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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. Undisplaced surgical neck of humerous?
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.
Intubate - tracheostromy or nebulized adrenaline.
Antidotes are atropine sulfate and pralidoxime chloride.

2. Funnel web and red back
Release NEUROTOXINS both have antivenom
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

3. Anticholinergics
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 - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Objective signs of growth - tidiness - weight -

4. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

5. Ethylene glycol
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.
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.

6. Mx of snake bit
Aspiration Pneumonia
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Neurotoxins - procagulants. Rhabdomyolysins.

7. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Ceftriaxone
Bone scan for occult fracture
Antidotes are atropine sulfate and pralidoxime chloride.

8. Calcium channel blocker overdose antidote
Calcium chloride
Flumazenil
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
... blood sugars for hypoglycaemia

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

10. what makes you suspicious of non-accidental injury.
Neurosurgery if trauma. Give mannitol.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

11. Hydrocarbons
Collar and cuff. Check integrity of nerve.
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

12. When is reduction required in fracture?
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.
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.
Flurescence in ultraviolet light.
Skin or vascular compromise

13. Iron
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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
Rash bronchospasm and hypotension.
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

14. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Release NEUROTOXINS both have antivenom
Antidotes are atropine sulfate and pralidoxime chloride.
Flurescence in ultraviolet light.

15. Carbon monoxide
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Flurescence in ultraviolet light.

16. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Croup.
Release NEUROTOXINS both have antivenom

17. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Intubate - tracheostromy or nebulized adrenaline.
Skin or vascular compromise

18. Sympathomimetics
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.
Antidote is naloxone.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

19. Epinephrine
... blood sugars for hypoglycaemia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Nausea vomiting and anorexia.
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

20. Benzodiazepine overdose antidote
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.
Flumazenil
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.
Skin or vascular compromise

21. 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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Aspiration Pneumonia

22. What is the most important investigation in suspected alcohol poisoning in young person?
It can cause fatal bronchioloitis obliterans
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blood glucose level for hypoglycaemia!!

23. What else is in the management of snake bite?
Munchausen's by proxy
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

24. What are the early symptoms of paracetamol overdose?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Calcium chloride
Nausea vomiting and anorexia.
Antidote is naloxone.

25. Opiates
Stomach pumping.
Antidote is naloxone.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

26. Signs of psychological maltreatment?
Aspiration pneumonia even if intubated.
Neurotoxins - procagulants. Rhabdomyolysins.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.

27. Atropine
Esmolol
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

28. Ibuprofen
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Abdo XRAY!!!! do it!

29. When and how would you do whole bowel irrigation?
Esmolol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

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

31. Indications of non-accidental injury
Immobilize with plaster slab
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Munchausen's by proxy

32. Sympathomimetics
Abdo XRAY!!!! do it!
Antidote is naloxone.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

33. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Nausea vomiting and anorexia.
Normally treated with sling alone. Seek advice.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

34. Cyanide
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Intubate - tracheostromy or nebulized adrenaline.
Discobalt edetate

35. Beta-blocker overdose antidote
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.

36. Management of septicaemia shock

37. What is gastric lavage?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Stomach pumping.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Neurosurgery if trauma. Give mannitol.

38. What is an important point to note about anaphylaxis?
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Nausea vomiting and anorexia.

39. What are the special features that must be done to correct haemorrhagic shock.
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.
Nausea vomiting and anorexia.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Notify if abuse CONSIDERED. CONSIDERED.

40. Ethylene glycol
Abdo XRAY!!!! do it!
Digoxin Fab
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.
Discobalt edetate

41. Ingesting Petrol. Cx?
Aspiration Pneumonia
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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

42. Acetaminophen
Discobalt edetate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidotes are atropine sulfate and pralidoxime chloride.

43. Methanol
Notify if abuse CONSIDERED. CONSIDERED.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Antidotes are atropine sulfate and pralidoxime chloride.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

44. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Bone scan for occult fracture
Flumazenil
Collar and cuff. Check integrity of nerve.

45. Organophosphates
Digoxin Fab
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

46. What is the general management of poisoning?
Sling for 3 weeks - fracture clinic at 7 days.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

47. Digoxin antedote
Digoxin Fab
Bone scan for occult fracture
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.

48. Opiates
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
Digoxin Fab

49. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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 even if intubated.

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