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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Aspiration pneumonia even if intubated.

2. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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 -

3. Mx of critical asthma
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
It can cause fatal bronchioloitis obliterans

4. Digoxin antedote
Digoxin Fab
Croup.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Aspiration pneumonia even if intubated.

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

6. What is the most important investigation in suspected alcohol poisoning in young person?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Blood glucose level for hypoglycaemia!!
Esmolol

7. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
... blood sugars for hypoglycaemia

8. Atropine
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Croup.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

9. What evidence should a doctor give about parental neglect
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Esmolol
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Objective signs of growth - tidiness - weight -

10. Methanol
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Cyanosis and irregular respiratory effort
Neurosurgery if trauma. Give mannitol.

11. Organophosphates antidotes
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
Antidotes are atropine sulfate and pralidoxime chloride.
Collar and cuff. Check integrity of nerve.
Skin or vascular compromise

12. When is gastric lavage indicated and contraindicated?
Sling for 3 weeks - fracture clinic at 7 days.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

13. Sodium Bicarbonate
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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

14. What is an important point to note about anaphylaxis?
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 -
Neurosurgery if trauma. Give mannitol.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Antidotes are atropine sulfate and pralidoxime chloride.

15. What is the most common caUse of acute laryngeal obstruction?
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Croup.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

16. What are the special features that must be done to correct haemorrhagic shock.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
'I WOULD CALL POISON HOTLINE'.

17. Ethanol
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Aspiration Pneumonia
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

18. What is the general management of poisoning?
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Aspiration Pneumonia
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

19. Ethylene glycol
Class of drugs encompassing decongestants - amphetamines - cocaine.
Nausea vomiting and anorexia.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Aspiration Pneumonia

20. 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
Release NEUROTOXINS both have antivenom
Esmolol
Normally treated with sling alone. Seek advice.

21. Acetaminophen
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.
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
IM adrenaline: vasopressor and bronchodilator.

22. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Intubate - tracheostromy or nebulized adrenaline.
Ceftriaxone
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

23. Oedema causing laryngeal obstruction?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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
Calcium chloride
Intubate - tracheostromy or nebulized adrenaline.

24. Sympathomimetics
Skin or vascular compromise
Class of drugs encompassing decongestants - amphetamines - cocaine.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

25. Acetaminophen
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

26. Organophosphates
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Bone scan for occult fracture

27. Methanol
Poisoning causes decreased cholinesterase activity.
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)
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

28. Sympathomimetics
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.
Flurescence in ultraviolet light.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

29. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Digoxin Fab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.

30. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Aspiration Pneumonia
Antidote is naloxone.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

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

32. Mx of snake bit
Skin or vascular compromise
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
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.
Objective signs of growth - tidiness - weight -

33. Cyanide
Discobalt edetate
Intubate - tracheostromy or nebulized adrenaline.
Glucagon prefered - otherwise massive dose of adrenaline.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

34. OSCE: how can i prevent accidents in my children
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Neurotoxins - procagulants. Rhabdomyolysins.

35. Iron
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

36. Salicylates
Abdo XRAY!!!! do it!
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

37. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

38. Management of near drowning.
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.
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
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

39. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Glucagon prefered - otherwise massive dose of adrenaline.
Class of drugs encompassing decongestants - amphetamines - cocaine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

40. Procainamide
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.
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 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
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

41. Beta-blocker overdose antidote
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
Glucagon prefered - otherwise massive dose of adrenaline.

42. What is the most important treatment for anaphylaxis
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
IM adrenaline: vasopressor and bronchodilator.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

43. Signs of abuse from the history
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Flurescence in ultraviolet light.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

44. What are the three features of anaphylaxis
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
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

45. What psychiatric disease defined as childabuse?

46. What is gastric lavage?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Stomach pumping.

47. Anticholinergics
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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
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

48. You must consider abuse in
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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. Indications of non-accidental injury
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

50. Epinephrine
Sling for 3 weeks - fracture clinic at 7 days.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

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