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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

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1. Signs of abuse from the history
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

2. You must consider abuse in
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.
Discobalt edetate
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

3. What is the most common caUse of acute laryngeal obstruction?
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Nausea vomiting and anorexia.
Croup.

4. 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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Ceftriaxone

5. OSCE: What are the five princples of discharging a patient with a fracture?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Class of drugs encompassing decongestants - amphetamines - cocaine.
CHARCOAL! except for lithium - iron - alcohol - lead.

6. What is the most important treatment for anaphylaxis
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Normally treated with sling alone. Seek advice.
IM adrenaline: vasopressor and bronchodilator.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

7. When is reduction required in fracture?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Skin or vascular compromise

8. Middle Clavicle fracture management?
Class of drugs encompassing decongestants - amphetamines - cocaine.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Digoxin Fab

9. 20
Aspiration Pneumonia
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

10. Signs of psychological maltreatment?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Sling for 3 weeks - fracture clinic at 7 days.
It can cause fatal bronchioloitis obliterans

11. What must you do before sending fracture to radiology?
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
Stomach pumping.
Immobilize with plaster slab

12. 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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Esmolol
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

13. What evidence should a doctor give about parental neglect
Flurescence in ultraviolet light.
Objective signs of growth - tidiness - weight -
Glucagon prefered - otherwise massive dose of adrenaline.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

14. Management of septicaemia shock

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15. Amiodarone
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

16. Carbon monoxide
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Calcium chloride
Munchausen's by proxy

17. 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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
CHARCOAL! except for lithium - iron - alcohol - lead.

18. What psychiatric disease defined as childabuse?

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19. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized 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.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

20. Opiates
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nausea vomiting and anorexia.

21. Iron
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes decreased cholinesterase activity.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidote is deferoxamine chelation. Charcoal is ineffective.

22. Undisplaced surgical neck of humerous?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Sling for 3 weeks - fracture clinic at 7 days.
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.
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.

23. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
It can cause fatal bronchioloitis obliterans
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.

24. Beta-blocker overdose antidote
Rash bronchospasm and hypotension.
Collar and cuff. Check integrity of nerve.
Aspiration pneumonia even if intubated.
Glucagon prefered - otherwise massive dose of adrenaline.

25. Organophosphates
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

26. Mx severe croup
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
'I WOULD CALL POISON HOTLINE'.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

27. Funnel web and red back
Release NEUROTOXINS both have antivenom
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

28. 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
Abdo XRAY!!!! do it!
Severe illness - past history of injuries - 18 months or less - inconstent story.

29. Anticholinergics
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

30. What happens if charcoal is aspirated?
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.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
It can cause fatal bronchioloitis obliterans

31. Mx of critical asthma
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

32. What is the antibiotic for Epiglottitis?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Ceftriaxone

33. Anticholinergics
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 3 weeks - fracture clinic at 7 days.
Nausea vomiting and anorexia.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

34. Procainamide
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Neurotoxins - procagulants. Rhabdomyolysins.

35. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Nausea vomiting and anorexia.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

36. Sodium Bicarbonate
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Blood glucose level for hypoglycaemia!!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

37. Lidocaine
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Abdo XRAY!!!! do it!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
'I WOULD CALL POISON HOTLINE'.

38. Ethylene glycol
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Munchausen's by proxy
Collar and cuff. Check integrity of nerve.

39. Amphetamine antidote
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Esmolol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

40. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.

41. Digoxin antedote
Digoxin Fab
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Glucagon prefered - otherwise massive dose of adrenaline.
Neurotoxins - procagulants. Rhabdomyolysins.

42. Tricyclic antidepressants
Release NEUROTOXINS both have antivenom
Stomach pumping.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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

43. Cyanide
IM adrenaline: vasopressor and bronchodilator.
Objective signs of growth - tidiness - weight -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Discobalt edetate

44. Undisplaced radial shaft fracture
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Collar and cuff. Check integrity of nerve.
Antidotes are atropine sulfate and pralidoxime chloride.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

45. Lead
Munchausen's by proxy
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Blood glucose level for hypoglycaemia!!
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

46. What are the terminal signs of acute laryngeal obstruction?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

47. what makes you suspicious of non-accidental injury.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

48. Benzodiazepine overdose antidote
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.
Flumazenil
Release NEUROTOXINS both have antivenom
Antidote is deferoxamine chelation. Charcoal is ineffective.

49. Ingesting Petrol. Cx?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Aspiration Pneumonia
Croup.
Objective signs of growth - tidiness - weight -

50. Organophosphates
Poisoning causes decreased cholinesterase activity.
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'.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

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