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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. Funnel web and red back
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 3 weeks - fracture clinic at 7 days.
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
Release NEUROTOXINS both have antivenom

2. When is gastric lavage indicated and contraindicated?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

3. Which is better - activated charcoal or gastric lavage.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Esmolol
CHARCOAL! except for lithium - iron - alcohol - lead.
Discobalt edetate

4. Amphetamine 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.
Esmolol
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.

5. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
It can cause fatal bronchioloitis obliterans
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Croup.

6. Acetaminophen
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
Flumazenil
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

7. Amiodarone
Give steroids for management of serum sickness. Must do coagulation screen!!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

8. 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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Skin or vascular compromise
Causes BAD constipation. Upsets fluid and electrolyte balance.

9. Undisplaced radial shaft fracture
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Collar and cuff. Check integrity of nerve.
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

10. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Glucagon prefered - otherwise massive dose of adrenaline.
Flumazenil

11. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Skin or vascular compromise
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.

12. Tricyclic antidepressants
Immobilize with plaster slab
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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

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

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14. How may you detect semen?
Esmolol
Flurescence in ultraviolet light.
Stomach pumping.
Aspiration pneumonia even if intubated.

15. What is the first line investigation in a young child who has consumed alcohol?
Aspiration Pneumonia
... blood sugars for hypoglycaemia
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

16. What are the special features that must be done to correct haemorrhagic shock.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

17. Indications of non-accidental injury
Antidotes are atropine sulfate and pralidoxime chloride.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

18. Ingesting Petrol. Cx?
It can cause fatal bronchioloitis obliterans
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Aspiration Pneumonia

19. Iron
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidote is deferoxamine chelation. Charcoal is ineffective.

20. What investigations should you do in suspected child abuse
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Bone scan for occult fracture

21. Mx raised intracranial pressure.
Croup.
Neurosurgery if trauma. Give mannitol.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

22. 20
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Release NEUROTOXINS both have antivenom
... blood sugars for hypoglycaemia

23. Management of near drowning.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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

24. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.

25. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Intubate - tracheostromy or nebulized adrenaline.
Class of drugs encompassing decongestants - amphetamines - cocaine.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

26. What are the side effects of N-acety-p-benzoquinine?
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Rash bronchospasm and hypotension.
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

27. Calcium channel blocker overdose antidote
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidotes are atropine sulfate and pralidoxime chloride.
Aspiration Pneumonia
Calcium chloride

28. You must consider abuse in
'I WOULD CALL POISON HOTLINE'.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

29. Mx of critical asthma
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

30. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Discobalt edetate
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

31. Carbon monoxide
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
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Ceftriaxone

32. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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 even if intubated.
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.

33. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Digoxin Fab
... blood sugars for hypoglycaemia
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 -

34. What happens if charcoal is aspirated?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
It can cause fatal bronchioloitis obliterans

35. what makes you suspicious of non-accidental injury.
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

36. Management of septicaemia shock

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37. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

38. Sympathomimetics
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

39. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

40. Salicylates
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 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.
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

41. Mx severe croup
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
'I WOULD CALL POISON HOTLINE'.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Flurescence in ultraviolet light.

42. Procainamide
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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 causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

43. Methanol
Objective signs of growth - tidiness - weight -
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

44. Epinephrine
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Blood glucose level for hypoglycaemia!!

45. What is a side effect of charcoal?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 -
Causes BAD constipation. Upsets fluid and electrolyte balance.

46. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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

47. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

48. Signs of abuse from the history
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Intubate - tracheostromy or nebulized adrenaline.
Nausea vomiting and anorexia.

49. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
CHARCOAL! except for lithium - iron - alcohol - lead.
Flumazenil

50. Displaced surgical neck of humerous
Collar and cuff. Check integrity of nerve.
Abdo XRAY!!!! do it!
Normally treated with sling alone. Seek advice.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema