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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. Amiodarone
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Calcium chloride
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.
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.

2. What are the three features of anaphylaxis
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

3. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

4. How do snake bites damage?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Neurotoxins - procagulants. Rhabdomyolysins.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

5. Organophosphates antidotes
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidotes are atropine sulfate and pralidoxime chloride.
Give steroids for management of serum sickness. Must do coagulation screen!!!

6. Anticholinergics
Poisoning causes decreased cholinesterase activity.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Discobalt edetate
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.

7. What is the most important treatment for anaphylaxis
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Give IM adrenaline - steroids - salbutamol - antihistamine.
IM adrenaline: vasopressor and bronchodilator.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

8. What evidence should a doctor give about parental neglect
Digoxin Fab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Cyanosis and irregular respiratory effort
Objective signs of growth - tidiness - weight -

9. Atropine
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Intubate - tracheostromy or nebulized adrenaline.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cyanosis and irregular respiratory effort

10. When and how would you do whole bowel irrigation?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

11. Undisplaced radial shaft fracture
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Aspiration Pneumonia
Collar and cuff. Check integrity of nerve.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

12. OSCE: how can i prevent accidents in my children
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.
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
Blood glucose level for hypoglycaemia!!
Causes BAD constipation. Upsets fluid and electrolyte balance.

13. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Antidotes are atropine sulfate and pralidoxime chloride.
Aspiration pneumonia even if intubated.
Skin or vascular compromise
Cyanosis and irregular respiratory effort

14. Calcium channel blocker overdose antidote
Antidote is deferoxamine chelation. Charcoal is ineffective.
Glucagon prefered - otherwise massive dose of adrenaline.
Calcium chloride
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

15. Ethanol
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 -
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurosurgery if trauma. Give mannitol.

16. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

17. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Normally treated with sling alone. Seek advice.
Esmolol
Causes BAD constipation. Upsets fluid and electrolyte balance.

18. Management of near drowning.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

19. Iron
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Munchausen's by proxy
Severe illness - past history of injuries - 18 months or less - inconstent story.

20. Benzodiazepine overdose antidote
Flumazenil
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

21. What is an important point to note about anaphylaxis?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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 -
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

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

23. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Discobalt edetate
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

24. Anticholinergics
Abdo XRAY!!!! do it!
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
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

25. Indications of non-accidental injury
Neurosurgery if trauma. Give mannitol.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Digoxin Fab
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

26. Ethylene glycol
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
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
CHARCOAL! except for lithium - iron - alcohol - lead.
Release NEUROTOXINS both have antivenom

27. Carbon monoxide
Normally treated with sling alone. Seek advice.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Neurotoxins - procagulants. Rhabdomyolysins.
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 -

28. What is the general management of poisoning?
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
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.

29. 20
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurotoxins - procagulants. Rhabdomyolysins.

30. Beta-blocker overdose antidote
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
Calcium chloride
Glucagon prefered - otherwise massive dose of adrenaline.
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.

31. When is gastric lavage indicated and contraindicated?
Croup.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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

32. what makes you suspicious of non-accidental injury.
Aspiration Pneumonia
Bone scan for occult fracture
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

33. What is a side effect of charcoal?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
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
Causes BAD constipation. Upsets fluid and electrolyte balance.

34. What else is in the management of snake bite?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Digoxin Fab
Give steroids for management of serum sickness. Must do coagulation screen!!!
Skin or vascular compromise

35. Methanol
Normally treated with sling alone. Seek advice.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.

36. Mx of critical asthma
Neurosurgery if trauma. Give mannitol.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Neurotoxins - procagulants. Rhabdomyolysins.

37. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Rash bronchospasm and hypotension.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

38. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
Aspiration pneumonia even if intubated.

39. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Sling for 3 weeks - fracture clinic at 7 days.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

40. Carbon monoxide
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
... blood sugars for hypoglycaemia

41. When is reduction required in fracture?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.

42. Ingesting Petrol. Cx?
Skin or vascular compromise
Digoxin Fab
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Aspiration Pneumonia

43. What is the most common caUse of acute laryngeal obstruction?
IM adrenaline: vasopressor and bronchodilator.
Munchausen's by proxy
Croup.
Digoxin Fab

44. Methanol
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Collar and cuff. Check integrity of nerve.
Digoxin Fab

45. Tricyclic antidepressants overdose
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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 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

46. Oedema causing laryngeal obstruction?
Munchausen's by proxy
Intubate - tracheostromy or nebulized adrenaline.
Blood glucose level for hypoglycaemia!!
... blood sugars for hypoglycaemia

47. Acetaminophen
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
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.

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

49. Calcium gluconate
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes BAD constipation. Upsets fluid and electrolyte balance.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

50. Management of septicaemia shock