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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. What are the other treatments for anaphylaxis?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Aspiration pneumonia even if intubated.

2. what makes you suspicious of non-accidental injury.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of drugs encompassing decongestants - amphetamines - cocaine.

3. Sympathomimetics
Aspiration pneumonia even if intubated.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Nausea vomiting and anorexia.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

4. What happens if charcoal is aspirated?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
It can cause fatal bronchioloitis obliterans
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

5. Ethylene glycol
Aspiration pneumonia even if intubated.
IM adrenaline: vasopressor and bronchodilator.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

6. Lead
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

7. Calcium gluconate
Release NEUROTOXINS both have antivenom
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

8. What is the most common caUse of acute laryngeal obstruction?
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
Croup.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Stomach pumping.

9. Theophylline
Rash bronchospasm and hypotension.
Aspiration pneumonia even if intubated.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

10. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Glucagon prefered - otherwise massive dose of adrenaline.

11. 20
Digoxin Fab
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Ceftriaxone

12. OSCE: What are the five princples of discharging a patient with a fracture?
Croup.
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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

13. Benzodiazepine overdose antidote
Munchausen's by proxy
Flumazenil
Blood glucose level for hypoglycaemia!!
Neurosurgery if trauma. Give mannitol.

14. 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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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

15. Carbon monoxide
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Calcium chloride
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.

16. Indications of non-accidental injury
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

17. Tricyclic antidepressants
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
Blood glucose level for hypoglycaemia!!
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

18. Management of septicaemia shock

19. Funnel web and red back
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Flurescence in ultraviolet light.
Release NEUROTOXINS both have antivenom
Munchausen's by proxy

20. Signs of abuse from the history
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

21. Digoxin antedote
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
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.
Flumazenil
Digoxin Fab

22. Ethylene glycol
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
CHARCOAL! except for lithium - iron - alcohol - lead.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

23. What is the first line investigation in a young child who has consumed alcohol?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
... blood sugars for hypoglycaemia
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
It can cause fatal bronchioloitis obliterans

24. 45; 70
Esmolol
Croup.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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

25. Anticholinergics
Blood glucose level for hypoglycaemia!!
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

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

27. Calcium channel blocker overdose antidote
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 -
Calcium chloride
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurotoxins - procagulants. Rhabdomyolysins.

28. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flumazenil
Aspiration pneumonia even if intubated.
Immobilize with plaster slab

29. What else is in the management of snake bite?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Discobalt edetate
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Give steroids for management of serum sickness. Must do coagulation screen!!!

30. Anticholinergics
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

31. What is the antibiotic for Epiglottitis?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Blood glucose level for hypoglycaemia!!
Ceftriaxone
Antidote is deferoxamine chelation. Charcoal is ineffective.

32. Legal requirement in childabuse
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

33. How may you detect semen?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Flurescence in ultraviolet light.
Antidote is naloxone.
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.

34. What are the early symptoms of paracetamol overdose?
Rash bronchospasm and hypotension.
Antidote is naloxone.
Objective signs of growth - tidiness - weight -
Nausea vomiting and anorexia.

35. Ethanol
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.

36. Iron
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Nausea vomiting and anorexia.
Antidote is deferoxamine chelation. Charcoal is ineffective.

37. What investigations should you do in suspected child abuse
Poisoning causes decreased cholinesterase activity.
Bone scan for occult fracture
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Notify if abuse CONSIDERED. CONSIDERED.

38. OSCE: how can i prevent accidents in my children
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
Cyanosis and irregular respiratory effort
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

39. Procainamide
Antidotes are atropine sulfate and pralidoxime chloride.
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Blood glucose level for hypoglycaemia!!

40. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
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.

41. When is gastric lavage indicated and contraindicated?
Flumazenil
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Objective signs of growth - tidiness - weight -
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

42. Amiodarone
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Flumazenil
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

43. What is gastric lavage?
Skin or vascular compromise
Stomach pumping.
Croup.
Poisoning causes decreased cholinesterase activity.

44. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.
Collar and cuff. Check integrity of nerve.

45. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Esmolol
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.

46. Salicylates
Cyanosis and irregular respiratory effort
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Collar and cuff. Check integrity of nerve.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

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

48. You must consider abuse in
Skin or vascular compromise
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

49. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
Blood glucose level for hypoglycaemia!!

50. Beta-blocker overdose antidote
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Glucagon prefered - otherwise massive dose of adrenaline.