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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 three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

2. Management of near drowning.
Blood glucose level for hypoglycaemia!!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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
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.

3. Mx of snake bit
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Glucagon prefered - otherwise massive dose of adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.

4. What is the general management of poisoning?
Release NEUROTOXINS both have antivenom
Severe illness - past history of injuries - 18 months or less - inconstent story.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Normally treated with sling alone. Seek advice.

5. 20
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Poisoning causes decreased cholinesterase activity.

6. What must you do before sending fracture to radiology?
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Skin or vascular compromise

7. What is a side effect of charcoal?
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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

8. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Skin or vascular compromise
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Class of drugs encompassing decongestants - amphetamines - cocaine.

9. 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
Stomach pumping.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

10. Legal requirement in childabuse
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Notify if abuse CONSIDERED. CONSIDERED.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

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

12. Acetaminophen
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
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

13. Middle Clavicle fracture management?
Notify if abuse CONSIDERED. CONSIDERED.
Bone scan for occult fracture
Digoxin Fab
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

14. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Glucagon prefered - otherwise massive dose of adrenaline.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Intubate - tracheostromy or nebulized adrenaline.

15. OSCE: what must you say you would do if someone is poisoned?

16. what makes you suspicious of non-accidental injury.
Flurescence in ultraviolet light.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

17. Tricyclic antidepressants
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.
Aspiration pneumonia even if intubated.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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

18. Iron
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
Aspiration Pneumonia
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.
Neurosurgery if trauma. Give mannitol.

19. Opiates
Antidote is naloxone.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 -
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

20. You must consider abuse in
It can cause fatal bronchioloitis obliterans
Glucagon prefered - otherwise massive dose of adrenaline.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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

21. Organophosphates
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.
Normally treated with sling alone. Seek advice.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

22. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Give steroids for management of serum sickness. Must do coagulation screen!!!
'I WOULD CALL POISON HOTLINE'.

23. Procainamide
Stomach pumping.
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.
Poisoning causes decreased cholinesterase activity.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

24. Ingesting Petrol. Cx?
Munchausen's by proxy
Flumazenil
Aspiration Pneumonia
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. What are the early symptoms of paracetamol overdose?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Nausea vomiting and anorexia.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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

26. Epinephrine
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Normally treated with sling alone. Seek advice.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.

27. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Release NEUROTOXINS both have antivenom
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 -
Severe illness - past history of injuries - 18 months or less - inconstent story.

28. Mx raised intracranial pressure.
Sling for 3 weeks - fracture clinic at 7 days.
Neurosurgery if trauma. Give mannitol.
Calcium chloride
Aspiration pneumonia even if intubated.

29. What is one of the technicalities of childabuse.
Rash bronchospasm and hypotension.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

30. Organophosphates
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes decreased cholinesterase activity.
Give IM adrenaline - steroids - salbutamol - antihistamine.

31. Mx of critical asthma
Calcium chloride
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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 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

32. Methanol
Stomach pumping.
Poisoning causes decreased cholinesterase activity.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Collar and cuff. Check integrity of nerve.

33. When is gastric lavage indicated and contraindicated?
Neurosurgery if trauma. Give mannitol.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

34. Displaced surgical neck of humerous
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.
Normally treated with sling alone. Seek advice.
Digoxin Fab
... blood sugars for hypoglycaemia

35. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Abdo XRAY!!!! do it!
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.

36. What psychiatric disease defined as childabuse?

37. Acetaminophen
Esmolol
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

38. Anticholinergics
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Croup.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

39. How may you detect semen?
Flurescence in ultraviolet light.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Croup.

40. Calcium channel blocker overdose antidote
Antidotes are atropine sulfate and pralidoxime chloride.
Calcium chloride
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

41. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Objective signs of growth - tidiness - weight -
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. Ibuprofen
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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 - 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 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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Skin or vascular compromise

44. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Blood glucose level for hypoglycaemia!!
CHARCOAL! except for lithium - iron - alcohol - lead.

45. What are the special features that must be done to correct haemorrhagic shock.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

46. Amphetamine antidote
Rash bronchospasm and hypotension.
Antidotes are atropine sulfate and pralidoxime chloride.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Esmolol

47. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
IM adrenaline: vasopressor and bronchodilator.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Calcium chloride

48. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Notify if abuse CONSIDERED. CONSIDERED.

49. What are the other treatments for anaphylaxis?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Give IM adrenaline - steroids - salbutamol - antihistamine.
Immobilize with plaster slab
Antidotes are atropine sulfate and pralidoxime chloride.

50. Sympathomimetics
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Class of drugs encompassing decongestants - amphetamines - cocaine.