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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. When is reduction required in fracture?
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.
Skin or vascular compromise
Neurotoxins - procagulants. Rhabdomyolysins.
Discobalt edetate

2. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Aspiration Pneumonia
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

3. OSCE: how can i prevent accidents in my children
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

4. Signs of psychological maltreatment?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidotes are atropine sulfate and pralidoxime chloride.

5. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Antidote is naloxone.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Objective signs of growth - tidiness - weight -

6. When and how would you do whole bowel irrigation?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

7. Undisplaced radial shaft fracture
Notify if abuse CONSIDERED. CONSIDERED.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Collar and cuff. Check integrity of nerve.

8. Tricyclic antidepressants overdose
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

9. A child has swallowed a battery. Mx
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 3 weeks - fracture clinic at 7 days.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
'I WOULD CALL POISON HOTLINE'.

10. Signs of abuse from the history
Poisoning causes decreased cholinesterase activity.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

11. What is one of the technicalities of childabuse.
Stomach pumping.
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
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent

12. Calcium channel blocker overdose antidote
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Calcium chloride
Cyanosis and irregular respiratory effort

13. Funnel web and red back
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Release NEUROTOXINS both have antivenom
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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

14. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

15. What is the most common caUse of acute laryngeal obstruction?
Abdo XRAY!!!! do it!
Croup.
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

16. Procainamide
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
'I WOULD CALL POISON HOTLINE'.
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.
Collar and cuff. Check integrity of nerve.

17. What investigations should you do in suspected child abuse
IM adrenaline: vasopressor and bronchodilator.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Bone scan for occult fracture
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.

18. Sympathomimetics
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.
'I WOULD CALL POISON HOTLINE'.
Esmolol
Class of drugs encompassing decongestants - amphetamines - cocaine.

19. Acetaminophen
Stomach pumping.
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 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.

20. Methanol
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.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

21. Opiates
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

22. Opiates
Antidote is naloxone.
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.
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
... blood sugars for hypoglycaemia

23. Mx of critical asthma
Munchausen's by proxy
Skin or vascular compromise
Blood glucose level for hypoglycaemia!!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

24. What are the terminal signs of acute laryngeal obstruction?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Cyanosis and irregular respiratory effort
Notify if abuse CONSIDERED. CONSIDERED.
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.

25. Which is better - activated charcoal or gastric lavage.
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.
Neurotoxins - procagulants. Rhabdomyolysins.
CHARCOAL! except for lithium - iron - alcohol - lead.

26. what makes you suspicious of non-accidental injury.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

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

28. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Severe illness - past history of injuries - 18 months or less - inconstent story.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Give IM adrenaline - steroids - salbutamol - antihistamine.

29. Organophosphates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Skin or vascular compromise

30. OSCE: What are the five princples of discharging a patient with a fracture?
Munchausen's by proxy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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 BAD constipation. Upsets fluid and electrolyte balance.

31. Ingesting Petrol. Cx?
Rash bronchospasm and hypotension.
Croup.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Aspiration Pneumonia

32. Mx of petroleum overdose
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Aspiration Pneumonia

33. Anticholinergics
Sling for 3 weeks - fracture clinic at 7 days.
Cyanosis and irregular respiratory effort
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

34. 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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Munchausen's by proxy
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.

35. What is the most appropriate examination in a child with suspected lead ingestion?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Flumazenil
Abdo XRAY!!!! do it!
Release NEUROTOXINS both have antivenom

36. Acetaminophen
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.

37. Hydrocarbons
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.

38. What is an important point to note about anaphylaxis?
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 -
Collar and cuff. Check integrity of nerve.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

39. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Rash bronchospasm and hypotension.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

40. What else is in the management of snake bite?
Esmolol
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Give steroids for management of serum sickness. Must do coagulation screen!!!

41. Calcium gluconate
Ceftriaxone
Give IM adrenaline - steroids - salbutamol - antihistamine.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

42. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidote is naloxone.
Discobalt edetate

43. What is the most important treatment for anaphylaxis
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.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

44. What is the general management of poisoning?
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

45. Management of septicaemia shock

46. What evidence should a doctor give about parental neglect
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Objective signs of growth - tidiness - weight -
Collar and cuff. Check integrity of nerve.
IM adrenaline: vasopressor and bronchodilator.

47. Digoxin antedote
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Digoxin Fab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

48. Indications of non-accidental injury
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
CHARCOAL! except for lithium - iron - alcohol - lead.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

49. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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'.

50. Ethylene glycol
Immobilize with plaster slab
Flumazenil
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.