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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 is a side effect of charcoal?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.

2. Sympathomimetics
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 -

3. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Notify if abuse CONSIDERED. CONSIDERED.
IM adrenaline: vasopressor and bronchodilator.
Glucagon prefered - otherwise massive dose of adrenaline.

4. Iron
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Discobalt edetate

5. Ethanol
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

6. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

7. Which is better - activated charcoal or gastric lavage.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
CHARCOAL! except for lithium - iron - alcohol - lead.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Nausea vomiting and anorexia.

8. How do snake bites damage?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.

9. What are the early symptoms of paracetamol overdose?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Nausea vomiting and anorexia.
Croup.

10. Amiodarone
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

11. What is the first line investigation in a young child who has consumed alcohol?
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
... blood sugars for hypoglycaemia
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

12. Undisplaced radial shaft fracture
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Collar and cuff. Check integrity of nerve.

13. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Class of drugs encompassing decongestants - amphetamines - cocaine.

14. Ethylene glycol
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

15. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
It can cause fatal bronchioloitis obliterans
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Esmolol

16. Signs of abuse from the history
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.
Antidotes are atropine sulfate and pralidoxime chloride.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Ceftriaxone

17. What must you do before sending fracture to radiology?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Digoxin Fab
Immobilize with plaster slab
Antidote is naloxone.

18. Benzodiazepine overdose antidote
Flumazenil
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Give steroids for management of serum sickness. Must do coagulation screen!!!

19. Lead
Rash bronchospasm and hypotension.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

20. Atropine
Aspiration Pneumonia
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

21. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Sling for 3 weeks - fracture clinic at 7 days.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurosurgery if trauma. Give mannitol.

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

23. What evidence should a doctor give about parental neglect
Release NEUROTOXINS both have antivenom
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Aspiration Pneumonia
Objective signs of growth - tidiness - weight -

24. Anticholinergics
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
It can cause fatal bronchioloitis obliterans
Neurosurgery if trauma. Give mannitol.

25. What happens if charcoal is aspirated?
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
It can cause fatal bronchioloitis obliterans
Munchausen's by proxy

26. Adenosine
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

27. Ibuprofen
Class of drugs encompassing decongestants - amphetamines - cocaine.
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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

28. Sodium Bicarbonate
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Rash bronchospasm and hypotension.

29. How may you detect semen?
Antidotes are atropine sulfate and pralidoxime chloride.
Flurescence in ultraviolet light.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

30. Beta-blocker overdose antidote
Cyanosis and irregular respiratory effort
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Glucagon prefered - otherwise massive dose of adrenaline.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

31. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Stomach pumping.
Intubate - tracheostromy or nebulized adrenaline.
Release NEUROTOXINS both have antivenom

32. Undisplaced surgical neck of humerous?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
CHARCOAL! except for lithium - iron - alcohol - lead.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Sling for 3 weeks - fracture clinic at 7 days.

33. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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 -
Abdo XRAY!!!! do it!
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

34. Hydrocarbons
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

35. Middle Clavicle fracture management?
Antidotes are atropine sulfate and pralidoxime chloride.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

36. What is the most important investigation in suspected alcohol poisoning in young person?
'I WOULD CALL POISON HOTLINE'.
Digoxin Fab
Blood glucose level for hypoglycaemia!!
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

37. Legal requirement in childabuse
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Notify if abuse CONSIDERED. CONSIDERED.
Stomach pumping.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

38. What is the most common caUse of acute laryngeal obstruction?
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

39. Procainamide
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.
Collar and cuff. Check integrity of nerve.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Normally treated with sling alone. Seek advice.

40. Iron
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 - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

41. Tricyclic antidepressants overdose
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Esmolol
Ceftriaxone

42. What are the other treatments for anaphylaxis?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

43. Organophosphates antidotes
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

44. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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 -
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

45. What else is in the management of snake bite?
Munchausen's by proxy
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
... blood sugars for hypoglycaemia
Give steroids for management of serum sickness. Must do coagulation screen!!!

46. Funnel web and red back
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes decreased cholinesterase activity.
Release NEUROTOXINS both have antivenom
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

47. Ethylene glycol
... blood sugars for hypoglycaemia
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 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.
Calcium chloride

48. Management of septicaemia shock

49. Salicylates
Skin or vascular compromise
Release NEUROTOXINS both have antivenom
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

50. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Collar and cuff. Check integrity of nerve.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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