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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. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
Esmolol
Intubate - tracheostromy or nebulized adrenaline.

2. Methanol
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.
Neurosurgery if trauma. Give mannitol.

3. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Blood glucose level for hypoglycaemia!!
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 -
Normally treated with sling alone. Seek advice.

4. Acetaminophen
Normally treated with sling alone. Seek advice.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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 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.

5. Organophosphates
Bone scan for occult fracture
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes decreased cholinesterase activity.

6. Ethylene glycol
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Digoxin Fab
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

7. Oedema causing laryngeal obstruction?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Normally treated with sling alone. Seek advice.
Notify if abuse CONSIDERED. CONSIDERED.
Intubate - tracheostromy or nebulized adrenaline.

8. Adenosine
Rash bronchospasm and hypotension.
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

9. Hydrocarbons
Class of drugs encompassing decongestants - amphetamines - cocaine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

10. Legal requirement in childabuse
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
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Rash bronchospasm and hypotension.

11. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Give steroids for management of serum sickness. Must do coagulation screen!!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Notify if abuse CONSIDERED. CONSIDERED.

12. Funnel web and red back
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.
Release NEUROTOXINS both have antivenom
... blood sugars for hypoglycaemia

13. Signs of psychological maltreatment?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Objective signs of growth - tidiness - weight -
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

14. You must consider abuse in
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

15. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Stomach pumping.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ceftriaxone

16. A child has swallowed a battery. Mx
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidote is naloxone.
Munchausen's by proxy
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

17. Beta-blocker overdose antidote
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Glucagon prefered - otherwise massive dose of adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

18. What is the most important treatment for anaphylaxis
Notify if abuse CONSIDERED. CONSIDERED.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
IM adrenaline: vasopressor and bronchodilator.

19. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

20. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidotes are atropine sulfate and pralidoxime chloride.
CHARCOAL! except for lithium - iron - alcohol - lead.

21. Digoxin antedote
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
IM adrenaline: vasopressor and bronchodilator.
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.

22. Anticholinergics
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 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
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

23. What is the antibiotic for Epiglottitis?
Ceftriaxone
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

24. How may you detect semen?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Flurescence in ultraviolet light.
Stomach pumping.
Notify if abuse CONSIDERED. CONSIDERED.

25. What else is in the management of snake bite?
Poisoning causes decreased cholinesterase activity.
Sling for 3 weeks - fracture clinic at 7 days.
... blood sugars for hypoglycaemia
Give steroids for management of serum sickness. Must do coagulation screen!!!

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

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27. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Neurotoxins - procagulants. Rhabdomyolysins.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Aspiration pneumonia even if intubated.

28. Anticholinergics
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Bone scan for occult fracture

29. When is gastric lavage indicated and contraindicated?
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidotes are atropine sulfate and pralidoxime chloride.

30. Sympathomimetics
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Objective signs of growth - tidiness - weight -
Class of drugs encompassing decongestants - amphetamines - cocaine.

31. Ethanol
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent

32. What evidence should a doctor give about parental neglect
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
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
Objective signs of growth - tidiness - weight -

33. OSCE: how can i prevent accidents in my children
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
Normally treated with sling alone. Seek advice.
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.

34. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

35. What are the side effects of N-acety-p-benzoquinine?
Notify if abuse CONSIDERED. CONSIDERED.
Neurotoxins - procagulants. Rhabdomyolysins.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Rash bronchospasm and hypotension.

36. 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.
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 -
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Notify if abuse CONSIDERED. CONSIDERED.

37. OSCE: What are the five princples of discharging a patient with a fracture?
... blood sugars for hypoglycaemia
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. What are the early symptoms of paracetamol overdose?
Severe illness - past history of injuries - 18 months or less - inconstent story.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Nausea vomiting and anorexia.

39. Lidocaine
Aspiration pneumonia even if intubated.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

40. Middle Clavicle fracture management?
It can cause fatal bronchioloitis obliterans
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

41. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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

42. Carbon monoxide
Flurescence in ultraviolet light.
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.
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

43. what makes you suspicious of non-accidental injury.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

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

45. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Skin or vascular compromise
Croup.

46. Management of septicaemia shock

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47. Mx raised intracranial pressure.
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Neurosurgery if trauma. Give mannitol.
Antidotes are atropine sulfate and pralidoxime chloride.

48. What is the general management of poisoning?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Causes BAD constipation. Upsets fluid and electrolyte balance.
Immobilize with plaster slab
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

49. Calcium gluconate
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Collar and cuff. Check integrity of nerve.

50. What investigations should you do in suspected child abuse
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Bone scan for occult fracture