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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. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

2. Salicylates
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
'I WOULD CALL POISON HOTLINE'.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

3. What is gastric lavage?
Flumazenil
Normally treated with sling alone. Seek advice.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Stomach pumping.

4. Organophosphates antidotes
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
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
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are atropine sulfate and pralidoxime chloride.

5. Organophosphates
Antidote is deferoxamine chelation. Charcoal is ineffective.
Aspiration pneumonia even if intubated.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Croup.

6. Digoxin antedote
Digoxin Fab
Severe illness - past history of injuries - 18 months or less - inconstent story.
Croup.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

7. Signs of psychological maltreatment?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Rash bronchospasm and hypotension.
Objective signs of growth - tidiness - weight -
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.

8. Ethanol
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 -
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

9. Acetaminophen
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Discobalt edetate
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

10. OSCE: how can i prevent accidents in my children
Causes BAD constipation. Upsets fluid and electrolyte balance.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
Aspiration Pneumonia

11. What evidence should a doctor give about parental neglect
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidote is naloxone.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Objective signs of growth - tidiness - weight -

12. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

13. What is the most important investigation in suspected alcohol poisoning in young person?
Antidotes are atropine sulfate and pralidoxime chloride.
Neurosurgery if trauma. Give mannitol.
Blood glucose level for hypoglycaemia!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

14. Undisplaced surgical neck of humerous?
Nausea vomiting and anorexia.
Ceftriaxone
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Sling for 3 weeks - fracture clinic at 7 days.

15. Lead
Objective signs of growth - tidiness - weight -
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Bone scan for occult fracture
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

16. Hydrocarbons
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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 decreased cholinesterase activity.

17. Amiodarone
Aspiration Pneumonia
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.
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.

18. Mx of critical asthma
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.

19. What are the other treatments for anaphylaxis?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Skin or vascular compromise
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 -
Give IM adrenaline - steroids - salbutamol - antihistamine.

20. What happens if charcoal is aspirated?
Aspiration Pneumonia
Esmolol
It can cause fatal bronchioloitis obliterans
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 -

21. 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.
Normally treated with sling alone. Seek advice.
Bone scan for occult fracture

22. What are the side effects of N-acety-p-benzoquinine?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Esmolol
Rash bronchospasm and hypotension.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

23. Anticholinergics
Digoxin Fab
Stomach pumping.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

24. Carbon monoxide
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.
Discobalt edetate

25. What is an important point to note about anaphylaxis?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
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 causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

26. 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 temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Esmolol

27. Tricyclic antidepressants overdose
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

28. Indications of non-accidental injury
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
CHARCOAL! except for lithium - iron - alcohol - lead.

29. When is gastric lavage indicated and contraindicated?
Rash bronchospasm and hypotension.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

30. Sympathomimetics
Skin or vascular compromise
Class of drugs encompassing decongestants - amphetamines - cocaine.
Digoxin Fab
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

31. Calcium channel blocker overdose antidote
Calcium chloride
Discobalt edetate
Sling for 3 weeks - fracture clinic at 7 days.
Abdo XRAY!!!! do it!

32. Adenosine
Class of drugs encompassing decongestants - amphetamines - cocaine.
Normally treated with sling alone. Seek advice.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

33. 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.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Causes BAD constipation. Upsets fluid and electrolyte balance.

34. 45; 70
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
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

35. Opiates
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidote is naloxone.

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

37. Sympathomimetics
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

38. What is the general management of poisoning?
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.
Skin or vascular compromise
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?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Neurotoxins - procagulants. Rhabdomyolysins.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

40. A child has swallowed a battery. Mx
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.
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
Skin or vascular compromise

41. what makes you suspicious of non-accidental injury.
Intubate - tracheostromy or nebulized adrenaline.
Blood glucose level for hypoglycaemia!!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

42. Tricyclic antidepressants
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
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

43. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

44. Ibuprofen
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Discobalt edetate
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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

45. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.

46. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
CHARCOAL! except for lithium - iron - alcohol - lead.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

47. What are the three features of anaphylaxis
Abdo XRAY!!!! do it!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Nausea vomiting and anorexia.
... blood sugars for hypoglycaemia

48. When is reduction required in fracture?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Calcium chloride
Skin or vascular compromise
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

49. Amphetamine antidote
Poisoning causes decreased cholinesterase activity.
Esmolol
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Munchausen's by proxy

50. 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.
Objective signs of growth - tidiness - weight -
Aspiration pneumonia even if intubated.
Give IM adrenaline - steroids - salbutamol - antihistamine.