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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.
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1. Undisplaced surgical neck of humerous?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

2. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
IM adrenaline: vasopressor and bronchodilator.
Release NEUROTOXINS both have antivenom

3. Acetaminophen
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Digoxin Fab
Glucagon prefered - otherwise massive dose of adrenaline.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

4. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Normally treated with sling alone. Seek advice.
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.

5. 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 -
Notify if abuse CONSIDERED. CONSIDERED.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

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

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7. What must you do before sending fracture to radiology?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Immobilize with plaster slab
Severe illness - past history of injuries - 18 months or less - inconstent story.
Normally treated with sling alone. Seek advice.

8. Cyanide
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.
Discobalt edetate
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Causes BAD constipation. Upsets fluid and electrolyte balance.

9. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
CHARCOAL! except for lithium - iron - alcohol - lead.

10. Anticholinergics
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

11. Middle Clavicle fracture management?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Munchausen's by proxy
Collar and cuff. Check integrity of nerve.

12. Mx of critical asthma
Class of drugs encompassing decongestants - amphetamines - cocaine.
Aspiration pneumonia even if intubated.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Neurosurgery if trauma. Give mannitol.

13. What is the most common caUse of acute laryngeal obstruction?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Croup.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

14. What are the three features of anaphylaxis
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Bone scan for occult fracture

15. 20
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

16. What are the special features that must be done to correct haemorrhagic shock.
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.
Stomach pumping.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

17. What investigations should you do in suspected child abuse
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Bone scan for occult fracture

18. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Glucagon prefered - otherwise massive dose of adrenaline.
Give steroids for management of serum sickness. Must do coagulation screen!!!

19. Theophylline
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 -
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 - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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.

20. 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.
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
Objective signs of growth - tidiness - weight -
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

21. Digoxin antedote
Intubate - tracheostromy or nebulized adrenaline.
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

22. What is the most appropriate examination in a child with suspected lead ingestion?
Munchausen's by proxy
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Abdo XRAY!!!! do it!

23. What is the general management of poisoning?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Ceftriaxone
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Antidotes are atropine sulfate and pralidoxime chloride.

24. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Cyanosis and irregular respiratory effort
Objective signs of growth - tidiness - weight -

25. Iron
Flumazenil
Antidote is deferoxamine chelation. Charcoal is ineffective.
Release NEUROTOXINS both have antivenom
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

26. Tricyclic antidepressants overdose
Intubate - tracheostromy or nebulized adrenaline.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

27. Mx of snake bit
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.

28. Procainamide
Give steroids for management of serum sickness. Must do coagulation screen!!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

29. What is gastric lavage?
Stomach pumping.
Antidote is naloxone.
Croup.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

30. What is the most important investigation in suspected alcohol poisoning in young person?
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Blood glucose level for hypoglycaemia!!
Calcium chloride

31. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

32. Hydrocarbons
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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 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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

33. Anticholinergics
Munchausen's by proxy
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Severe illness - past history of injuries - 18 months or less - inconstent story.

34. Calcium channel blocker overdose antidote
... blood sugars for hypoglycaemia
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Calcium chloride

35. When is reduction required in fracture?
Skin or vascular compromise
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
... 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.

36. You must consider abuse in
Discobalt edetate
Antidotes are atropine sulfate and pralidoxime chloride.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Abdo XRAY!!!! do it!

37. What evidence should a doctor give about parental neglect
Nausea vomiting and anorexia.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Skin or vascular compromise
Objective signs of growth - tidiness - weight -

38. Management of septicaemia shock

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39. Undisplaced radial shaft fracture
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Collar and cuff. Check integrity of nerve.

40. Sympathomimetics
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Flumazenil
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

41. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

42. Organophosphates
Intubate - tracheostromy or nebulized adrenaline.
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 decreased cholinesterase activity.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

43. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Neurotoxins - procagulants. Rhabdomyolysins.
Intubate - tracheostromy or nebulized adrenaline.
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 -

44. Benzodiazepine overdose antidote
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Flumazenil
Abdo XRAY!!!! do it!
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.

45. Amphetamine antidote
Discobalt edetate
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

46. Ingesting Petrol. Cx?
Aspiration Pneumonia
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

47. What is the first line investigation in a young child who has consumed alcohol?
Normally treated with sling alone. Seek advice.
... blood sugars for hypoglycaemia
Discobalt edetate
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

48. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Flurescence in ultraviolet light.
Abdo XRAY!!!! do it!
Flumazenil

49. Adenosine
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Glucagon prefered - otherwise massive dose of adrenaline.
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

50. Calcium gluconate
IM adrenaline: vasopressor and bronchodilator.
Neurotoxins - procagulants. Rhabdomyolysins.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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