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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

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1. What is an important point to note about anaphylaxis?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Aspiration pneumonia even if intubated.
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 -
Give steroids for management of serum sickness. Must do coagulation screen!!!

2. Management of septicaemia shock

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3. How do snake bites damage?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Give steroids for management of serum sickness. Must do coagulation screen!!!
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Neurotoxins - procagulants. Rhabdomyolysins.

4. 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
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

5. Ibuprofen
'I WOULD CALL POISON HOTLINE'.
Cyanosis and irregular respiratory effort
Flurescence in ultraviolet light.
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

6. What is the first line investigation in a young child who has consumed alcohol?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Normally treated with sling alone. Seek advice.
... blood sugars for hypoglycaemia

7. Tricyclic antidepressants
Collar and cuff. Check integrity of nerve.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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

8. What are the three features of anaphylaxis
Flumazenil
Bone scan for occult fracture
Antidotes are atropine sulfate and pralidoxime chloride.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

9. Signs of psychological maltreatment?
Objective signs of growth - tidiness - weight -
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 -
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

10. Opiates
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Antidote is naloxone.
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

11. Mx of critical asthma
Collar and cuff. Check integrity of nerve.
Abdo XRAY!!!! do it!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

12. Funnel web and red back
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Aspiration Pneumonia
Release NEUROTOXINS both have antivenom
Neurosurgery if trauma. Give mannitol.

13. Anticholinergics
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

14. Amiodarone
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.
IM adrenaline: vasopressor and bronchodilator.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

15. Lidocaine
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Digoxin Fab
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

16. what makes you suspicious of non-accidental injury.
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 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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
IM adrenaline: vasopressor and bronchodilator.

17. Sympathomimetics
Aspiration pneumonia even if intubated.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

18. Cyanide
Discobalt edetate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

19. What are the side effects of N-acety-p-benzoquinine?
... blood sugars for hypoglycaemia
Rash bronchospasm and hypotension.
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

20. When is reduction required in fracture?
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.
Skin or vascular compromise
Release NEUROTOXINS both have antivenom
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

21. Mx severe croup
Abdo XRAY!!!! do it!
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

22. Epinephrine
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Munchausen's by proxy
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

23. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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

24. Anticholinergics
Blood glucose level for hypoglycaemia!!
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.
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.

25. Ingesting Petrol. Cx?
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.
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
Aspiration Pneumonia
Glucagon prefered - otherwise massive dose of adrenaline.

26. Theophylline
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.
Discobalt edetate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

27. Organophosphates
Poisoning causes decreased cholinesterase activity.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

28. Procainamide
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
Poisoning causes decreased cholinesterase activity.

29. Which is better - activated charcoal or gastric lavage.
Causes BAD constipation. Upsets fluid and electrolyte balance.
CHARCOAL! except for lithium - iron - alcohol - lead.
Intubate - tracheostromy or nebulized adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

30. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
CHARCOAL! except for lithium - iron - alcohol - lead.
Notify if abuse CONSIDERED. CONSIDERED.

31. What is the most common caUse of acute laryngeal obstruction?
Release NEUROTOXINS both have antivenom
Croup.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.

32. Middle Clavicle fracture management?
Glucagon prefered - otherwise massive dose of adrenaline.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Aspiration pneumonia even if intubated.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

33. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.

34. What is the antibiotic for Epiglottitis?
Flumazenil
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.
Ceftriaxone

35. 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
Discobalt edetate
Severe illness - past history of injuries - 18 months or less - inconstent story.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

36. What psychiatric disease defined as childabuse?

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37. What else is in the management of snake bite?
... blood sugars for hypoglycaemia
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Aspiration pneumonia even if intubated.
Give steroids for management of serum sickness. Must do coagulation screen!!!

38. Anticholinergics
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

39. What investigations should you do in suspected child abuse
Poisoning causes decreased cholinesterase activity.
... blood sugars for hypoglycaemia
Bone scan for occult fracture
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

40. Oedema causing laryngeal obstruction?
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
Intubate - tracheostromy or nebulized adrenaline.

41. A child has swallowed a battery. Mx
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

42. What is the most appropriate examination in a child with suspected lead ingestion?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Abdo XRAY!!!! do it!
Immobilize with plaster slab
Before a child can be examined for child abuse - a parent or legal guardian must give consent

43. What are the other treatments for anaphylaxis?
Sling for 3 weeks - fracture clinic at 7 days.
IM adrenaline: vasopressor and bronchodilator.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Give IM adrenaline - steroids - salbutamol - antihistamine.

44. Tricyclic antidepressants overdose
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Discobalt edetate
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Aspiration pneumonia even if intubated.

45. Calcium channel blocker overdose antidote
Calcium chloride
Skin or vascular compromise
Abdo XRAY!!!! do it!
Flumazenil

46. Carbon monoxide
Give IM adrenaline - steroids - salbutamol - antihistamine.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Digoxin Fab

47. Carbon monoxide
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Aspiration Pneumonia
Aspiration pneumonia even if intubated.

48. What are the terminal signs of acute laryngeal obstruction?
Esmolol
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cyanosis and irregular respiratory effort

49. Amphetamine antidote
Esmolol
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

50. Benzodiazepine overdose antidote
Flumazenil
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

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