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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. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

2. What are the three features of anaphylaxis
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Neurotoxins - procagulants. Rhabdomyolysins.
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 -
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

3. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Notify if abuse CONSIDERED. CONSIDERED.
Esmolol

4. What else is in the management of snake bite?
Skin or vascular compromise
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are atropine sulfate and pralidoxime chloride.

5. What must you do before sending fracture to radiology?
Immobilize with plaster slab
It can cause fatal bronchioloitis obliterans
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

6. 45; 70
Digoxin Fab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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
Collar and cuff. Check integrity of nerve.

7. What happens if charcoal is aspirated?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
It can cause fatal bronchioloitis obliterans
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

8. What are the special features that must be done to correct haemorrhagic shock.
Flurescence in ultraviolet light.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

9. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Objective signs of growth - tidiness - weight -
Antidote is naloxone.
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

10. You must consider abuse in
Rash bronchospasm and hypotension.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Collar and cuff. Check integrity of nerve.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

11. Hydrocarbons
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Flurescence in ultraviolet light.
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.

12. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Normally treated with sling alone. Seek advice.
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.

13. Sympathomimetics
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Release NEUROTOXINS both have antivenom

14. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Rash bronchospasm and hypotension.
Poisoning causes decreased cholinesterase activity.
'I WOULD CALL POISON HOTLINE'.

15. Methanol
... blood sugars for hypoglycaemia
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.
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.

16. When is reduction required in fracture?
... blood sugars for hypoglycaemia
Skin or vascular compromise
'I WOULD CALL POISON HOTLINE'.
CHARCOAL! except for lithium - iron - alcohol - lead.

17. What are the early symptoms of paracetamol overdose?
Flumazenil
Ceftriaxone
It can cause fatal bronchioloitis obliterans
Nausea vomiting and anorexia.

18. What is the general management of poisoning?
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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
Rash bronchospasm and hypotension.

19. What are the other treatments for anaphylaxis?
Stomach pumping.
Release NEUROTOXINS both have antivenom
Give IM adrenaline - steroids - salbutamol - antihistamine.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

20. Indications of non-accidental injury
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

21. Opiates
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Release NEUROTOXINS both have antivenom

22. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
... blood sugars for hypoglycaemia
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

23. Displaced surgical neck of humerous
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Flurescence in ultraviolet light.
Normally treated with sling alone. Seek advice.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

24. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

25. Sympathomimetics
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

26. Anticholinergics
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

27. What are the side effects of N-acety-p-benzoquinine?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Esmolol
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Rash bronchospasm and hypotension.

28. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes decreased cholinesterase activity.
Calcium chloride
Bone scan for occult fracture

29. What is the most common caUse of acute laryngeal obstruction?
Antidotes are atropine sulfate and pralidoxime chloride.
Croup.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Objective signs of growth - tidiness - weight -

30. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
'I WOULD CALL POISON HOTLINE'.
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

31. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Objective signs of growth - tidiness - weight -
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

32. Opiates
'I WOULD CALL POISON HOTLINE'.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidote is naloxone.
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.

33. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Munchausen's by proxy
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Aspiration Pneumonia

34. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Immobilize with plaster slab

35. Amiodarone
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.
Antidote is naloxone.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

36. Atropine
... blood sugars for hypoglycaemia
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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 -

37. Adenosine
Glucagon prefered - otherwise massive dose of adrenaline.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration pneumonia even if intubated.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

38. Ethylene glycol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Flurescence in ultraviolet light.
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.

39. Acetaminophen
Croup.
Intubate - tracheostromy or nebulized adrenaline.
Normally treated with sling alone. Seek advice.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

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

41. What is one of the technicalities of childabuse.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

42. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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 even if intubated.
Esmolol
Lead poisoning is defined as a serum level greater than ___ ug/dL.

43. Lead
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Give IM adrenaline - steroids - salbutamol - antihistamine.

44. Mx severe croup
Cyanosis and irregular respiratory effort
Blood glucose level for hypoglycaemia!!
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Digoxin Fab

45. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

46. Procainamide
Poisoning causes decreased cholinesterase activity.
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.
Cyanosis and irregular respiratory effort
Nausea vomiting and anorexia.

47. When is gastric lavage indicated and contraindicated?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Notify if abuse CONSIDERED. CONSIDERED.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

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

49. Ethanol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

50. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is naloxone.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.