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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. Carbon monoxide
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Neurotoxins - procagulants. Rhabdomyolysins.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

2. You must consider abuse in
Intubate - tracheostromy or nebulized adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Severe illness - past history of injuries - 18 months or less - inconstent story.

3. Organophosphates
Aspiration pneumonia even if intubated.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - 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.

4. Atropine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

5. Management of near drowning.
Antidotes are atropine sulfate and pralidoxime chloride.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

6. Mx of snake bit
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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
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) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

7. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Objective signs of growth - tidiness - weight -
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
'I WOULD CALL POISON HOTLINE'.

8. What are the three features of anaphylaxis
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Neurosurgery if trauma. Give mannitol.
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.

9. Funnel web and red back
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Release NEUROTOXINS both have antivenom
Nausea vomiting and anorexia.

10. Methanol
Cyanosis and irregular respiratory effort
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

11. Mx of petroleum overdose
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

12. What investigations should you do in suspected child abuse
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Bone scan for occult fracture
Neurotoxins - procagulants. Rhabdomyolysins.

13. Iron
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flumazenil
Blood glucose level for hypoglycaemia!!

14. Acetaminophen
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Give IM adrenaline - steroids - salbutamol - antihistamine.

15. Ingesting Petrol. Cx?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Aspiration Pneumonia
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

16. Sodium Bicarbonate
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Flumazenil
Ceftriaxone
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

17. what makes you suspicious of non-accidental injury.
Abdo XRAY!!!! do it!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

18. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
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.
It can cause fatal bronchioloitis obliterans
Immobilize with plaster slab

19. Management of septicaemia shock

20. Anticholinergics
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 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.
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.

21. Amphetamine antidote
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.
Esmolol
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
Calcium chloride

22. Calcium channel blocker overdose antidote
Release NEUROTOXINS both have antivenom
Rash bronchospasm and hypotension.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Calcium chloride

23. Epinephrine
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Discobalt edetate

24. Indications of non-accidental injury
Flurescence in ultraviolet light.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

25. What must you do before sending fracture to radiology?
Immobilize with plaster slab
'I WOULD CALL POISON HOTLINE'.
Stomach pumping.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

26. What happens if charcoal is aspirated?
Skin or vascular compromise
It can cause fatal bronchioloitis obliterans
Neurosurgery if trauma. Give mannitol.
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.

27. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Collar and cuff. Check integrity of nerve.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

28. Mx severe croup
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

29. Undisplaced surgical neck of humerous?
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 3 weeks - fracture clinic at 7 days.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidote is naloxone.

30. Displaced surgical neck of humerous
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Aspiration pneumonia even if intubated.
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.
Normally treated with sling alone. Seek advice.

31. Oedema causing laryngeal obstruction?
Aspiration pneumonia even if intubated.
Release NEUROTOXINS both have antivenom
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Intubate - tracheostromy or nebulized adrenaline.

32. 20
Glucagon prefered - otherwise massive dose of adrenaline.
Immobilize with plaster slab
'I WOULD CALL POISON HOTLINE'.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

33. What are the terminal signs of acute laryngeal obstruction?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blood glucose level for hypoglycaemia!!
Cyanosis and irregular respiratory effort

34. When is reduction required in fracture?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
Skin or vascular compromise

35. Carbon monoxide
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.
Antidote is deferoxamine chelation. Charcoal is ineffective.

36. Opiates
Antidote is naloxone.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
... blood sugars for hypoglycaemia
Rash bronchospasm and hypotension.

37. Iron
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Discobalt edetate
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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

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

39. How do snake bites damage?
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

40. Middle Clavicle fracture management?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Flumazenil

41. Opiates
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidote is deferoxamine chelation. Charcoal is ineffective.

42. OSCE: how can i prevent accidents in my children
Intubate - tracheostromy or nebulized adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Flumazenil
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 is one of the technicalities of childabuse.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Glucagon prefered - otherwise massive dose of adrenaline.
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

44. What is an important point to note about anaphylaxis?
Munchausen's by proxy
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -
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

45. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration pneumonia even if intubated.
Give IM adrenaline - steroids - salbutamol - antihistamine.

46. Beta-blocker overdose antidote
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
Glucagon prefered - otherwise massive dose of adrenaline.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Aspiration Pneumonia

47. What is the antibiotic for Epiglottitis?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Bone scan for occult fracture
Ceftriaxone
Sling for 3 weeks - fracture clinic at 7 days.

48. How may you detect semen?
Flurescence in ultraviolet light.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Collar and cuff. Check integrity of nerve.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

49. Lead
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give steroids for management of serum sickness. Must do coagulation screen!!!

50. Mx raised intracranial pressure.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Neurosurgery if trauma. Give mannitol.
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.