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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 happens if charcoal is aspirated?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
CHARCOAL! except for lithium - iron - alcohol - lead.
It can cause fatal bronchioloitis obliterans

2. Opiates
Antidote is naloxone.
Cyanosis and irregular respiratory effort
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

3. Atropine
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 medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

4. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
'I WOULD CALL POISON HOTLINE'.
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 -

5. Calcium channel blocker overdose antidote
Calcium chloride
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Stomach pumping.
Neurotoxins - procagulants. Rhabdomyolysins.

6. How do snake bites damage?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Neurotoxins - procagulants. Rhabdomyolysins.
Abdo XRAY!!!! do it!
Causes BAD constipation. Upsets fluid and electrolyte balance.

7. What must you do before sending fracture to radiology?
Stomach pumping.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Croup.
Immobilize with plaster slab

8. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes decreased cholinesterase activity.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Flurescence in ultraviolet light.

9. 20
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.
Neurosurgery if trauma. Give mannitol.
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.

10. Funnel web and red back
Release NEUROTOXINS both have antivenom
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Aspiration Pneumonia
Munchausen's by proxy

11. What are the terminal signs of acute laryngeal obstruction?
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
Cyanosis and irregular respiratory effort
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.

12. Oedema causing laryngeal obstruction?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Intubate - tracheostromy or nebulized adrenaline.
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

13. Anticholinergics
Aspiration pneumonia even if intubated.
Munchausen's by proxy
Flumazenil
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

14. 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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Normally treated with sling alone. Seek advice.
Blood glucose level for hypoglycaemia!!

15. Sympathomimetics
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Intubate - tracheostromy or nebulized adrenaline.
Croup.

16. Ethylene glycol
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

17. 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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Give IM adrenaline - steroids - salbutamol - antihistamine.

18. Methanol
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Stomach pumping.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

19. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Munchausen's by proxy
Neurotoxins - procagulants. Rhabdomyolysins.
Immobilize with plaster slab

20. 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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurosurgery if trauma. Give mannitol.

21. what makes you suspicious of non-accidental injury.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Bone scan for occult fracture
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Abdo XRAY!!!! do it!

22. 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.
Aspiration pneumonia even if intubated.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

23. Opiates
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Ceftriaxone

24. Sodium Bicarbonate
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

25. Anticholinergics
It can cause fatal bronchioloitis obliterans
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

26. When and how would you do whole bowel irrigation?
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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

27. Digoxin antedote
IM adrenaline: vasopressor and bronchodilator.
Digoxin Fab
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Cyanosis and irregular respiratory effort

28. What is gastric lavage?
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidote is naloxone.
Stomach pumping.

29. Organophosphates
... blood sugars for hypoglycaemia
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes decreased cholinesterase activity.
Abdo XRAY!!!! do it!

30. Theophylline
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

31. What are the special features that must be done to correct haemorrhagic shock.
Release NEUROTOXINS both have antivenom
Esmolol
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Notify if abuse CONSIDERED. CONSIDERED.

32. Mx raised intracranial pressure.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Neurosurgery if trauma. Give mannitol.

33. What is the most common caUse of acute laryngeal obstruction?
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
Croup.
Immobilize with plaster slab
... blood sugars for hypoglycaemia

34. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Notify if abuse CONSIDERED. CONSIDERED.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

35. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Glucagon prefered - otherwise massive dose of adrenaline.
Esmolol

36. Middle Clavicle fracture management?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

37. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration pneumonia even if intubated.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

38. Organophosphates
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.
'I WOULD CALL POISON HOTLINE'.

39. Salicylates
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

40. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Aspiration pneumonia even if intubated.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Skin or vascular compromise

41. Displaced surgical neck of humerous
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
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

42. Legal requirement in childabuse
Aspiration pneumonia even if intubated.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Notify if abuse CONSIDERED. CONSIDERED.
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. Organophosphates antidotes
'I WOULD CALL POISON HOTLINE'.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidotes are atropine sulfate and pralidoxime chloride.
Glucagon prefered - otherwise massive dose of adrenaline.

44. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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. Mx severe croup
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

46. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

47. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

48. Ethylene glycol
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.
Abdo XRAY!!!! do it!
IM adrenaline: vasopressor and bronchodilator.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

49. What is the first line investigation in a young child who has consumed alcohol?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
... blood sugars for hypoglycaemia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes decreased cholinesterase activity.

50. Hydrocarbons
It can cause fatal bronchioloitis obliterans
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
IM adrenaline: vasopressor and bronchodilator.
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.