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

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2. Mx raised intracranial pressure.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Stomach pumping.
Neurosurgery if trauma. Give mannitol.
Objective signs of growth - tidiness - weight -

3. What is a side effect of charcoal?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Nausea vomiting and anorexia.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Causes BAD constipation. Upsets fluid and electrolyte balance.

4. Oedema causing laryngeal obstruction?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Intubate - tracheostromy or nebulized adrenaline.
Discobalt edetate
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

5. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
'I WOULD CALL POISON HOTLINE'.
Neurosurgery if trauma. Give mannitol.

6. What is an important point to note about anaphylaxis?
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.
Skin or vascular compromise
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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 -

7. Cyanide
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Discobalt edetate
Cyanosis and irregular respiratory effort
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

8. Ethanol
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 -
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

9. Hydrocarbons
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nausea vomiting and anorexia.

10. Mx of snake bit
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.
Munchausen's by proxy
Release NEUROTOXINS both have antivenom
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

11. Mx of petroleum overdose
Collar and cuff. Check integrity of nerve.
Notify if abuse CONSIDERED. CONSIDERED.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

12. What psychiatric disease defined as childabuse?

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13. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Nausea vomiting and anorexia.
Blood glucose level for hypoglycaemia!!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

14. What investigations should you do in suspected child abuse
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Bone scan for occult fracture

15. Organophosphates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes decreased cholinesterase activity.
Discobalt edetate
Give steroids for management of serum sickness. Must do coagulation screen!!!

16. Lead
Munchausen's by proxy
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

17. How do snake bites damage?
Immobilize with plaster slab
Antidote is deferoxamine chelation. Charcoal is ineffective.
Neurotoxins - procagulants. Rhabdomyolysins.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

18. When is reduction required in fracture?
Give IM adrenaline - steroids - salbutamol - antihistamine.
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 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
Skin or vascular compromise

19. 20
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Flumazenil

20. Anticholinergics
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

21. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Class of drugs encompassing decongestants - amphetamines - cocaine.

22. What evidence should a doctor give about parental neglect
Poisoning causes decreased cholinesterase activity.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Objective signs of growth - tidiness - weight -
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

23. When and how would you do whole bowel irrigation?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

24. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Aspiration pneumonia even if intubated.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Intubate - tracheostromy or nebulized adrenaline.

25. Undisplaced surgical neck of humerous?
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
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab
Sling for 3 weeks - fracture clinic at 7 days.

26. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Aspiration pneumonia even if intubated.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidote is naloxone.

27. Which is better - activated charcoal or gastric lavage.
Skin or vascular compromise
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
CHARCOAL! except for lithium - iron - alcohol - lead.
Nausea vomiting and anorexia.

28. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Release NEUROTOXINS both have antivenom
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

29. What is the antibiotic for Epiglottitis?
Calcium chloride
Ceftriaxone
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

30. What is gastric lavage?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Stomach pumping.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

31. Methanol
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Collar and cuff. Check integrity of nerve.
Nausea vomiting and anorexia.

32. Ingesting Petrol. Cx?
Bone scan for occult fracture
IM adrenaline: vasopressor and bronchodilator.
Cyanosis and irregular respiratory effort
Aspiration Pneumonia

33. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidotes are atropine sulfate and pralidoxime chloride.
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.

34. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Discobalt edetate
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

35. Benzodiazepine overdose antidote
Antidote is naloxone.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Neurotoxins - procagulants. Rhabdomyolysins.
Flumazenil

36. 45; 70
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
CHARCOAL! except for lithium - iron - alcohol - lead.
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

37. OSCE: What are the five princples of discharging a patient with a fracture?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

38. Iron
Objective signs of growth - tidiness - weight -
Glucagon prefered - otherwise massive dose of adrenaline.
Nausea vomiting and anorexia.
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

39. What is one of the technicalities of childabuse.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Objective signs of growth - tidiness - weight -
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

40. Carbon monoxide
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

41. What must you do before sending fracture to radiology?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Immobilize with plaster slab
Release NEUROTOXINS both have antivenom
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

42. How may you detect semen?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Flurescence in ultraviolet light.

43. Middle Clavicle fracture management?
Flurescence in ultraviolet light.
Collar and cuff. Check integrity of nerve.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

44. Calcium channel blocker overdose antidote
Immobilize with plaster slab
Glucagon prefered - otherwise massive dose of adrenaline.
Calcium chloride
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

45. When is gastric lavage indicated and contraindicated?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

46. Signs of abuse from the history
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

47. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

48. Indications of non-accidental injury
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 3 weeks - fracture clinic at 7 days.

49. Opiates
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurosurgery if trauma. Give mannitol.
It can cause fatal bronchioloitis obliterans
Antidote is naloxone.

50. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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 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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy