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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. Management of septicaemia shock

2. Organophosphates antidotes
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Calcium chloride
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidotes are atropine sulfate and pralidoxime chloride.

3. What investigations should you do in suspected child abuse
Normally treated with sling alone. Seek advice.
Bone scan for occult fracture
Nausea vomiting and anorexia.
Munchausen's by proxy

4. Mx of snake bit
Rash bronchospasm and hypotension.
CHARCOAL! except for lithium - iron - alcohol - lead.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and 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.

5. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Discobalt edetate
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

6. Opiates
Antidote is naloxone.
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.
Flumazenil
Antidote is deferoxamine chelation. Charcoal is ineffective.

7. What must you do before sending fracture to radiology?
Aspiration Pneumonia
Immobilize with plaster slab
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 steroids for management of serum sickness. Must do coagulation screen!!!

8. Undisplaced radial shaft fracture
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Collar and cuff. Check integrity of nerve.

9. Salicylates
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Neurosurgery if trauma. Give mannitol.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Abdo XRAY!!!! do it!

10. What is an important point to note about anaphylaxis?
It can cause fatal bronchioloitis obliterans
Stomach pumping.
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 -
'I WOULD CALL POISON HOTLINE'.

11. Tricyclic antidepressants
Blood glucose level for hypoglycaemia!!
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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

12. What psychiatric disease defined as childabuse?

13. 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
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.
Aspiration Pneumonia
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

14. What is the most important treatment for anaphylaxis
Give IM adrenaline - steroids - salbutamol - antihistamine.
Skin or vascular compromise
Objective signs of growth - tidiness - weight -
IM adrenaline: vasopressor and bronchodilator.

15. Digoxin antedote
Digoxin Fab
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

16. Cyanide
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 -
Discobalt edetate
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
Abdo XRAY!!!! do it!

17. Middle Clavicle fracture management?
IM adrenaline: vasopressor and bronchodilator.
Croup.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

18. Hydrocarbons
'I WOULD CALL POISON HOTLINE'.
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.
Discobalt edetate

19. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Munchausen's by proxy
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

20. 45; 70
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
Flurescence in ultraviolet light.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Give steroids for management of serum sickness. Must do coagulation screen!!!

21. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Normally treated with sling alone. Seek advice.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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

22. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are atropine sulfate and pralidoxime chloride.

23. Calcium channel blocker overdose antidote
Digoxin Fab
Intubate - tracheostromy or nebulized adrenaline.
Blood glucose level for hypoglycaemia!!
Calcium chloride

24. Carbon monoxide
... blood sugars for hypoglycaemia
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

25. Opiates
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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) 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

26. Anticholinergics
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
'I WOULD CALL POISON HOTLINE'.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

27. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Skin or vascular compromise
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

28. What are the special features that must be done to correct haemorrhagic shock.
Cyanosis and irregular respiratory effort
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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
Flumazenil

29. Ethanol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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 - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

30. Mx of petroleum overdose
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
Notify if abuse CONSIDERED. CONSIDERED.
Immobilize with plaster slab
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

31. Anticholinergics
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Aspiration pneumonia even if intubated.

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

33. Carbon monoxide
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 causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

34. Mx severe croup
Poisoning causes decreased cholinesterase activity.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
CHARCOAL! except for lithium - iron - alcohol - lead.

35. Epinephrine
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

36. What are the terminal signs of acute laryngeal obstruction?
... blood sugars for hypoglycaemia
Flurescence in ultraviolet light.
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.
Cyanosis and irregular respiratory effort

37. Methanol
Normally treated with sling alone. Seek advice.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Munchausen's by proxy
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

38. Management of near drowning.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

39. Procainamide
IM adrenaline: vasopressor and bronchodilator.
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

40. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
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 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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

41. When is reduction required in fracture?
Blood glucose level for hypoglycaemia!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes decreased cholinesterase activity.
Skin or vascular compromise

42. Iron
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Flurescence in ultraviolet light.

43. Signs of psychological maltreatment?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

44. Ingesting Petrol. Cx?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Aspiration Pneumonia
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.

45. Carbon monoxide
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Bone scan for occult fracture

46. Ethylene glycol
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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!

47. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
... blood sugars for hypoglycaemia

48. Iron
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.
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.
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

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

50. What is the most important investigation in suspected alcohol poisoning in young person?
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
Immobilize with plaster slab
Notify if abuse CONSIDERED. CONSIDERED.
Blood glucose level for hypoglycaemia!!