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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.
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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. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Release NEUROTOXINS both have antivenom
Sling for 3 weeks - fracture clinic at 7 days.
Discobalt edetate

2. Sympathomimetics
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Collar and cuff. Check integrity of nerve.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

3. Organophosphates antidotes
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidotes are atropine sulfate and pralidoxime chloride.

4. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

5. When and how would you do whole bowel irrigation?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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 -
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

6. What is the most important investigation in suspected alcohol poisoning in young person?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Immobilize with plaster slab
Release NEUROTOXINS both have antivenom
Blood glucose level for hypoglycaemia!!

7. Lead
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Antidotes are atropine sulfate and pralidoxime chloride.

8. 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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

9. Oedema causing laryngeal obstruction?
Neurosurgery if trauma. Give mannitol.
'I WOULD CALL POISON HOTLINE'.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Intubate - tracheostromy or nebulized adrenaline.

10. What are the side effects of N-acety-p-benzoquinine?
Antidotes are atropine sulfate and pralidoxime chloride.
Rash bronchospasm and hypotension.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

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

12. Mx severe croup
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.
Notify if abuse CONSIDERED. CONSIDERED.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

13. Calcium channel blocker overdose antidote
Calcium chloride
Cyanosis and irregular respiratory effort
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.
'I WOULD CALL POISON HOTLINE'.

14. Amphetamine antidote
Cyanosis and irregular respiratory effort
Esmolol
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

15. What must you do before sending fracture to radiology?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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
Immobilize with plaster slab

16. Opiates
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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 -
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

17. Beta-blocker overdose antidote
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

18. Acetaminophen
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

19. Which is better - activated charcoal or gastric lavage.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
CHARCOAL! except for lithium - iron - alcohol - lead.
Bone scan for occult fracture

20. Cyanide
Discobalt edetate
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 causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - 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.

21. Carbon monoxide
Aspiration Pneumonia
Bone scan for occult fracture
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Discobalt edetate

22. Mx of snake bit
Ceftriaxone
'I WOULD CALL POISON HOTLINE'.
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.

23. Amiodarone
Skin or vascular compromise
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.

24. Theophylline
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
Croup.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Esmolol

25. 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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

26. Salicylates
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Cyanosis and irregular respiratory effort
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

27. Undisplaced radial shaft fracture
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Collar and cuff. Check integrity of nerve.
Flumazenil
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.

28. Middle Clavicle fracture management?
Calcium chloride
Normally treated with sling alone. Seek advice.
Collar and cuff. Check integrity of nerve.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

29. What is the first line investigation in a young child who has consumed alcohol?
Antidotes are atropine sulfate and pralidoxime chloride.
CHARCOAL! except for lithium - iron - alcohol - lead.
... blood sugars for hypoglycaemia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

30. Displaced surgical neck of humerous
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Normally treated with sling alone. Seek advice.
Rash bronchospasm and hypotension.
Skin or vascular compromise

31. Salicylates
Cyanosis and irregular respiratory effort
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

32. Anticholinergics
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

33. Ethanol
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Aspiration Pneumonia
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

34. Anticholinergics
Collar and cuff. Check integrity of nerve.
Neurosurgery if trauma. Give mannitol.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

35. What is the most important treatment for anaphylaxis
Flumazenil
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
IM adrenaline: vasopressor and bronchodilator.
Aspiration Pneumonia

36. 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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Aspiration Pneumonia
CHARCOAL! except for lithium - iron - alcohol - lead.

37. Carbon monoxide
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Neurotoxins - procagulants. Rhabdomyolysins.
Neurosurgery if trauma. Give mannitol.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

38. Organophosphates
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 -
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

39. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
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 -
Intubate - tracheostromy or nebulized adrenaline.
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

40. What are the three features of anaphylaxis
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
It can cause fatal bronchioloitis obliterans
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

41. What are the other treatments for anaphylaxis?
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.
Discobalt edetate
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

42. When is reduction required in fracture?
Skin or vascular compromise
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

43. What is one of the technicalities of childabuse.
Croup.
Rash bronchospasm and hypotension.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

44. Epinephrine
Abdo XRAY!!!! do it!
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Severe illness - past history of injuries - 18 months or less - inconstent story.
'I WOULD CALL POISON HOTLINE'.

45. What are the special features that must be done to correct haemorrhagic shock.
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Blood glucose level for hypoglycaemia!!
... blood sugars for hypoglycaemia

46. 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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Aspiration pneumonia even if intubated.
Bone scan for occult fracture

47. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
... blood sugars for hypoglycaemia

48. Tricyclic antidepressants overdose
Flumazenil
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Bone scan for occult fracture

49. How do snake bites damage?
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.
Release NEUROTOXINS both have antivenom
Calcium chloride

50. Mx of petroleum overdose
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Rash bronchospasm and hypotension.
Flurescence in ultraviolet light.