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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. Salicylates
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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.
Sling for 3 weeks - fracture clinic at 7 days.

2. When is gastric lavage indicated and contraindicated?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

3. Anticholinergics
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

4. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Aspiration Pneumonia
Lead poisoning is defined as a serum level greater than ___ ug/dL.

5. Opiates
Antidote is naloxone.
Abdo XRAY!!!! do it!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) 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.

6. 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.
Poisoning causes decreased cholinesterase activity.
Flurescence in ultraviolet light.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

7. 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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

8. What are the early symptoms of paracetamol overdose?
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 fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Nausea vomiting and anorexia.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

9. Indications of non-accidental injury
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Aspiration pneumonia even if intubated.

10. What is the antibiotic for Epiglottitis?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Ceftriaxone
Flumazenil
Give IM adrenaline - steroids - salbutamol - antihistamine.

11. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Esmolol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

12. What investigations should you do in suspected child abuse
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of drugs encompassing decongestants - amphetamines - cocaine.
Bone scan for occult fracture

13. Oedema causing laryngeal obstruction?
Immobilize with plaster slab
Intubate - tracheostromy or nebulized adrenaline.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Bone scan for occult fracture

14. Signs of abuse from the history
Give IM adrenaline - steroids - salbutamol - antihistamine.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Digoxin Fab

15. Amiodarone
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.
Munchausen's by proxy
Sling for 3 weeks - fracture clinic at 7 days.

16. Mx of snake bit
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
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

17. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
'I WOULD CALL POISON HOTLINE'.

18. what makes you suspicious of non-accidental injury.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Antidotes are atropine sulfate and pralidoxime chloride.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

19. Displaced surgical neck of humerous
Abdo XRAY!!!! do it!
Normally treated with sling alone. Seek advice.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
'I WOULD CALL POISON HOTLINE'.

20. Undisplaced radial shaft fracture
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Intubate - tracheostromy or nebulized adrenaline.
Discobalt edetate
Collar and cuff. Check integrity of nerve.

21. What evidence should a doctor give about parental neglect
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Esmolol
Objective signs of growth - tidiness - weight -
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

22. 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.
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
Esmolol
Skin or vascular compromise

23. What happens if charcoal is aspirated?
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 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
It can cause fatal bronchioloitis obliterans
Digoxin Fab

24. What is the first line investigation in a young child who has consumed alcohol?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Stomach pumping.
... blood sugars for hypoglycaemia
Normally treated with sling alone. Seek advice.

25. Management of near drowning.
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'.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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

26. Carbon monoxide
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Abdo XRAY!!!! do it!
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

27. Carbon monoxide
Skin or vascular compromise
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes decreased cholinesterase activity.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

28. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 3 weeks - fracture clinic at 7 days.
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.

29. Hydrocarbons
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.
It can cause fatal bronchioloitis obliterans
Notify if abuse CONSIDERED. CONSIDERED.
Neurotoxins - procagulants. Rhabdomyolysins.

30. Management of septicaemia shock

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31. When is reduction required in fracture?
Blood glucose level for hypoglycaemia!!
Skin or vascular compromise
Cyanosis and irregular respiratory effort
Glucagon prefered - otherwise massive dose of adrenaline.

32. Organophosphates
Calcium chloride
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes decreased cholinesterase activity.

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

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34. OSCE: What are the five princples of discharging a patient with a fracture?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Give steroids for management of serum sickness. Must do coagulation screen!!!

35. Ethylene glycol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Neurotoxins - procagulants. Rhabdomyolysins.
Release NEUROTOXINS both have antivenom

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

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37. 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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Immobilize with plaster slab

38. 20
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

39. Atropine
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Croup.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

40. Mx of critical asthma
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Immobilize with plaster slab
Blood glucose level for hypoglycaemia!!

41. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Digoxin Fab
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

42. Ibuprofen
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

43. What else is in the management of snake bite?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Calcium chloride
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Give steroids for management of serum sickness. Must do coagulation screen!!!

44. What is the most common caUse of acute laryngeal obstruction?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Croup.
CHARCOAL! except for lithium - iron - alcohol - lead.

45. Sympathomimetics
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.
Release NEUROTOXINS both have antivenom
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

46. Benzodiazepine overdose antidote
Flumazenil
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Normally treated with sling alone. Seek advice.

47. What are the three features of anaphylaxis
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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

48. Funnel web and red back
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Bone scan for occult fracture
Release NEUROTOXINS both have antivenom
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

49. Organophosphates
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

50. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.