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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

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Answer 50 questions in 15 minutes.
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1. 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.
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.
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
It can cause fatal bronchioloitis obliterans

2. What are the three features of anaphylaxis
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

3. 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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

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

5. 45; 70
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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
'I WOULD CALL POISON HOTLINE'.

6. What is the first line investigation in a young child who has consumed alcohol?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
... blood sugars for hypoglycaemia
CHARCOAL! except for lithium - iron - alcohol - lead.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

7. What must you do before sending fracture to radiology?
Antidote is naloxone.
Immobilize with plaster slab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

8. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Objective signs of growth - tidiness - weight -
Calcium chloride
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

9. Ethylene glycol
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Aspiration pneumonia even if intubated.

10. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Class of drugs encompassing decongestants - amphetamines - cocaine.

11. Amphetamine antidote
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Notify if abuse CONSIDERED. CONSIDERED.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

12. What evidence should a doctor give about parental neglect
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 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 -
Objective signs of growth - tidiness - weight -

13. what makes you suspicious of non-accidental injury.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

14. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
Neurotoxins - procagulants. Rhabdomyolysins.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

15. What is gastric lavage?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Discobalt edetate
Stomach pumping.
Intubate - tracheostromy or nebulized adrenaline.

16. Management of near drowning.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Calcium chloride
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

17. Tricyclic antidepressants
Collar and cuff. Check integrity of nerve.
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
Munchausen's by proxy
Rash bronchospasm and hypotension.

18. Organophosphates antidotes
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

19. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
Ceftriaxone
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

20. Sympathomimetics
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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. What is the most important treatment for anaphylaxis
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
IM adrenaline: vasopressor and bronchodilator.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

22. Tricyclic antidepressants overdose
Digoxin Fab
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Give IM adrenaline - steroids - salbutamol - antihistamine.
Collar and cuff. Check integrity of nerve.

23. Funnel web and red back
Discobalt edetate
Release NEUROTOXINS both have antivenom
Rash bronchospasm and hypotension.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

24. How do snake bites damage?
Antidotes are atropine sulfate and pralidoxime chloride.
Neurotoxins - procagulants. Rhabdomyolysins.
'I WOULD CALL POISON HOTLINE'.
Notify if abuse CONSIDERED. CONSIDERED.

25. Epinephrine
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

26. Management of septicaemia shock

27. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Ceftriaxone
Rash bronchospasm and hypotension.

28. Oedema causing laryngeal obstruction?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Intubate - tracheostromy or nebulized adrenaline.

29. Indications of non-accidental injury
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

30. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidote is naloxone.
'I WOULD CALL POISON HOTLINE'.
Give steroids for management of serum sickness. Must do coagulation screen!!!

31. How may you detect semen?
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Flurescence in ultraviolet light.

32. Signs of abuse from the history
Release NEUROTOXINS both have antivenom
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes decreased cholinesterase activity.

33. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Sling for 3 weeks - fracture clinic at 7 days.
Antidotes are atropine sulfate and pralidoxime chloride.

34. Opiates
Antidotes are atropine sulfate and pralidoxime chloride.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidote is naloxone.

35. Undisplaced radial shaft fracture
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.
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
Collar and cuff. Check integrity of nerve.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

36. Mx of petroleum overdose
'I WOULD CALL POISON HOTLINE'.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

37. Cyanide
Discobalt edetate
CHARCOAL! except for lithium - iron - alcohol - lead.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

38. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
Immobilize with plaster slab

39. What investigations should you do in suspected child abuse
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.
Bone scan for occult fracture

40. 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 BAD constipation. Upsets fluid and electrolyte balance.
CHARCOAL! except for lithium - iron - alcohol - lead.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

41. OSCE: how can i prevent accidents in my children
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
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Cyanosis and irregular respiratory effort
Severe illness - past history of injuries - 18 months or less - inconstent story.

42. Calcium channel blocker overdose antidote
Ceftriaxone
Calcium chloride
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

43. What are the early symptoms of paracetamol overdose?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nausea vomiting and anorexia.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
... blood sugars for hypoglycaemia

44. Methanol
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 causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.

45. Sodium Bicarbonate
Flurescence in ultraviolet light.
CHARCOAL! except for lithium - iron - alcohol - lead.
Digoxin Fab
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

46. Procainamide
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 -
It can cause fatal bronchioloitis obliterans
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

47. Benzodiazepine overdose antidote
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Flumazenil
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

48. What are the special features that must be done to correct haemorrhagic shock.
Cyanosis and irregular respiratory effort
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

49. Ethanol
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 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.
Nausea vomiting and anorexia.

50. Iron
CHARCOAL! except for lithium - iron - alcohol - lead.
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 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

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Pediatric Emergency Medicine

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