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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. Beta-blocker overdose antidote
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.
... blood sugars for hypoglycaemia
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

2. Mx of petroleum overdose
CHARCOAL! except for lithium - iron - alcohol - lead.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

3. Benzodiazepine overdose antidote
Blood glucose level for hypoglycaemia!!
Flumazenil
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

4. Mx of snake bit
Aspiration Pneumonia
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 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.
Sling for 3 weeks - fracture clinic at 7 days.

5. What else is in the management of snake bite?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
... blood sugars for hypoglycaemia

6. Salicylates
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.
... blood sugars for hypoglycaemia
Stomach pumping.
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.

7. What are the terminal signs of acute laryngeal obstruction?
Poisoning causes decreased cholinesterase activity.
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.
Antidote is naloxone.
Cyanosis and irregular respiratory effort

8. Anticholinergics
Flurescence in ultraviolet light.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
IM adrenaline: vasopressor and bronchodilator.
Glucagon prefered - otherwise massive dose of adrenaline.

9. 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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
'I WOULD CALL POISON HOTLINE'.
Neurosurgery if trauma. Give mannitol.

10. A child has swallowed a battery. Mx
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Intubate - tracheostromy or nebulized adrenaline.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

11. Methanol
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.
Intubate - tracheostromy or nebulized adrenaline.
Abdo XRAY!!!! do it!
Croup.

12. Anticholinergics
Neurosurgery if trauma. Give mannitol.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
... blood sugars for hypoglycaemia

13. What is one of the technicalities of childabuse.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
'I WOULD CALL POISON HOTLINE'.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

14. Epinephrine
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

15. What is the most appropriate examination in a child with suspected lead ingestion?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
IM adrenaline: vasopressor and bronchodilator.

16. Middle Clavicle fracture management?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

17. Oedema causing laryngeal obstruction?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Aspiration Pneumonia
Intubate - tracheostromy or nebulized adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

18. Anticholinergics
Sling for 3 weeks - fracture clinic at 7 days.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidotes are atropine sulfate and pralidoxime chloride.

19. What investigations should you do in suspected child abuse
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
IM adrenaline: vasopressor and bronchodilator.
Bone scan for occult fracture
Give IM adrenaline - steroids - salbutamol - antihistamine.

20. What is a side effect of charcoal?
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Causes BAD constipation. Upsets fluid and electrolyte balance.

21. Tricyclic antidepressants
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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 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

22. Ethanol
Normally treated with sling alone. Seek advice.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Munchausen's by proxy
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

23. OSCE: how can i prevent accidents in my children
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.
Antidotes are atropine sulfate and pralidoxime chloride.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

24. 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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Sling for 3 weeks - fracture clinic at 7 days.

25. Opiates
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Give IM adrenaline - steroids - salbutamol - antihistamine.

26. What are the side effects of N-acety-p-benzoquinine?
Release NEUROTOXINS both have antivenom
Stomach pumping.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Rash bronchospasm and hypotension.

27. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Munchausen's by proxy
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

28. Organophosphates
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Bone scan for occult fracture
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

29. Digoxin antedote
Flumazenil
Munchausen's by proxy
Digoxin Fab
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.

30. You must consider abuse in
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Severe illness - past history of injuries - 18 months or less - inconstent story.

31. Displaced surgical neck of humerous
Give steroids for management of serum sickness. Must do coagulation screen!!!
Normally treated with sling alone. Seek advice.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

32. When and how would you do whole bowel irrigation?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

33. Atropine
Normally treated with sling alone. Seek advice.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Immobilize with plaster slab

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

35. Amphetamine antidote
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.
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.
Esmolol
Collar and cuff. Check integrity of nerve.

36. Iron
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
CHARCOAL! except for lithium - iron - alcohol - lead.

37. 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
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 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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

38. What are the other treatments for anaphylaxis?
Stomach pumping.
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
Rash bronchospasm and hypotension.

39. Undisplaced surgical neck of humerous?
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 3 weeks - fracture clinic at 7 days.

40. What is the most important investigation in suspected alcohol poisoning in young person?
Abdo XRAY!!!! do it!
Blood glucose level for hypoglycaemia!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Give steroids for management of serum sickness. Must do coagulation screen!!!

41. What happens if charcoal is aspirated?
Collar and cuff. Check integrity of nerve.
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Croup.

42. Amiodarone
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.
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.
'I WOULD CALL POISON HOTLINE'.
... blood sugars for hypoglycaemia

43. Carbon monoxide
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.
Release NEUROTOXINS both have antivenom
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

44. What is an important point to note about anaphylaxis?
Immobilize with plaster slab
Notify if abuse CONSIDERED. CONSIDERED.
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

45. How do snake bites damage?
Notify if abuse CONSIDERED. CONSIDERED.
Neurotoxins - procagulants. Rhabdomyolysins.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

46. Signs of psychological maltreatment?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.
Glucagon prefered - otherwise massive dose of adrenaline.

47. Ethylene glycol
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

48. Management of septicaemia shock

49. Methanol
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

50. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.