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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. Tricyclic antidepressants
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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
Sling for 3 weeks - fracture clinic at 7 days.

2. What is the most important treatment for anaphylaxis
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
IM adrenaline: vasopressor and bronchodilator.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

3. Tricyclic antidepressants overdose
Rash bronchospasm and hypotension.
Neurosurgery if trauma. Give mannitol.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

4. Digoxin antedote
Neurosurgery if trauma. Give mannitol.
Digoxin Fab
... blood sugars for hypoglycaemia
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

5. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes decreased cholinesterase activity.
Neurotoxins - procagulants. Rhabdomyolysins.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

6. Salicylates
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Digoxin Fab

7. Methanol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 3 weeks - fracture clinic at 7 days.
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
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.

8. Funnel web and red back
Intubate - tracheostromy or nebulized adrenaline.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Release NEUROTOXINS both have antivenom

9. Amphetamine antidote
Severe illness - past history of injuries - 18 months or less - inconstent story.
Normally treated with sling alone. Seek advice.
Esmolol
Neurotoxins - procagulants. Rhabdomyolysins.

10. Organophosphates
Neurosurgery if trauma. Give mannitol.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

11. What are the terminal signs of acute laryngeal obstruction?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nausea vomiting and anorexia.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Cyanosis and irregular respiratory effort

12. Mx severe croup
Antidote is naloxone.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

13. Mx of snake bit
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.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

14. Lead
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.
Flurescence in ultraviolet light.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

15. Carbon monoxide
Antidote is naloxone.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

16. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
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
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 causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

17. Iron
IM adrenaline: vasopressor and bronchodilator.
Antidote is naloxone.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is deferoxamine chelation. Charcoal is ineffective.

18. Signs of psychological maltreatment?
Sling for 3 weeks - fracture clinic at 7 days.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Skin or vascular compromise

19. What is a side effect of charcoal?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Normally treated with sling alone. Seek advice.
'I WOULD CALL POISON HOTLINE'.
Causes BAD constipation. Upsets fluid and electrolyte balance.

20. Signs of abuse from the history
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Cyanosis and irregular respiratory effort
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 decreased cholinesterase activity.

21. Ethanol
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Stomach pumping.
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.

22. Which is better - activated charcoal or gastric lavage.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
CHARCOAL! except for lithium - iron - alcohol - lead.
Digoxin Fab
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

23. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
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.

24. Displaced surgical neck of humerous
Severe illness - past history of injuries - 18 months or less - inconstent story.
Normally treated with sling alone. Seek advice.
Digoxin Fab
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

25. Epinephrine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

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

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27. Iron
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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
... blood sugars for hypoglycaemia

28. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

29. Undisplaced surgical neck of humerous?
Neurotoxins - procagulants. Rhabdomyolysins.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 3 weeks - fracture clinic at 7 days.
Stomach pumping.

30. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Calcium chloride
Poisoning causes decreased cholinesterase activity.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

31. Acetaminophen
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

32. Cyanide
Class of drugs encompassing decongestants - amphetamines - cocaine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Discobalt edetate

33. What is the antibiotic for Epiglottitis?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Ceftriaxone
Objective signs of growth - tidiness - weight -
Digoxin Fab

34. Atropine
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Bone scan for occult fracture
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
It can cause fatal bronchioloitis obliterans

35. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give IM adrenaline - steroids - salbutamol - antihistamine.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

36. What else is in the management of snake bite?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Glucagon prefered - otherwise massive dose of adrenaline.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

37. Indications of non-accidental injury
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Rash bronchospasm and hypotension.

38. What happens if charcoal is aspirated?
Esmolol
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
It can cause fatal bronchioloitis obliterans

39. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Blood glucose level for hypoglycaemia!!
Skin or vascular compromise
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

40. How do snake bites damage?
Bone scan for occult fracture
Digoxin Fab
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurotoxins - procagulants. Rhabdomyolysins.

41. Ibuprofen
Abdo XRAY!!!! do it!
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
Discobalt edetate
Antidote is naloxone.

42. What is one of the technicalities of childabuse.
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.
Neurosurgery if trauma. Give mannitol.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

43. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

44. How may you detect semen?
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.
Flurescence in ultraviolet light.
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

45. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Rash bronchospasm and hypotension.

46. What is the general management of poisoning?
Release NEUROTOXINS both have antivenom
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Cyanosis and irregular respiratory effort
Antidote is deferoxamine chelation. Charcoal is ineffective.

47. What is the first line investigation in a young child who has consumed alcohol?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
... blood sugars for hypoglycaemia

48. What is the most common caUse of acute laryngeal obstruction?
Digoxin Fab
Croup.
Antidote is naloxone.
Release NEUROTOXINS both have antivenom

49. Calcium channel blocker overdose antidote
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Nausea vomiting and anorexia.
Calcium chloride

50. Salicylates
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.