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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.
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. Organophosphates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flurescence in ultraviolet light.
Poisoning causes decreased cholinesterase activity.
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.

2. Lead
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

3. 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.
'I WOULD CALL POISON HOTLINE'.
Objective signs of growth - tidiness - weight -
Bone scan for occult fracture

4. Mx severe croup
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Objective signs of growth - tidiness - weight -
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

5. Funnel web and red back
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Release NEUROTOXINS both have antivenom
Give steroids for management of serum sickness. Must do coagulation screen!!!

6. Digoxin antedote
It can cause fatal bronchioloitis obliterans
Normally treated with sling alone. Seek advice.
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

7. Adenosine
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Stomach pumping.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

8. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

9. Management of near drowning.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Intubate - tracheostromy or nebulized adrenaline.

10. Hydrocarbons
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
Severe illness - past history of injuries - 18 months or less - inconstent story.
Skin or vascular compromise
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.

11. Ethanol
Give steroids for management of serum sickness. Must do coagulation screen!!!
Discobalt edetate
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

12. What is gastric lavage?
Stomach pumping.
Glucagon prefered - otherwise massive dose of adrenaline.
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

13. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Stomach pumping.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Croup.

14. Ingesting Petrol. Cx?
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Aspiration Pneumonia
Stomach pumping.

15. Calcium gluconate
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
IM adrenaline: vasopressor and bronchodilator.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Release NEUROTOXINS both have antivenom

16. Mx of snake bit
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Stomach pumping.

17. Undisplaced surgical neck of humerous?
Bone scan for occult fracture
Sling for 3 weeks - fracture clinic at 7 days.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

18. Salicylates
Aspiration pneumonia even if intubated.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Blood glucose level for hypoglycaemia!!
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

19. Carbon monoxide
Stomach pumping.
IM adrenaline: vasopressor and bronchodilator.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
It can cause fatal bronchioloitis obliterans

20. Anticholinergics
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Give IM adrenaline - steroids - salbutamol - antihistamine.

21. Which is better - activated charcoal or gastric lavage.
Skin or vascular compromise
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Aspiration pneumonia even if intubated.
CHARCOAL! except for lithium - iron - alcohol - lead.

22. What is the most important treatment for anaphylaxis
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
'I WOULD CALL POISON HOTLINE'.
IM adrenaline: vasopressor and bronchodilator.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

23. Tricyclic antidepressants overdose
IM adrenaline: vasopressor and bronchodilator.
Croup.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

24. Anticholinergics
Neurosurgery if trauma. Give mannitol.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

25. Amiodarone
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Neurosurgery if trauma. Give mannitol.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.

26. What is the most common caUse of acute laryngeal obstruction?
Glucagon prefered - otherwise massive dose of adrenaline.
Croup.
Digoxin Fab
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

27. What are the side effects of N-acety-p-benzoquinine?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Digoxin Fab
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Rash bronchospasm and hypotension.

28. Signs of psychological maltreatment?
Blood glucose level for hypoglycaemia!!
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.

29. Legal requirement in childabuse
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.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Neurosurgery if trauma. Give mannitol.

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

31. What are the early symptoms of paracetamol overdose?
Glucagon prefered - otherwise massive dose of adrenaline.
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.
Rash bronchospasm and hypotension.
Nausea vomiting and anorexia.

32. What is the most important investigation in suspected alcohol poisoning in young person?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Blood glucose level for hypoglycaemia!!
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

33. Procainamide
Discobalt edetate
Glucagon prefered - otherwise massive dose of adrenaline.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

34. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
... blood sugars for hypoglycaemia

35. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

36. When is gastric lavage indicated and contraindicated?
'I WOULD CALL POISON HOTLINE'.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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

37. Sodium Bicarbonate
Aspiration Pneumonia
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. Salicylates
... blood sugars for hypoglycaemia
Glucagon prefered - otherwise massive dose of adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.

39. Signs of abuse from the history
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.
It can cause fatal bronchioloitis obliterans

40. Methanol
Neurosurgery if trauma. Give mannitol.
Release NEUROTOXINS both have antivenom
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 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.

41. When and how would you do whole bowel irrigation?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

42. Iron
Aspiration pneumonia even if intubated.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
Abdo XRAY!!!! do it!

43. Management of septicaemia shock

44. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Sling for 3 weeks - fracture clinic at 7 days.
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
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

45. You must consider abuse in
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.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

46. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

47. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Aspiration pneumonia even if intubated.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

48. What is the antibiotic for Epiglottitis?
Glucagon prefered - otherwise massive dose of adrenaline.
Ceftriaxone
Discobalt edetate
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

49. Atropine
Cyanosis and irregular respiratory effort
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

50. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Calcium chloride
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 fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.