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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
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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 other treatments for anaphylaxis?
Normally treated with sling alone. Seek advice.
Neurosurgery if trauma. Give mannitol.
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 IM adrenaline - steroids - salbutamol - antihistamine.

2. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
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.
Intubate - tracheostromy or nebulized adrenaline.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

3. Management of near drowning.
Flurescence in ultraviolet light.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidotes are atropine sulfate and pralidoxime 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

4. What evidence should a doctor give about parental neglect
Glucagon prefered - otherwise massive dose of adrenaline.
'I WOULD CALL POISON HOTLINE'.
Objective signs of growth - tidiness - weight -
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

5. Cyanide
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.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

6. Mx of snake bit
... blood sugars for hypoglycaemia
Glucagon prefered - otherwise massive dose of 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.
IM adrenaline: vasopressor and bronchodilator.

7. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Release NEUROTOXINS both have antivenom
Flurescence in ultraviolet light.

8. Atropine
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

9. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
It can cause fatal bronchioloitis obliterans
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

10. What is gastric lavage?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Stomach pumping.
Flumazenil
... blood sugars for hypoglycaemia

11. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

12. Indications of non-accidental injury
Flumazenil
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.
Ceftriaxone

13. what makes you suspicious of non-accidental injury.
Antidotes are atropine sulfate and pralidoxime chloride.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Croup.

14. Opiates
Aspiration pneumonia even if intubated.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes decreased cholinesterase activity.

15. Anticholinergics
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Intubate - tracheostromy or nebulized adrenaline.

16. Ethylene glycol
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
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.

17. When is gastric lavage indicated and contraindicated?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

18. Opiates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidote is naloxone.

19. What are the early symptoms of paracetamol overdose?
Esmolol
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.
Nausea vomiting and anorexia.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

20. When is reduction required in fracture?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes decreased cholinesterase activity.
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.
Skin or vascular compromise

21. Mx of critical asthma
Intubate - tracheostromy or nebulized adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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

22. What is the most common caUse of acute laryngeal obstruction?
Aspiration Pneumonia
Croup.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

23. Sympathomimetics
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Bone scan for occult fracture
Class of drugs encompassing decongestants - amphetamines - cocaine.

24. 20
Collar and cuff. Check integrity of nerve.
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

25. Sympathomimetics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
... blood sugars for hypoglycaemia

26. Organophosphates
Flumazenil
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes decreased cholinesterase activity.

27. What else is in the management of snake bite?
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
Calcium chloride
Normally treated with sling alone. Seek advice.
Give steroids for management of serum sickness. Must do coagulation screen!!!

28. Carbon monoxide
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 -
Nausea vomiting and anorexia.
Aspiration pneumonia even if intubated.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

29. Anticholinergics
Neurosurgery if trauma. Give mannitol.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
It can cause fatal bronchioloitis obliterans
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

30. How may you detect semen?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Flurescence in ultraviolet light.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

31. Oedema causing laryngeal obstruction?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Intubate - tracheostromy or nebulized adrenaline.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

32. OSCE: how can i prevent accidents in my children
Aspiration pneumonia even if intubated.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Immobilize with plaster slab
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

33. Ibuprofen
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.
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 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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

34. Lidocaine
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
IM adrenaline: vasopressor and bronchodilator.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

35. Digoxin antedote
Digoxin Fab
IM adrenaline: vasopressor and bronchodilator.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

36. Lead
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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

37. Middle Clavicle fracture management?
... blood sugars for hypoglycaemia
Bone scan for occult fracture
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Aspiration Pneumonia

38. What is the first line investigation in a young child who has consumed alcohol?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
... blood sugars for hypoglycaemia
Stomach pumping.
IM adrenaline: vasopressor and bronchodilator.

39. Signs of abuse from the history
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.

40. What psychiatric disease defined as childabuse?

41. Iron
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Antidote is deferoxamine chelation. Charcoal is ineffective.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

42. Signs of psychological maltreatment?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
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.

43. Sodium Bicarbonate
Poisoning causes decreased cholinesterase activity.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

44. A child has swallowed a battery. Mx
Cyanosis and irregular respiratory effort
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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

45. What is one of the technicalities of childabuse.
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
Antidote is naloxone.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

46. Salicylates
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.
Ceftriaxone
Croup.
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.

47. Theophylline
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

48. What is an important point to note about anaphylaxis?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Flurescence in ultraviolet light.
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 -

49. Iron
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

50. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
IM adrenaline: vasopressor and bronchodilator.