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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. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are atropine sulfate and pralidoxime chloride.

2. 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.
Notify if abuse CONSIDERED. CONSIDERED.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

3. Carbon monoxide
Neurotoxins - procagulants. Rhabdomyolysins.
Aspiration pneumonia even if intubated.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

4. Benzodiazepine overdose antidote
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Flumazenil

5. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
... blood sugars for hypoglycaemia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

6. Anticholinergics
Immobilize with plaster slab
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Flumazenil

7. 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
Stomach pumping.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Discobalt edetate

8. Organophosphates
Poisoning causes decreased cholinesterase activity.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Nausea vomiting and anorexia.

9. 45; 70
Calcium chloride
Munchausen's by proxy
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

10. Calcium gluconate
CHARCOAL! except for lithium - iron - alcohol - lead.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Class of drugs encompassing decongestants - amphetamines - cocaine.

11. What happens if charcoal is aspirated?
Glucagon prefered - otherwise massive dose of adrenaline.
Neurotoxins - procagulants. Rhabdomyolysins.
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.
It can cause fatal bronchioloitis obliterans

12. Middle Clavicle fracture management?
Neurosurgery if trauma. Give mannitol.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Blood glucose level for hypoglycaemia!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

13. What is the general management of poisoning?
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.
Croup.
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.

14. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Digoxin Fab
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
Skin or vascular compromise

15. Ethylene glycol
... blood sugars for hypoglycaemia
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.
Rash bronchospasm and hypotension.

16. What is the most common caUse of acute laryngeal obstruction?
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Croup.
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.

17. Mx of petroleum overdose
Class of drugs encompassing decongestants - amphetamines - cocaine.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.
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.

18. What are the side effects of N-acety-p-benzoquinine?
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
Rash bronchospasm and hypotension.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

19. What are the three features of anaphylaxis
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Croup.
Notify if abuse CONSIDERED. CONSIDERED.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

20. 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.
Glucagon prefered - otherwise massive dose of adrenaline.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

21. Indications of non-accidental injury
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Digoxin Fab

22. Beta-blocker overdose antidote
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

23. How may you detect semen?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Flurescence in ultraviolet light.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

24. What is the antibiotic for Epiglottitis?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Ceftriaxone
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Objective signs of growth - tidiness - weight -

25. 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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidotes are atropine sulfate and pralidoxime chloride.

26. Ibuprofen
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 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
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 -

27. Management of septicaemia shock

28. Organophosphates antidotes
Causes BAD constipation. Upsets fluid and electrolyte balance.
Digoxin Fab
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidotes are atropine sulfate and pralidoxime chloride.

29. 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.
Esmolol
Give steroids for management of serum sickness. Must do coagulation screen!!!
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

30. Displaced surgical neck of humerous
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.
Normally treated with sling alone. Seek advice.
'I WOULD CALL POISON HOTLINE'.
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.

31. What psychiatric disease defined as childabuse?

32. How do snake bites damage?
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Rash bronchospasm and hypotension.
Skin or vascular compromise

33. Acetaminophen
Normally treated with sling alone. Seek advice.
IM adrenaline: vasopressor and bronchodilator.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

34. You must consider abuse in
Nausea vomiting and anorexia.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Immobilize with plaster slab
IM adrenaline: vasopressor and bronchodilator.

35. Hydrocarbons
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Rash bronchospasm and hypotension.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

36. Lead
Nausea vomiting and anorexia.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes decreased cholinesterase activity.

37. Amphetamine antidote
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Esmolol
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

38. Signs of abuse from the history
Normally treated with sling alone. Seek advice.
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 decreased cholinesterase activity.
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

39. Tricyclic antidepressants
Ceftriaxone
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 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
Antidote is deferoxamine chelation. Charcoal is ineffective.

40. 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.
It can cause fatal bronchioloitis obliterans
Ceftriaxone
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

41. Ingesting Petrol. Cx?
Flumazenil
Aspiration Pneumonia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
'I WOULD CALL POISON HOTLINE'.

42. Adenosine
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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 -

43. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Collar and cuff. Check integrity of nerve.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Intubate - tracheostromy or nebulized adrenaline.

44. When is reduction required in fracture?
Normally treated with sling alone. Seek advice.
Rash bronchospasm and hypotension.
Skin or vascular compromise
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.

45. Salicylates
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

46. Iron
Bone scan for occult fracture
Antidote is deferoxamine chelation. Charcoal is ineffective.
Calcium chloride
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.

47. Methanol
Immobilize with plaster slab
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!

48. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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 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
IM adrenaline: vasopressor and bronchodilator.

49. 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.
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
Ceftriaxone

50. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
'I WOULD CALL POISON HOTLINE'.
IM adrenaline: vasopressor and bronchodilator.
Munchausen's by proxy