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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 must you do before sending fracture to radiology?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Immobilize with plaster slab
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Stomach pumping.

2. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Aspiration pneumonia even if intubated.

3. 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.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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

4. Anticholinergics
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

5. What else is in the management of snake bite?
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
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Neurotoxins - procagulants. Rhabdomyolysins.

6. Opiates
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidote is naloxone.

7. Signs of psychological maltreatment?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Sling for 3 weeks - fracture clinic at 7 days.
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.

8. Atropine
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Objective signs of growth - tidiness - weight -
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

9. How do snake bites damage?
... blood sugars for hypoglycaemia
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.

10. Amiodarone
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Intubate - tracheostromy or nebulized adrenaline.

11. What is the most common caUse of acute laryngeal obstruction?
Croup.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

12. What is an important point to note about anaphylaxis?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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 -
Notify if abuse CONSIDERED. CONSIDERED.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

13. Mx of snake bit
Notify if abuse CONSIDERED. CONSIDERED.
Cyanosis and irregular respiratory effort
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.
Flurescence in ultraviolet light.

14. OSCE: What are the five princples of discharging a patient with a fracture?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flumazenil
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

15. Anticholinergics
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Neurotoxins - procagulants. Rhabdomyolysins.
Glucagon prefered - otherwise massive dose of adrenaline.

16. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Rash bronchospasm and hypotension.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Discobalt edetate

17. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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 -
Blood glucose level for hypoglycaemia!!

18. Undisplaced surgical neck of humerous?
Flurescence in ultraviolet light.
Calcium chloride
Bone scan for occult fracture
Sling for 3 weeks - fracture clinic at 7 days.

19. Theophylline
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Normally treated with sling alone. Seek advice.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

20. Amphetamine antidote
Esmolol
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Calcium chloride
Normally treated with sling alone. Seek advice.

21. Management of near drowning.
Nausea vomiting and anorexia.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

22. 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.
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 -
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

23. Ethanol
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Intubate - tracheostromy or nebulized adrenaline.

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

25. When is reduction required in fracture?
It can cause fatal bronchioloitis obliterans
Skin or vascular compromise
Ceftriaxone
Objective signs of growth - tidiness - weight -

26. When is gastric lavage indicated and contraindicated?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

27. What psychiatric disease defined as childabuse?

28. Management of septicaemia shock

29. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Rash bronchospasm and hypotension.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

30. What is gastric lavage?
Stomach pumping.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

31. What is a side effect of charcoal?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

32. What is the antibiotic for Epiglottitis?
Ceftriaxone
Antidote is naloxone.
Release NEUROTOXINS both have antivenom
Munchausen's by proxy

33. Calcium gluconate
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
Digoxin Fab
Rash bronchospasm and hypotension.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

34. Ibuprofen
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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

35. Procainamide
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Stomach pumping.
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 even if intubated.

36. Mx of petroleum overdose
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

37. Hydrocarbons
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

38. Salicylates
Blood glucose level for hypoglycaemia!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

39. Funnel web and red back
Causes BAD constipation. Upsets fluid and electrolyte balance.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Release NEUROTOXINS both have antivenom

40. What is the most important investigation in suspected alcohol poisoning in young person?
Sling for 3 weeks - fracture clinic at 7 days.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Objective signs of growth - tidiness - weight -
Blood glucose level for hypoglycaemia!!

41. What is the first line investigation in a young child who has consumed alcohol?
Give steroids for management of serum sickness. Must do coagulation screen!!!
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
... blood sugars for hypoglycaemia
Croup.

42. Tricyclic antidepressants
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
... blood sugars for hypoglycaemia
Intubate - tracheostromy or nebulized adrenaline.
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

43. A child has swallowed a battery. Mx
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes decreased cholinesterase activity.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

44. Iron
Nausea vomiting and anorexia.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidote is deferoxamine chelation. Charcoal is ineffective.

45. Ingesting Petrol. Cx?
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
Aspiration Pneumonia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Neurotoxins - procagulants. Rhabdomyolysins.

46. Acetaminophen
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Cyanosis and irregular respiratory effort

47. Iron
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
Objective signs of growth - tidiness - weight -
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidote is naloxone.

48. Which is better - activated charcoal or gastric lavage.
Stomach pumping.
Croup.
Flurescence in ultraviolet light.
CHARCOAL! except for lithium - iron - alcohol - lead.

49. Ethylene glycol
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

50. What is one of the technicalities of childabuse.
Poisoning causes decreased cholinesterase activity.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Digoxin Fab