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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. Adenosine
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

2. 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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidotes are atropine sulfate and pralidoxime chloride.
Glucagon prefered - otherwise massive dose of adrenaline.

3. Beta-blocker overdose antidote
Esmolol
Glucagon prefered - otherwise massive dose of adrenaline.
Normally treated with sling alone. Seek advice.
Aspiration pneumonia even if intubated.

4. Opiates
Antidote is naloxone.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Glucagon prefered - otherwise massive dose of adrenaline.
Flumazenil

5. Displaced surgical neck of humerous
Poisoning causes decreased cholinesterase activity.
Normally treated with sling alone. Seek advice.
Aspiration Pneumonia
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

6. Calcium gluconate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

7. What is the most important investigation in suspected alcohol poisoning in young person?
Normally treated with sling alone. Seek advice.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Blood glucose level for hypoglycaemia!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

8. Iron
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration Pneumonia
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

9. Management of septicaemia shock

10. 45; 70
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
Release NEUROTOXINS both have antivenom
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

11. What is the general management of poisoning?
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

12. Benzodiazepine overdose antidote
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.
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
Flumazenil

13. Carbon monoxide
Blood glucose level for hypoglycaemia!!
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Causes BAD constipation. Upsets fluid and electrolyte balance.

14. Tricyclic antidepressants
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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
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
Immobilize with plaster slab

15. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Glucagon prefered - otherwise massive dose of adrenaline.
Esmolol
Antidote is naloxone.

16. How do snake bites damage?
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.
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Normally treated with sling alone. Seek advice.

17. 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
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

18. Acetaminophen
Nausea vomiting and anorexia.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

19. 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.
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidotes are atropine sulfate and pralidoxime chloride.

20. Ethanol
Severe illness - past history of injuries - 18 months or less - inconstent story.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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 -

21. Ethylene glycol
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Flumazenil
Neurotoxins - procagulants. Rhabdomyolysins.

22. Iron
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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
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

23. What is the most common caUse of acute laryngeal obstruction?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Croup.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Aspiration pneumonia even if intubated.

24. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Flumazenil
... blood sugars for hypoglycaemia
Objective signs of growth - tidiness - weight -

25. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Calcium chloride
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

26. Amiodarone
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Stomach pumping.

27. what makes you suspicious of non-accidental injury.
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)
'I WOULD CALL POISON HOTLINE'.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

28. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
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

29. What investigations should you do in suspected child abuse
Croup.
Stomach pumping.
Bone scan for occult fracture
Nausea vomiting and anorexia.

30. Anticholinergics
Calcium chloride
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

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

32. You must consider abuse in
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Nausea vomiting and anorexia.
IM adrenaline: vasopressor and bronchodilator.
Severe illness - past history of injuries - 18 months or less - inconstent story.

33. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Give IM adrenaline - steroids - salbutamol - antihistamine.
... blood sugars for hypoglycaemia
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

34. Opiates
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

35. What psychiatric disease defined as childabuse?

36. Organophosphates
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
Digoxin Fab
Poisoning causes decreased cholinesterase activity.
Glucagon prefered - otherwise massive dose of adrenaline.

37. How may you detect semen?
Flurescence in ultraviolet light.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Flumazenil
Immobilize with plaster slab

38. What are the other treatments for anaphylaxis?
Rash bronchospasm and hypotension.
Discobalt edetate
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 -

39. Carbon monoxide
Munchausen's by proxy
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Release NEUROTOXINS both have antivenom

40. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Sling for 3 weeks - fracture clinic at 7 days.
Aspiration pneumonia even if intubated.

41. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
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.

42. Acetaminophen
Intubate - tracheostromy or nebulized adrenaline.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.
... blood sugars for hypoglycaemia

43. Hydrocarbons
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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
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

44. Undisplaced surgical neck of humerous?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Sling for 3 weeks - fracture clinic at 7 days.
Skin or vascular compromise

45. Middle Clavicle fracture management?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

46. Management of near drowning.
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Notify if abuse CONSIDERED. CONSIDERED.

47. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
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
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.
Collar and cuff. Check integrity of nerve.

48. Sodium Bicarbonate
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 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

49. Salicylates
Flumazenil
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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.
Digoxin Fab

50. Carbon monoxide
Stomach pumping.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.