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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.
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. What psychiatric disease defined as childabuse?

2. Management of septicaemia shock

3. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Release NEUROTOXINS both have antivenom

4. What is one of the technicalities of childabuse.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidote is naloxone.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

5. Theophylline
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Stomach pumping.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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

6. Signs of psychological maltreatment?
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.
Blood glucose level for hypoglycaemia!!
Stomach pumping.
Antidote is deferoxamine chelation. Charcoal is ineffective.

7. Acetaminophen
Stomach pumping.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

8. OSCE: how can i prevent accidents in my children
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Intubate - tracheostromy or nebulized adrenaline.
Sling for 3 weeks - fracture clinic at 7 days.
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

9. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Flurescence in ultraviolet light.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Digoxin Fab

10. Carbon monoxide
Collar and cuff. Check integrity of nerve.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

11. Calcium channel blocker overdose antidote
Objective signs of growth - tidiness - weight -
Calcium chloride
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.

12. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Sling for 3 weeks - fracture clinic at 7 days.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes decreased cholinesterase activity.

13. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Calcium chloride

14. Mx severe croup
Class of drugs encompassing decongestants - amphetamines - cocaine.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Esmolol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

15. Acetaminophen
Objective signs of growth - tidiness - weight -
Digoxin Fab
Normally treated with sling alone. Seek advice.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

16. Funnel web and red back
Neurotoxins - procagulants. Rhabdomyolysins.
Release NEUROTOXINS both have antivenom
Severe illness - past history of injuries - 18 months or less - inconstent story.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

17. What is the most important treatment for anaphylaxis
Antidote is naloxone.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
IM adrenaline: vasopressor and bronchodilator.

18. What are the other treatments for anaphylaxis?
Esmolol
Munchausen's by proxy
Give IM adrenaline - steroids - salbutamol - antihistamine.
Causes BAD constipation. Upsets fluid and electrolyte balance.

19. Anticholinergics
Esmolol
Class of drugs encompassing decongestants - amphetamines - cocaine.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Flumazenil

20. How do snake bites damage?
Aspiration pneumonia even if intubated.
Neurotoxins - procagulants. Rhabdomyolysins.
Abdo XRAY!!!! do it!
Flumazenil

21. Salicylates
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
... blood sugars for hypoglycaemia
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

22. Adenosine
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Aspiration Pneumonia
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Flurescence in ultraviolet light.

23. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
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.
... blood sugars for hypoglycaemia
Flurescence in ultraviolet light.

24. You must consider abuse in
Abdo XRAY!!!! do it!
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

25. Ethylene glycol
Aspiration pneumonia even if intubated.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.

26. Digoxin antedote
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Digoxin Fab

27. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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
Digoxin Fab
Immobilize with plaster slab

28. Organophosphates antidotes
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Discobalt edetate

29. What is an important point to note about anaphylaxis?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
'I WOULD CALL POISON HOTLINE'.
Flumazenil
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 -

30. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.

31. What is the first line investigation in a young child who has consumed alcohol?
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.
Sling for 3 weeks - fracture clinic at 7 days.
... blood sugars for hypoglycaemia
Bone scan for occult fracture

32. Benzodiazepine overdose antidote
Flumazenil
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

33. Mx of snake bit
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.

34. Amphetamine antidote
Aspiration pneumonia even if intubated.
Esmolol
Poisoning causes decreased cholinesterase activity.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

35. What are the side effects of N-acety-p-benzoquinine?
Nausea vomiting and anorexia.
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Rash bronchospasm and hypotension.

36. What is the antibiotic for Epiglottitis?
Ceftriaxone
Croup.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

37. Legal requirement in 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.
Notify if abuse CONSIDERED. CONSIDERED.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Neurosurgery if trauma. Give mannitol.

38. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Esmolol
Neurotoxins - procagulants. Rhabdomyolysins.

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

40. Methanol
Glucagon prefered - otherwise massive dose of adrenaline.
'I WOULD CALL POISON HOTLINE'.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

41. Sodium Bicarbonate
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Sling for 3 weeks - fracture clinic at 7 days.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Objective signs of growth - tidiness - weight -

42. Procainamide
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.
Aspiration Pneumonia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Esmolol

43. Atropine
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Nausea vomiting and anorexia.

44. 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.
Munchausen's by proxy
Objective signs of growth - tidiness - weight -
Severe illness - past history of injuries - 18 months or less - inconstent story.

45. Carbon monoxide
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Flurescence in ultraviolet light.
Release NEUROTOXINS both have antivenom

46. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Ceftriaxone
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
Calcium chloride

47. What investigations should you do in suspected child abuse
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Bone scan for occult fracture

48. How may you detect semen?
Notify if abuse CONSIDERED. CONSIDERED.
Flurescence in ultraviolet light.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Croup.

49. When is gastric lavage indicated and contraindicated?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

50. Ingesting Petrol. Cx?
Aspiration Pneumonia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
IM adrenaline: vasopressor and bronchodilator.
Antidote is naloxone.