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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. Sodium Bicarbonate
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Class of drugs encompassing decongestants - amphetamines - cocaine.

2. What else is in the management of snake bite?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Esmolol
Give steroids for management of serum sickness. Must do coagulation screen!!!
Blood glucose level for hypoglycaemia!!

3. When is gastric lavage indicated and contraindicated?
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

4. Hydrocarbons
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Digoxin Fab

5. Lead
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ceftriaxone
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

6. Ethylene glycol
Nausea vomiting and anorexia.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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

7. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

8. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Intubate - tracheostromy or nebulized adrenaline.

9. Ethylene glycol
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

10. What are the side effects of N-acety-p-benzoquinine?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Neurotoxins - procagulants. Rhabdomyolysins.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Rash bronchospasm and hypotension.

11. Acetaminophen
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidote is naloxone.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

12. Methanol
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Flurescence in ultraviolet light.
Cyanosis and irregular respiratory effort

13. Mx of snake bit
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Collar and cuff. Check integrity of nerve.

14. Carbon monoxide
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

15. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
It can cause fatal bronchioloitis obliterans
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.
Objective signs of growth - tidiness - weight -

16. Organophosphates antidotes
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Aspiration pneumonia even if intubated.
Objective signs of growth - tidiness - weight -
Antidotes are atropine sulfate and pralidoxime chloride.

17. What is one of the technicalities of childabuse.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Notify if abuse CONSIDERED. CONSIDERED.
Blood glucose level for hypoglycaemia!!

18. What must you do before sending fracture to radiology?
Skin or vascular compromise
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.
Immobilize with plaster slab
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

19. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Digoxin Fab

20. Amphetamine antidote
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.
Esmolol
Poisoning causes decreased cholinesterase activity.
Neurosurgery if trauma. Give mannitol.

21. What is the most important investigation in suspected alcohol poisoning in young person?
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 -
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.
Blood glucose level for hypoglycaemia!!

22. Management of near drowning.
Flumazenil
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) 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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

23. Mx severe croup
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.

24. What is the antibiotic for Epiglottitis?
Abdo XRAY!!!! do it!
Sling for 3 weeks - fracture clinic at 7 days.
Ceftriaxone
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.

25. What are the three features of anaphylaxis
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Give steroids for management of serum sickness. Must do coagulation screen!!!
Digoxin Fab

26. Indications of non-accidental injury
'I WOULD CALL POISON HOTLINE'.
Immobilize with plaster slab
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Notify if abuse CONSIDERED. CONSIDERED.

27. Ingesting Petrol. Cx?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans

28. Acetaminophen
Rash bronchospasm and hypotension.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

29. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
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.
Aspiration Pneumonia
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

30. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
... blood sugars for hypoglycaemia
Class of drugs encompassing decongestants - amphetamines - cocaine.
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

31. Opiates
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Normally treated with sling alone. Seek advice.
Antidote is naloxone.

32. Opiates
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Aspiration pneumonia even if intubated.

33. Amiodarone
Rash bronchospasm and hypotension.
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
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) 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

34. How may you detect semen?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flurescence in ultraviolet light.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

35. 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
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 3 weeks - fracture clinic at 7 days.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

36. Mx of petroleum overdose
Digoxin Fab
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans

37. Tricyclic antidepressants overdose
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

38. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Neurosurgery if trauma. Give mannitol.
... blood sugars for hypoglycaemia
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

39. Methanol
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Glucagon prefered - otherwise massive dose of adrenaline.

40. Mx of critical asthma
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

41. Benzodiazepine overdose antidote
Antidote is naloxone.
Notify if abuse CONSIDERED. CONSIDERED.
Flumazenil
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

42. Management of septicaemia shock

43. Oedema causing laryngeal obstruction?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Intubate - tracheostromy or nebulized adrenaline.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

44. Carbon monoxide
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
Rash bronchospasm and hypotension.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

45. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

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.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Collar and cuff. Check integrity of nerve.

47. Funnel web and red back
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Release NEUROTOXINS both have antivenom

48. Organophosphates
Normally treated with sling alone. Seek advice.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes decreased cholinesterase activity.
Abdo XRAY!!!! do it!

49. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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

50. Procainamide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Discobalt edetate
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.