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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 is the risk of gastrointestinal decompression in a person with decreased conscious state?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Aspiration pneumonia even if intubated.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

2. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

3. Oedema causing laryngeal obstruction?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Intubate - tracheostromy or nebulized adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Severe illness - past history of injuries - 18 months or less - inconstent story.

4. What is a side effect of charcoal?
Poisoning causes decreased cholinesterase activity.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Aspiration Pneumonia

5. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Calcium chloride
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

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

7. Ethylene glycol
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
... blood sugars for hypoglycaemia
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

8. Digoxin antedote
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Digoxin Fab

9. Lidocaine
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Croup.

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

11. 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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Croup.

12. 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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

13. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Abdo XRAY!!!! do it!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

14. How do snake bites damage?
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Neurotoxins - procagulants. Rhabdomyolysins.

15. Carbon monoxide
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Esmolol
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

16. Management of near drowning.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Digoxin Fab

17. Salicylates
Neurotoxins - procagulants. Rhabdomyolysins.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Immobilize with plaster slab
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.

18. Organophosphates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Skin or vascular compromise

19. Carbon monoxide
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Stomach pumping.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Abdo XRAY!!!! do it!

20. What is the most important investigation in suspected alcohol poisoning in young person?
Nausea vomiting and anorexia.
Blood glucose level for hypoglycaemia!!
Glucagon prefered - otherwise massive dose of adrenaline.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

21. Mx of snake bit
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Digoxin Fab
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. When is gastric lavage indicated and contraindicated?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Munchausen's by proxy
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blood glucose level for hypoglycaemia!!

23. Funnel web and red back
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Release NEUROTOXINS both have antivenom
Ceftriaxone
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

24. What investigations should you do in suspected child abuse
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Bone scan for occult fracture
Blood glucose level for hypoglycaemia!!

25. Displaced surgical neck of humerous
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
IM adrenaline: vasopressor and bronchodilator.
Normally treated with sling alone. Seek advice.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

26. 45; 70
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Stomach pumping.
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
Aspiration pneumonia even if intubated.

27. Cyanide
Intubate - tracheostromy or nebulized adrenaline.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Discobalt edetate
Aspiration Pneumonia

28. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Nausea vomiting and anorexia.
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 -

29. What else is in the management of snake bite?
Antidotes are atropine sulfate and pralidoxime chloride.
Ceftriaxone
Give steroids for management of serum sickness. Must do coagulation screen!!!
Stomach pumping.

30. Mx raised intracranial pressure.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Neurosurgery if trauma. Give mannitol.

31. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Flumazenil
Abdo XRAY!!!! do it!
Skin or vascular compromise

32. 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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
'I WOULD CALL POISON HOTLINE'.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

33. What is gastric lavage?
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.
Munchausen's by proxy
Collar and cuff. Check integrity of nerve.

34. What is the most important treatment for anaphylaxis
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes decreased cholinesterase activity.
Intubate - tracheostromy or nebulized adrenaline.
IM adrenaline: vasopressor and bronchodilator.

35. Iron
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

36. Mx of petroleum overdose
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

37. Organophosphates antidotes
Collar and cuff. Check integrity of nerve.
Antidotes are atropine sulfate and pralidoxime chloride.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

38. What are the three features of anaphylaxis
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidote is naloxone.

39. Opiates
Antidotes are atropine sulfate and pralidoxime chloride.
Nausea vomiting and anorexia.
Antidote is naloxone.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

40. What are the special features that must be done to correct haemorrhagic shock.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

41. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Rash bronchospasm and hypotension.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.

42. Theophylline
Poisoning causes decreased cholinesterase activity.
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 causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

43. Beta-blocker overdose antidote
It can cause fatal bronchioloitis obliterans
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Rash bronchospasm and hypotension.
Glucagon prefered - otherwise massive dose of adrenaline.

44. 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.
Collar and cuff. Check integrity of nerve.
'I WOULD CALL POISON HOTLINE'.
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

45. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Blood glucose level for hypoglycaemia!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

46. Mx severe croup
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Notify if abuse CONSIDERED. CONSIDERED.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

47. Amphetamine antidote
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Esmolol
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Flumazenil

48. Calcium channel blocker overdose antidote
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Skin or vascular compromise
Calcium chloride
Stomach pumping.

49. What are the early symptoms of paracetamol overdose?
... blood sugars for hypoglycaemia
Nausea vomiting and anorexia.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.

50. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Objective signs of growth - tidiness - weight -
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.