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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. 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 -
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
Nausea vomiting and anorexia.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

2. Epinephrine
CHARCOAL! except for lithium - iron - alcohol - lead.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

3. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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 -
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

4. 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.
Blood glucose level for hypoglycaemia!!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

5. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Munchausen's by proxy
Collar and cuff. Check integrity of nerve.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

6. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

7. How may you detect semen?
Aspiration Pneumonia
Ceftriaxone
Severe illness - past history of injuries - 18 months or less - inconstent story.
Flurescence in ultraviolet light.

8. Carbon monoxide
It can cause fatal bronchioloitis obliterans
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

9. When is reduction required in fracture?
Skin or vascular compromise
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

10. What are the three features of anaphylaxis
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.
Release NEUROTOXINS both have antivenom
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

11. Beta-blocker overdose antidote
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Immobilize with plaster slab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Glucagon prefered - otherwise massive dose of adrenaline.

12. Amiodarone
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.

13. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Skin or vascular compromise
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Severe illness - past history of injuries - 18 months or less - inconstent story.

14. OSCE: how can i prevent accidents in my children
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
... blood sugars for hypoglycaemia

15. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Digoxin Fab
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

16. What are the terminal signs of acute laryngeal obstruction?
Immobilize with plaster slab
Sling for 3 weeks - fracture clinic at 7 days.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Cyanosis and irregular respiratory effort

17. Mx of snake bit
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 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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurosurgery if trauma. Give mannitol.

18. Organophosphates
It can cause fatal bronchioloitis obliterans
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes decreased cholinesterase activity.
Neurosurgery if trauma. Give mannitol.

19. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blood glucose level for hypoglycaemia!!
Collar and cuff. Check integrity of nerve.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

20. Iron
Stomach pumping.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
CHARCOAL! except for lithium - iron - alcohol - lead.

21. What is a side effect of charcoal?
Flumazenil
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Give steroids for management of serum sickness. Must do coagulation screen!!!

22. Adenosine
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Immobilize with plaster slab
Neurotoxins - procagulants. Rhabdomyolysins.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

23. 20
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
Cyanosis and irregular respiratory effort
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Severe illness - past history of injuries - 18 months or less - inconstent story.

24. OSCE: What are the five princples of discharging a patient with a fracture?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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 -
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

25. A child has swallowed a battery. Mx
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
... blood sugars for hypoglycaemia

26. What are the other treatments for anaphylaxis?
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

27. What is one of the technicalities of childabuse.
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 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 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

28. Organophosphates antidotes
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Cyanosis and irregular respiratory effort
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidotes are atropine sulfate and pralidoxime chloride.

29. 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.
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

30. What is the most important treatment for anaphylaxis
Collar and cuff. Check integrity of nerve.
IM adrenaline: vasopressor and bronchodilator.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

31. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Discobalt edetate
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Sling for 3 weeks - fracture clinic at 7 days.

32. Procainamide
Digoxin Fab
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.
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

33. Oedema causing laryngeal obstruction?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Intubate - tracheostromy or nebulized adrenaline.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

34. Calcium gluconate
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

35. Carbon monoxide
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

36. Ingesting Petrol. Cx?
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 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.
Aspiration Pneumonia
Blood glucose level for hypoglycaemia!!

37. What is the first line investigation in a young child who has consumed alcohol?
Skin or vascular compromise
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
... blood sugars for hypoglycaemia

38. Opiates
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Antidote is naloxone.
Release NEUROTOXINS both have antivenom
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.

39. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Croup.
IM adrenaline: vasopressor and bronchodilator.

40. Acetaminophen
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes decreased cholinesterase activity.
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.

41. Salicylates
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

42. Mx of petroleum overdose
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Class of drugs encompassing decongestants - amphetamines - cocaine.
Glucagon prefered - otherwise massive dose of adrenaline.

43. Iron
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Abdo XRAY!!!! do it!
Aspiration Pneumonia

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

45. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Cyanosis and irregular respiratory effort

46. Management of septicaemia shock

47. You must consider abuse in
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Abdo XRAY!!!! do it!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Severe illness - past history of injuries - 18 months or less - inconstent story.

48. 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.
Stomach pumping.
Croup.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

49. Mx severe croup
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 -
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Glucagon prefered - otherwise massive dose of adrenaline.

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