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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. Opiates
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

2. 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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
It can cause fatal bronchioloitis obliterans

3. What happens if charcoal is aspirated?
... blood sugars for hypoglycaemia
Normally treated with sling alone. Seek advice.
Severe illness - past history of injuries - 18 months or less - inconstent story.
It can cause fatal bronchioloitis obliterans

4. Ethylene glycol
Neurosurgery if trauma. Give mannitol.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

5. What is one of the technicalities of childabuse.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Skin or vascular compromise
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

6. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Severe illness - past history of injuries - 18 months or less - inconstent story.

7. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
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.

8. 45; 70
Sling for 3 weeks - fracture clinic at 7 days.
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.
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
Esmolol

9. Beta-blocker overdose antidote
Croup.
Glucagon prefered - otherwise massive dose of adrenaline.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Sling for 3 weeks - fracture clinic at 7 days.

10. What is the first line investigation in a young child who has consumed alcohol?
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.
IM adrenaline: vasopressor and bronchodilator.
... blood sugars for hypoglycaemia

11. Carbon monoxide
Esmolol
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.
Digoxin Fab
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

12. Mx severe croup
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Discobalt edetate
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

13. Ingesting Petrol. Cx?
Aspiration Pneumonia
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

14. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Flurescence in ultraviolet light.
Nausea vomiting and anorexia.

15. What investigations should you do in suspected child abuse
Rash bronchospasm and hypotension.
Sling for 3 weeks - fracture clinic at 7 days.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Bone scan for occult fracture

16. Atropine
Blood glucose level for hypoglycaemia!!
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Neurosurgery if trauma. Give mannitol.

17. 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.
Antidotes are atropine sulfate and pralidoxime chloride.
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
Nausea vomiting and anorexia.

18. Methanol
Notify if abuse CONSIDERED. CONSIDERED.
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.
Ceftriaxone
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

19. Management of septicaemia shock

20. Undisplaced radial shaft fracture
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.
Collar and cuff. Check integrity of nerve.
Digoxin Fab

21. What else is in the management of snake bite?
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
It can cause fatal bronchioloitis obliterans
Give steroids for management of serum sickness. Must do coagulation screen!!!

22. Management of near drowning.
Flumazenil
Stomach pumping.
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
Glucagon prefered - otherwise massive dose of adrenaline.

23. 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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
It can cause fatal bronchioloitis obliterans
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.

24. How do snake bites damage?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
Neurotoxins - procagulants. Rhabdomyolysins.

25. Amphetamine antidote
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Release NEUROTOXINS both have antivenom
Esmolol
Blood glucose level for hypoglycaemia!!

26. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are atropine sulfate and pralidoxime chloride.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

27. Iron
Abdo XRAY!!!! do it!
Glucagon prefered - otherwise massive dose of adrenaline.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

28. Organophosphates
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Rash bronchospasm and hypotension.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

29. Acetaminophen
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Skin or vascular compromise

30. Legal requirement in childabuse
Severe illness - past history of injuries - 18 months or less - inconstent story.
Notify if abuse CONSIDERED. CONSIDERED.
Calcium chloride
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

31. Mx of snake bit
Objective signs of growth - tidiness - weight -
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Release NEUROTOXINS both have antivenom

32. What is gastric lavage?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Stomach pumping.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.

33. Methanol
Skin or vascular compromise
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.
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.

34. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 -
Normally treated with sling alone. Seek advice.
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

35. Oedema causing laryngeal obstruction?
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Intubate - tracheostromy or nebulized adrenaline.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

36. What is the most important investigation in suspected alcohol poisoning in young person?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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 glucose level for hypoglycaemia!!

37. Lead
Normally treated with sling alone. Seek advice.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

38. What evidence should a doctor give about parental neglect
It can cause fatal bronchioloitis obliterans
Objective signs of growth - tidiness - weight -
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

39. What are the three features of anaphylaxis
Ceftriaxone
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!

40. Ethanol
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

41. Which is better - activated charcoal or gastric lavage.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Rash bronchospasm and hypotension.
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.
CHARCOAL! except for lithium - iron - alcohol - lead.

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

43. Signs of abuse from the history
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Objective signs of growth - tidiness - weight -
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

44. Sympathomimetics
Calcium chloride
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Release NEUROTOXINS both have antivenom
Collar and cuff. Check integrity of nerve.

45. Organophosphates
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes decreased cholinesterase activity.
Skin or vascular compromise
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

46. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Ceftriaxone
Croup.

47. What is the most appropriate examination in a child with suspected lead ingestion?
... blood sugars for hypoglycaemia
Discobalt edetate
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Abdo XRAY!!!! do it!

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

49. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Aspiration pneumonia even if intubated.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

50. What are the early symptoms of paracetamol overdose?
Stomach pumping.
Skin or vascular compromise
Nausea vomiting and anorexia.
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.