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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. Indications of non-accidental injury
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidote is deferoxamine chelation. Charcoal is ineffective.

2. Opiates
Antidotes are atropine sulfate and pralidoxime chloride.
Calcium chloride
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

3. Management of septicaemia shock

4. What are the side effects of N-acety-p-benzoquinine?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Rash bronchospasm and hypotension.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

5. Signs of psychological maltreatment?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Sling for 3 weeks - fracture clinic at 7 days.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

6. What happens if charcoal is aspirated?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
It can cause fatal bronchioloitis obliterans
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Calcium chloride

7. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Release NEUROTOXINS both have antivenom
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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

8. Beta-blocker overdose antidote
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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 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.
Glucagon prefered - otherwise massive dose of adrenaline.

9. Methanol
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
Immobilize with plaster slab
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

10. Mx raised intracranial pressure.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurosurgery if trauma. Give mannitol.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

11. What are the early symptoms of paracetamol overdose?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Nausea vomiting and anorexia.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

12. How may you detect semen?
Flurescence in ultraviolet light.
Ceftriaxone
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

13. What is the antibiotic for Epiglottitis?
Normally treated with sling alone. Seek advice.
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
Ceftriaxone

14. Lead
It can cause fatal bronchioloitis obliterans
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
CHARCOAL! except for lithium - iron - alcohol - lead.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

15. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Discobalt edetate
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

16. OSCE: how can i prevent accidents in my children
Ceftriaxone
Normally treated with sling alone. Seek advice.
Discobalt edetate
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

17. How do snake bites damage?
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.
Antidote is naloxone.
Neurotoxins - procagulants. Rhabdomyolysins.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

18. What are the other treatments for anaphylaxis?
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.

19. Mx of petroleum overdose
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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

20. Legal requirement in childabuse
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Notify if abuse CONSIDERED. CONSIDERED.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

21. Organophosphates
Antidotes are atropine sulfate and pralidoxime chloride.
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 decreased cholinesterase activity.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

22. Amphetamine antidote
Esmolol
... blood sugars for hypoglycaemia
Objective signs of growth - tidiness - weight -
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.

23. When is gastric lavage indicated and contraindicated?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

24. Calcium channel blocker overdose antidote
Digoxin Fab
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Blood glucose level for hypoglycaemia!!
Calcium chloride

25. Tricyclic antidepressants overdose
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Give steroids for management of serum sickness. Must do coagulation screen!!!
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

26. Mx severe croup
Sling for 3 weeks - fracture clinic at 7 days.
Croup.
Normally treated with sling alone. Seek advice.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

27. Procainamide
Sling for 3 weeks - fracture clinic at 7 days.
... blood sugars for hypoglycaemia
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

28. Theophylline
Digoxin Fab
Aspiration Pneumonia
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

29. Lidocaine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Sling for 3 weeks - fracture clinic at 7 days.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

30. What else is in the management of snake bite?
CHARCOAL! except for lithium - iron - alcohol - lead.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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 -

31. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

32. 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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Give steroids for management of serum sickness. Must do coagulation screen!!!

33. Undisplaced surgical neck of humerous?
Abdo XRAY!!!! do it!
Glucagon prefered - otherwise massive dose of adrenaline.
Sling for 3 weeks - fracture clinic at 7 days.
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

34. Digoxin antedote
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Digoxin Fab
Stomach pumping.
Release NEUROTOXINS both have antivenom

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

36. Anticholinergics
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Rash bronchospasm and hypotension.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

37. Opiates
Esmolol
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidote is naloxone.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

38. Acetaminophen
Antidote is naloxone.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
IM adrenaline: vasopressor and bronchodilator.

39. What is an important point to note about anaphylaxis?
Immobilize with plaster slab
Aspiration Pneumonia
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 -
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

40. Displaced surgical neck of humerous
... blood sugars for hypoglycaemia
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Normally treated with sling alone. Seek advice.
Digoxin Fab

41. Sympathomimetics
Abdo XRAY!!!! do it!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Digoxin Fab

42. Calcium gluconate
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.
Aspiration Pneumonia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

43. What is the most common caUse of acute laryngeal obstruction?
Antidotes are atropine sulfate and pralidoxime chloride.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Croup.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

44. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

45. Ethylene glycol
Esmolol
Neurotoxins - procagulants. Rhabdomyolysins.
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 -
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

46. What are the terminal signs of acute laryngeal obstruction?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Cyanosis and irregular respiratory effort

47. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurotoxins - procagulants. Rhabdomyolysins.
Blood glucose level for hypoglycaemia!!
Cyanosis and irregular respiratory effort

48. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Notify if abuse CONSIDERED. CONSIDERED.
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.

49. You must consider abuse in
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Severe illness - past history of injuries - 18 months or less - inconstent story.

50. What is the first line investigation in a young child who has consumed alcohol?
Intubate - tracheostromy or nebulized adrenaline.
Discobalt edetate
... blood sugars for hypoglycaemia
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.