

20. Theophylline
Discobalt edetate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.
Class of drugs encompassing decongestants - amphetamines - cocaine.

21. Mx of critical asthma
Discobalt edetate
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Digoxin Fab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

22. Anticholinergics
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

23. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Esmolol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Aspiration pneumonia even if intubated.

24. How may you detect semen?
Flurescence in ultraviolet light.
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 steroids for management of serum sickness. Must do coagulation screen!!!
Neurotoxins - procagulants. Rhabdomyolysins.

25. Mx raised intracranial pressure.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurosurgery if trauma. Give mannitol.
Cyanosis and irregular respiratory effort

26. Tricyclic antidepressants
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Blood glucose level for hypoglycaemia!!

27. How do snake bites damage?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

28. What are the three features of anaphylaxis
It can cause fatal bronchioloitis obliterans
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Digoxin Fab
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

29. Mx severe croup
Neurotoxins - procagulants. Rhabdomyolysins.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

30. 45; 70
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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 -
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

31. Hydrocarbons
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.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

32. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Release NEUROTOXINS both have antivenom

33. Organophosphates
Poisoning causes decreased cholinesterase activity.
It can cause fatal bronchioloitis obliterans
Severe illness - past history of injuries - 18 months or less - inconstent story.
Flurescence in ultraviolet light.

34. Methanol
Rash bronchospasm and hypotension.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Sling for 3 weeks - fracture clinic at 7 days.

35. Acetaminophen
Antidotes are atropine sulfate and pralidoxime chloride.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
CHARCOAL! except for lithium - iron - alcohol - lead.

36. Organophosphates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Immobilize with plaster slab
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

37. What investigations should you do in suspected child abuse
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Antidote is naloxone.
Bone scan for occult fracture

38. Middle Clavicle fracture management?
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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

39. Iron
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flumazenil

40. Lidocaine
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
CHARCOAL! except for lithium - iron - alcohol - lead.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.

41. Lead
Glucagon prefered - otherwise massive dose of adrenaline.
Flumazenil
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Blood glucose level for hypoglycaemia!!

42. Carbon monoxide
Aspiration pneumonia even if intubated.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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

43. Beta-blocker overdose antidote
Severe illness - past history of injuries - 18 months or less - inconstent story.
CHARCOAL! except for lithium - iron - alcohol - lead.
... blood sugars for hypoglycaemia
Glucagon prefered - otherwise massive dose of adrenaline.

44. What is the antibiotic for Epiglottitis?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Normally treated with sling alone. Seek advice.
Esmolol
Ceftriaxone

45. Opiates
Antidotes are atropine sulfate and pralidoxime chloride.
Abdo XRAY!!!! do it!
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

46. What is the most important investigation in suspected alcohol poisoning in young person?
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.
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 -
Blood glucose level for hypoglycaemia!!

47. Displaced surgical neck of humerous
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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
'I WOULD CALL POISON HOTLINE'.

48. Management of septicaemia shock

49. When and how would you do whole bowel irrigation?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

50. Methanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.