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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. Opiates
Intubate - tracheostromy or nebulized adrenaline.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidote is naloxone.
Bone scan for occult fracture

2. Acetaminophen
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
IM adrenaline: vasopressor and bronchodilator.

3. Legal requirement in childabuse
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Notify if abuse CONSIDERED. CONSIDERED.
Glucagon prefered - otherwise massive dose of adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

4. What are the special features that must be done to correct haemorrhagic shock.
Notify if abuse CONSIDERED. CONSIDERED.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Discobalt edetate

5. 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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

6. What are the other treatments for anaphylaxis?
Rash bronchospasm and hypotension.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.

7. Digoxin antedote
Flumazenil
Digoxin Fab
Nausea vomiting and anorexia.
Flurescence in ultraviolet light.

8. Which is better - activated charcoal or gastric lavage.
Class of drugs encompassing decongestants - amphetamines - cocaine.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

9. Amphetamine antidote
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of drugs encompassing decongestants - amphetamines - cocaine.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Esmolol

10. Middle Clavicle fracture management?
Objective signs of growth - tidiness - weight -
Class of drugs encompassing decongestants - amphetamines - cocaine.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

11. How do snake bites damage?
Aspiration Pneumonia
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Neurotoxins - procagulants. Rhabdomyolysins.
Flumazenil

12. Procainamide
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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

13. Adenosine
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

14. Oedema causing laryngeal obstruction?
Munchausen's by proxy
Intubate - tracheostromy or nebulized 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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

15. Anticholinergics
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Release NEUROTOXINS both have antivenom

16. What is the general management of poisoning?
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Blood glucose level for hypoglycaemia!!

17. Funnel web and red back
Release NEUROTOXINS both have antivenom
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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Rash bronchospasm and hypotension.

18. What is an important point to note about anaphylaxis?
Nausea vomiting and anorexia.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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

19. What evidence should a doctor give about parental neglect
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Objective signs of growth - tidiness - weight -
Glucagon prefered - otherwise massive dose of adrenaline.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

20. Benzodiazepine overdose antidote
Munchausen's by proxy
Flumazenil
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Abdo XRAY!!!! do it!

21. What is the most common caUse of acute laryngeal obstruction?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Croup.
Cyanosis and irregular respiratory effort
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

22. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Immobilize with plaster slab
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.

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

24. Carbon monoxide
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Blood glucose level for hypoglycaemia!!

25. what makes you suspicious of non-accidental injury.
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.
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
Skin or vascular compromise

26. Amiodarone
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
'I WOULD CALL POISON HOTLINE'.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.

27. Salicylates
Severe illness - past history of injuries - 18 months or less - inconstent story.
Bone scan for occult fracture
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidotes are atropine sulfate and pralidoxime chloride.

28. What psychiatric disease defined as childabuse?

29. Sympathomimetics
Antidote is naloxone.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans

30. Signs of abuse from the history
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Collar and cuff. Check integrity of nerve.
Release NEUROTOXINS both have antivenom
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

31. OSCE: What are the five princples of discharging a patient with a fracture?
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.
Abdo XRAY!!!! do it!
Esmolol
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

32. 45; 70
Notify if abuse CONSIDERED. CONSIDERED.
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.
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

33. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!

34. Signs of psychological maltreatment?
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Normally treated with sling alone. Seek advice.

35. Opiates
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Digoxin Fab
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

36. What is one of the technicalities of childabuse.
Calcium chloride
Esmolol
Abdo XRAY!!!! do it!
Before a child can be examined for child abuse - a parent or legal guardian must give consent

37. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidote is naloxone.
IM adrenaline: vasopressor and bronchodilator.
Esmolol

38. What is the antibiotic for Epiglottitis?
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 causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ceftriaxone
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. Lidocaine
Give steroids for management of serum sickness. Must do coagulation screen!!!
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Objective signs of growth - tidiness - weight -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

40. Carbon monoxide
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Digoxin Fab

41. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Intubate - tracheostromy or nebulized adrenaline.
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 drugs encompassing decongestants - amphetamines - cocaine.

42. What happens if charcoal is aspirated?
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
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.
It can cause fatal bronchioloitis obliterans
Flumazenil

43. Sodium Bicarbonate
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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

44. Calcium gluconate
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Objective signs of growth - tidiness - weight -
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

45. Methanol
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Blood glucose level for hypoglycaemia!!
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

46. Mx raised intracranial pressure.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Neurosurgery if trauma. Give mannitol.
Flurescence in ultraviolet light.

47. What is the first line investigation in a young child who has consumed alcohol?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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
... blood sugars for hypoglycaemia
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.

48. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

49. Management of near drowning.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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

50. Mx severe croup
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Antidote is naloxone.