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

2. Salicylates
Bone scan for occult fracture
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

3. Which is better - activated charcoal or gastric lavage.
Objective signs of growth - tidiness - weight -
CHARCOAL! except for lithium - iron - alcohol - lead.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

4. 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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Bone scan for occult fracture
Collar and cuff. Check integrity of nerve.

5. Cyanide
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Discobalt edetate
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

6. You must consider abuse in
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
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
Immobilize with plaster slab

7. What is the most appropriate examination in a child with suspected lead ingestion?
CHARCOAL! except for lithium - iron - alcohol - lead.
Abdo XRAY!!!! do it!
Nausea vomiting and anorexia.
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.

8. Management of near drowning.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Immobilize with plaster slab
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.

9. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidote is naloxone.
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

10. 45; 70
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blood glucose level for hypoglycaemia!!
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

11. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Intubate - tracheostromy or nebulized adrenaline.
IM adrenaline: vasopressor and bronchodilator.
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. Ibuprofen
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 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
Rash bronchospasm and hypotension.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

13. Ethylene glycol
Esmolol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Release NEUROTOXINS both have antivenom
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. How do snake bites damage?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurotoxins - procagulants. Rhabdomyolysins.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Objective signs of growth - tidiness - weight -

15. Amiodarone
Collar and cuff. Check integrity of nerve.
... blood sugars for hypoglycaemia
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

16. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.
Digoxin Fab
Abdo XRAY!!!! do it!

17. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
... blood sugars for hypoglycaemia
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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
Aspiration pneumonia even if intubated.

18. Mx of critical asthma
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.
It can cause fatal bronchioloitis obliterans
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

19. When is reduction required in fracture?
Ceftriaxone
Skin or vascular compromise
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.

20. Undisplaced surgical neck of humerous?
Munchausen's by proxy
Calcium chloride
Antidote is naloxone.
Sling for 3 weeks - fracture clinic at 7 days.

21. Indications of non-accidental injury
Severe illness - past history of injuries - 18 months or less - inconstent story.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

22. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Immobilize with plaster slab

23. What is the most common caUse of acute laryngeal obstruction?
Croup.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Neurosurgery if trauma. Give mannitol.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

24. When and how would you do whole bowel irrigation?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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

25. What must you do before sending fracture to radiology?
Poisoning causes decreased cholinesterase activity.
CHARCOAL! except for lithium - iron - alcohol - lead.
Immobilize with plaster slab
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

26. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Calcium chloride
Digoxin Fab

27. Mx of snake bit
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
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.
Aspiration pneumonia even if intubated.
Antidotes are atropine sulfate and pralidoxime chloride.

28. 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.
Calcium chloride
Stomach pumping.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

29. Carbon monoxide
It can cause fatal bronchioloitis obliterans
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

30. Calcium channel blocker overdose 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.
Calcium chloride
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

31. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Rash bronchospasm and hypotension.
IM adrenaline: vasopressor and bronchodilator.
Class of drugs encompassing decongestants - amphetamines - cocaine.

32. What is one of the technicalities of childabuse.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
CHARCOAL! except for lithium - iron - alcohol - lead.
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

33. Signs of psychological maltreatment?
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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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 - 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

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

35. Digoxin antedote
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Digoxin Fab

36. Amphetamine antidote
Esmolol
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.
Neurotoxins - procagulants. Rhabdomyolysins.

37. Sympathomimetics
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

38. Procainamide
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Aspiration pneumonia even if intubated.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

39. 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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Normally treated with sling alone. Seek advice.
Discobalt edetate

40. OSCE: how can i prevent accidents in my children
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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

41. Organophosphates
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Objective signs of growth - tidiness - weight -
Ceftriaxone
Poisoning causes decreased cholinesterase activity.

42. What is an important point to note about anaphylaxis?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Sling for 3 weeks - fracture clinic at 7 days.
Calcium chloride
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 -

43. Legal requirement in childabuse
Objective signs of growth - tidiness - weight -
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Notify if abuse CONSIDERED. CONSIDERED.

44. Benzodiazepine overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Stomach pumping.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Flumazenil

45. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

46. Acetaminophen
Blood glucose level for hypoglycaemia!!
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

47. What are the special features that must be done to correct haemorrhagic shock.
'I WOULD CALL POISON HOTLINE'.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Rash bronchospasm and hypotension.

48. What psychiatric disease defined as childabuse?

49. 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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Skin or vascular compromise

50. What is the most important investigation in suspected alcohol poisoning in young person?
Flurescence in ultraviolet light.
Objective signs of growth - tidiness - weight -
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blood glucose level for hypoglycaemia!!