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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

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Answer 50 questions in 30 minutes.
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1. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Collar and cuff. Check integrity of nerve.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Blood glucose level for hypoglycaemia!!

2. Lidocaine
Discobalt edetate
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 causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

3. What else is in the management of snake bite?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Intubate - tracheostromy or nebulized adrenaline.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

4. What are the early symptoms of paracetamol overdose?
Collar and cuff. Check integrity of nerve.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Nausea vomiting and anorexia.
Severe illness - past history of injuries - 18 months or less - inconstent story.

5. Beta-blocker overdose antidote
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Glucagon prefered - otherwise massive dose of adrenaline.
Neurotoxins - procagulants. Rhabdomyolysins.
Flumazenil

6. How may you detect semen?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flurescence in ultraviolet light.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Bone scan for occult fracture

7. Theophylline
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

8. Legal requirement in childabuse
Antidotes are atropine sulfate and pralidoxime chloride.
Digoxin Fab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Notify if abuse CONSIDERED. CONSIDERED.

9. Benzodiazepine overdose antidote
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.
Flumazenil
Nausea vomiting and anorexia.
Blood glucose level for hypoglycaemia!!

10. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
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
Antidote is naloxone.

11. Epinephrine
Croup.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

12. Undisplaced radial shaft fracture
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.
'I WOULD CALL POISON HOTLINE'.
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
Collar and cuff. Check integrity of nerve.

13. Anticholinergics
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

14. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

15. Mx of snake bit
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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

16. What investigations should you do in suspected child abuse
Lead poisoning is defined as a serum level greater than ___ ug/dL.
'I WOULD CALL POISON HOTLINE'.
Bone scan for occult fracture
Give steroids for management of serum sickness. Must do coagulation screen!!!

17. Digoxin antedote
Antidote is deferoxamine chelation. Charcoal is ineffective.
Digoxin Fab
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Cyanosis and irregular respiratory effort

18. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Munchausen's by proxy

19. A child has swallowed a battery. Mx
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Give IM adrenaline - steroids - salbutamol - antihistamine.
Ceftriaxone

20. Amphetamine antidote
Esmolol
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Blood glucose level for hypoglycaemia!!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

21. What is an important point to note about anaphylaxis?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
CHARCOAL! except for lithium - iron - alcohol - lead.
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 -
Objective signs of growth - tidiness - weight -

22. What must you do before sending fracture to radiology?
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.
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
... blood sugars for hypoglycaemia

23. Which is better - activated charcoal or gastric lavage.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
CHARCOAL! except for lithium - iron - alcohol - lead.
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

24. Sympathomimetics
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
Glucagon prefered - otherwise massive dose of adrenaline.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

25. Opiates
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.
Antidote is naloxone.
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 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.

26. What happens if charcoal is aspirated?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
It can cause fatal bronchioloitis obliterans

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

28. Ibuprofen
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
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

29. What is the first line investigation in a young child who has consumed alcohol?
Rash bronchospasm and hypotension.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
... blood sugars for hypoglycaemia

30. Mx raised intracranial pressure.
Collar and cuff. Check integrity of nerve.
Cyanosis and irregular respiratory effort
Neurosurgery if trauma. Give mannitol.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

31. What psychiatric disease defined as childabuse?

32. Management of near drowning.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Munchausen's by proxy
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

33. Displaced surgical neck of humerous
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Normally treated with sling alone. Seek advice.

34. Carbon monoxide
Intubate - tracheostromy or nebulized adrenaline.
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)
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

35. what makes you suspicious of non-accidental injury.
Munchausen's by proxy
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

36. You must consider abuse in
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Severe illness - past history of injuries - 18 months or less - inconstent story.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

37. Funnel web and red back
Objective signs of growth - tidiness - weight -
Flumazenil
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Release NEUROTOXINS both have antivenom

38. Iron
Aspiration pneumonia even if intubated.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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. Sympathomimetics
Neurosurgery if trauma. Give mannitol.
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

40. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Esmolol
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

41. 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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
... blood sugars for hypoglycaemia
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.

42. When is gastric lavage indicated and contraindicated?
Poisoning causes decreased cholinesterase activity.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Skin or vascular compromise
Give steroids for management of serum sickness. Must do coagulation screen!!!

43. When is reduction required in fracture?
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
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

44. Cyanide
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Discobalt edetate

45. Tricyclic antidepressants
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

46. What is a side effect of charcoal?
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 -
... blood sugars for hypoglycaemia
Causes BAD constipation. Upsets fluid and electrolyte balance.

47. Indications of non-accidental injury
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration Pneumonia
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.

48. What is the most important treatment for anaphylaxis
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Abdo XRAY!!!! do it!
IM adrenaline: vasopressor and bronchodilator.
Esmolol

49. What are the side effects of N-acety-p-benzoquinine?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Stomach pumping.
Discobalt edetate
Rash bronchospasm and hypotension.

50. What are the three features of anaphylaxis
Glucagon prefered - otherwise massive dose of adrenaline.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Before a child can be examined for child abuse - a parent or legal guardian must give consent

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Pediatric Emergency Medicine

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After Effects Keyboard Shortcuts

Agile Development

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