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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. Ingesting Petrol. Cx?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 decreased cholinesterase activity.
Aspiration Pneumonia

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.
Intubate - tracheostromy or nebulized adrenaline.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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

3. Adenosine
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
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
'I WOULD CALL POISON HOTLINE'.

4. Sympathomimetics
Collar and cuff. Check integrity of nerve.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

5. Benzodiazepine overdose antidote
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Flumazenil
Digoxin Fab

6. Amphetamine antidote
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Esmolol

7. 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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ceftriaxone

8. Cyanide
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.
Sling for 3 weeks - fracture clinic at 7 days.
Discobalt edetate
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

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

10. Beta-blocker overdose antidote
'I WOULD CALL POISON HOTLINE'.
Collar and cuff. Check integrity of nerve.
Glucagon prefered - otherwise massive dose of adrenaline.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

11. Management of septicaemia shock

12. Oedema causing laryngeal obstruction?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Intubate - tracheostromy or nebulized adrenaline.
Immobilize with plaster slab
Antidote is deferoxamine chelation. Charcoal is ineffective.

13. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Munchausen's by proxy
Flurescence in ultraviolet light.

14. What is the most important treatment for anaphylaxis
... blood sugars for hypoglycaemia
IM adrenaline: vasopressor and bronchodilator.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

15. Ibuprofen
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

16. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Blood glucose level for hypoglycaemia!!
'I WOULD CALL POISON HOTLINE'.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

17. Mx of critical asthma
Notify if abuse CONSIDERED. CONSIDERED.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Croup.

18. 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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
It can cause fatal bronchioloitis obliterans

19. What are the side effects of N-acety-p-benzoquinine?
Normally treated with sling alone. Seek advice.
Bone scan for occult fracture
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Rash bronchospasm and hypotension.

20. Management of near drowning.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

21. Anticholinergics
Skin or vascular compromise
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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

22. Signs of abuse from the history
Ceftriaxone
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

23. What is gastric lavage?
Croup.
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
Stomach pumping.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

24. Calcium channel blocker overdose antidote
Calcium chloride
Intubate - tracheostromy or nebulized adrenaline.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes decreased cholinesterase activity.

25. What is the most important investigation in suspected alcohol poisoning in young person?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Blood glucose level for hypoglycaemia!!
Neurotoxins - procagulants. Rhabdomyolysins.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

26. What are the other treatments for anaphylaxis?
Severe illness - past history of injuries - 18 months or less - inconstent story.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give IM adrenaline - steroids - salbutamol - antihistamine.

27. 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.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

28. what makes you suspicious 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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

29. Carbon monoxide
Objective signs of growth - tidiness - weight -
Calcium chloride
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

30. Hydrocarbons
Aspiration Pneumonia
Nausea vomiting and anorexia.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

31. What are the early symptoms of paracetamol overdose?
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 -
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Nausea vomiting and anorexia.
Skin or vascular compromise

32. Atropine
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.

33. Opiates
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
Flurescence in ultraviolet light.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidote is naloxone.

34. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
... blood sugars for hypoglycaemia
Discobalt edetate

35. Calcium gluconate
Skin or vascular compromise
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Neurosurgery if trauma. Give mannitol.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

36. Displaced surgical neck of humerous
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Release NEUROTOXINS both have antivenom
Normally treated with sling alone. Seek advice.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

37. Iron
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

38. Signs of psychological maltreatment?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

39. What is the general management of poisoning?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

40. Undisplaced radial shaft fracture
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Collar and cuff. Check integrity of nerve.

41. Opiates
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Esmolol
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

42. Sodium Bicarbonate
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

43. Undisplaced surgical neck of humerous?
Nausea vomiting and anorexia.
Aspiration pneumonia even if intubated.
Sling for 3 weeks - fracture clinic at 7 days.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

44. Carbon monoxide
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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

45. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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

46. Organophosphates
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes decreased cholinesterase activity.

47. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 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

48. What is a side effect of charcoal?
IM adrenaline: vasopressor and bronchodilator.
Cyanosis and irregular respiratory effort
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurosurgery if trauma. Give mannitol.

49. Indications of non-accidental injury
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.
It can cause fatal bronchioloitis obliterans
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 -

50. Legal requirement in childabuse
Munchausen's by proxy
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.
It can cause fatal bronchioloitis obliterans
Notify if abuse CONSIDERED. CONSIDERED.