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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

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Answer 50 questions in 15 minutes.
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1. When is gastric lavage indicated and contraindicated?
Antidote is naloxone.
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
Bone scan for occult fracture

2. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Discobalt edetate
Neurosurgery if trauma. Give mannitol.

3. Ingesting Petrol. Cx?
Nausea vomiting and anorexia.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Aspiration Pneumonia
Before a child can be examined for child abuse - a parent or legal guardian must give consent

4. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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 -
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

5. Sympathomimetics
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Glucagon prefered - otherwise massive dose of adrenaline.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

6. What are the special features that must be done to correct haemorrhagic shock.
Ceftriaxone
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Collar and cuff. Check integrity of nerve.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

7. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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
Neurotoxins - procagulants. Rhabdomyolysins.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

8. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
'I WOULD CALL POISON HOTLINE'.
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.

9. Sodium Bicarbonate
Ceftriaxone
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Glucagon prefered - otherwise massive dose of adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

10. What is a side effect of charcoal?
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Calcium chloride
Causes BAD constipation. Upsets fluid and electrolyte balance.

11. What psychiatric disease defined as childabuse?

12. What must you do before sending fracture to radiology?
Sling for 3 weeks - fracture clinic at 7 days.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Immobilize with plaster slab
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

13. Mx of critical asthma
Cyanosis and irregular respiratory effort
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Discobalt edetate

14. Salicylates
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

15. What is the most important investigation in suspected alcohol poisoning in young person?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Bone scan for occult fracture
Blood glucose level for hypoglycaemia!!
Intubate - tracheostromy or nebulized adrenaline.

16. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
It can cause fatal bronchioloitis obliterans
Flumazenil

17. What else is in the management of snake bite?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

18. Tricyclic antidepressants overdose
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Immobilize with plaster slab
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

19. Carbon monoxide
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.
Aspiration pneumonia even if intubated.
Normally treated with sling alone. Seek advice.

20. 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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 3 weeks - fracture clinic at 7 days.

21. Hydrocarbons
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

22. Lead
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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Esmolol

23. Ibuprofen
... blood sugars for hypoglycaemia
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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

24. 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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes decreased cholinesterase activity.
Glucagon prefered - otherwise massive dose of adrenaline.

25. Salicylates
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Abdo XRAY!!!! do it!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

26. Ethylene glycol
Neurosurgery if trauma. Give mannitol.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

27. Mx of petroleum overdose
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

28. Epinephrine
Abdo XRAY!!!! do it!
It can cause fatal bronchioloitis obliterans
Cyanosis and irregular respiratory effort
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

29. What is the most important treatment for anaphylaxis
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
... blood sugars for hypoglycaemia
Severe illness - past history of injuries - 18 months or less - inconstent story.
IM adrenaline: vasopressor and bronchodilator.

30. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

31. Organophosphates antidotes
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

32. Organophosphates
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.
Intubate - tracheostromy or nebulized adrenaline.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes decreased cholinesterase activity.

33. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Nausea vomiting and anorexia.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Stomach pumping.

34. What evidence should a doctor give about parental neglect
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Objective signs of growth - tidiness - weight -
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

35. Amphetamine antidote
Bone scan for occult fracture
Esmolol
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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 -

36. Procainamide
Causes BAD constipation. Upsets fluid and electrolyte balance.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

37. Mx raised intracranial pressure.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Munchausen's by proxy
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

38. 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 -
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Neurotoxins - procagulants. Rhabdomyolysins.

39. How do snake bites damage?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Neurotoxins - procagulants. Rhabdomyolysins.

40. 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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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

41. Signs of psychological maltreatment?
Digoxin Fab
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
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.

42. Atropine
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Ceftriaxone

43. Cyanide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Nausea vomiting and anorexia.
Discobalt edetate
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

44. Carbon monoxide
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is deferoxamine chelation. Charcoal is ineffective.

45. Signs of abuse from the history
Discobalt edetate
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

46. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Flumazenil
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.

47. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Stomach pumping.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

48. Opiates
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is naloxone.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Ceftriaxone

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

50. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

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Pediatric Emergency Medicine

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