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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. What is the most common caUse of acute laryngeal obstruction?
Croup.
Immobilize with plaster slab
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is naloxone.

2. Theophylline
Nausea vomiting and anorexia.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

3. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

4. A child has swallowed a battery. Mx
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
IM adrenaline: vasopressor and bronchodilator.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

5. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
IM adrenaline: vasopressor and bronchodilator.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Stomach pumping.

6. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
CHARCOAL! except for lithium - iron - alcohol - lead.
Intubate - tracheostromy or nebulized adrenaline.

7. Ethylene glycol
Calcium chloride
Aspiration pneumonia even if intubated.
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
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

8. How do snake bites damage?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Notify if abuse CONSIDERED. CONSIDERED.
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.

9. Ingesting Petrol. Cx?
Immobilize with plaster slab
Aspiration Pneumonia
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

10. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Release NEUROTOXINS both have antivenom
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

11. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Esmolol
Give IM adrenaline - steroids - salbutamol - antihistamine.

12. Legal requirement in childabuse
Antidote is naloxone.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Abdo XRAY!!!! do it!
Notify if abuse CONSIDERED. CONSIDERED.

13. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Munchausen's by proxy

14. Ethanol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

15. Calcium channel blocker overdose antidote
Release NEUROTOXINS both have antivenom
Calcium chloride
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.
Cyanosis and irregular respiratory effort

16. When is reduction required in fracture?
Skin or vascular compromise
Antidote is naloxone.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

17. Sympathomimetics
Blood glucose level for hypoglycaemia!!
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

18. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

19. What are the early symptoms of paracetamol overdose?
Neurosurgery if trauma. Give mannitol.
IM adrenaline: vasopressor and bronchodilator.
Nausea vomiting and anorexia.
Flurescence in ultraviolet light.

20. Methanol
Munchausen's by proxy
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
... blood sugars for hypoglycaemia

21. When and how would you do whole bowel irrigation?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Stomach pumping.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

22. Digoxin antedote
It can cause fatal bronchioloitis obliterans
Calcium chloride
Digoxin Fab
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.

23. What are the other treatments for anaphylaxis?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
It can cause fatal bronchioloitis obliterans

24. Atropine
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Objective signs of growth - tidiness - weight -
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.

25. What are the side effects of N-acety-p-benzoquinine?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Severe illness - past history of injuries - 18 months or less - inconstent story.
Rash bronchospasm and hypotension.

26. When is gastric lavage indicated and contraindicated?
Stomach pumping.
Intubate - tracheostromy or nebulized adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

27. What must you do before sending fracture to radiology?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Immobilize with plaster slab
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.
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

28. Carbon monoxide
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidotes are atropine sulfate and pralidoxime chloride.
Flumazenil

29. 20
IM adrenaline: vasopressor and bronchodilator.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

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

31. What is the most important treatment for anaphylaxis
CHARCOAL! except for lithium - iron - alcohol - lead.
IM adrenaline: vasopressor and bronchodilator.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

32. What is a side effect of charcoal?
Stomach pumping.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Causes BAD constipation. Upsets fluid and electrolyte balance.
It can cause fatal bronchioloitis obliterans

33. 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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Discobalt edetate

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

35. Signs of psychological maltreatment?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.
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

36. 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.
Antidote is naloxone.
Skin or vascular compromise
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

37. Organophosphates antidotes
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidotes are atropine sulfate and pralidoxime chloride.

38. What else is in the management of snake bite?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

39. What psychiatric disease defined as childabuse?

40. Lead
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

41. Mx of petroleum overdose
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Discobalt edetate
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Release NEUROTOXINS both have antivenom

42. 45; 70
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

43. Adenosine
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.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

44. Mx of critical asthma
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Abdo XRAY!!!! do it!

45. Mx of snake bit
Munchausen's by proxy
Skin or vascular compromise
Ceftriaxone
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.

46. What is an important point to note about anaphylaxis?
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 -
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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
Aspiration Pneumonia

47. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Collar and cuff. Check integrity of nerve.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

48. Oedema causing laryngeal obstruction?
Antidote is naloxone.
Normally treated with sling alone. Seek advice.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Intubate - tracheostromy or nebulized adrenaline.

49. What is gastric lavage?
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
Flurescence in ultraviolet light.
Give IM adrenaline - steroids - salbutamol - antihistamine.

50. 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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
It can cause fatal bronchioloitis obliterans
Skin or vascular compromise