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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. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
'I WOULD CALL POISON HOTLINE'.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

2. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

3. Oedema causing laryngeal obstruction?
Antidote is naloxone.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Intubate - tracheostromy or nebulized adrenaline.
CHARCOAL! except for lithium - iron - alcohol - lead.

4. Epinephrine
... blood sugars for hypoglycaemia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

5. 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.
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 -
Immobilize with plaster slab
Sling for 3 weeks - fracture clinic at 7 days.

6. Benzodiazepine overdose antidote
Calcium chloride
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Flumazenil

7. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

8. Beta-blocker overdose antidote
Rash bronchospasm and hypotension.
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
Glucagon prefered - otherwise massive dose of adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

9. Amphetamine antidote
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Esmolol
Normally treated with sling alone. Seek advice.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

10. Lead
Skin or vascular compromise
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

11. Methanol
Neurosurgery if trauma. Give mannitol.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Esmolol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

12. Ingesting Petrol. Cx?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Glucagon prefered - otherwise massive dose of adrenaline.
Collar and cuff. Check integrity of nerve.
Aspiration Pneumonia

13. Organophosphates
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

14. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
Immobilize with plaster slab
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.

15. Carbon monoxide
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Severe illness - past history of injuries - 18 months or less - inconstent story.

16. What is the first line investigation in a young child who has consumed alcohol?
Bone scan for occult fracture
... blood sugars for hypoglycaemia
Neurotoxins - procagulants. Rhabdomyolysins.
IM adrenaline: vasopressor and bronchodilator.

17. OSCE: What are the five princples of discharging a patient with a fracture?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
'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.

18. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Flurescence in ultraviolet light.
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.
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 -

19. Management of septicaemia shock

20. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Flurescence in ultraviolet light.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

21. When is reduction required in fracture?
Skin or vascular compromise
Notify if abuse CONSIDERED. CONSIDERED.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

22. Sympathomimetics
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Rash bronchospasm and hypotension.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidote is naloxone.

23. What is an important point to note about anaphylaxis?
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 -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Flumazenil

24. Calcium channel blocker overdose antidote
It can cause fatal bronchioloitis obliterans
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Calcium chloride
Give IM adrenaline - steroids - salbutamol - antihistamine.

25. Salicylates
Objective signs of growth - tidiness - weight -
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

26. How do snake bites damage?
Glucagon prefered - otherwise massive dose of adrenaline.
Neurotoxins - procagulants. Rhabdomyolysins.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

27. 20
Skin or vascular compromise
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Flurescence in ultraviolet light.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

28. What must you do before sending fracture to radiology?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Immobilize with plaster slab
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
It can cause fatal bronchioloitis obliterans

29. What is the general management of poisoning?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Causes BAD constipation. Upsets fluid and electrolyte balance.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
IM adrenaline: vasopressor and bronchodilator.

30. When and how would you do whole bowel irrigation?
Skin or vascular compromise
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Neurosurgery if trauma. Give mannitol.

31. What evidence should a doctor give about parental neglect
Ceftriaxone
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Objective signs of growth - tidiness - weight -
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.

32. Signs of psychological maltreatment?
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Give steroids for management of serum sickness. Must do coagulation screen!!!

33. What are the three features of anaphylaxis
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.
Flurescence in ultraviolet light.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Release NEUROTOXINS both have antivenom

34. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Flumazenil
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

35. Management of near drowning.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
Notify if abuse CONSIDERED. CONSIDERED.
Release NEUROTOXINS both have antivenom

36. Sympathomimetics
Ceftriaxone
Notify if abuse CONSIDERED. CONSIDERED.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

37. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes decreased cholinesterase activity.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

38. Salicylates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Abdo XRAY!!!! do it!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

39. What are the other treatments for anaphylaxis?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Cyanosis and irregular respiratory effort

40. Mx of critical asthma
Skin or vascular compromise
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

41. Ethylene glycol
Aspiration Pneumonia
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.
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 -

42. Organophosphates
Neurosurgery if trauma. Give mannitol.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes decreased cholinesterase activity.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

43. What happens if charcoal is aspirated?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
'I WOULD CALL POISON HOTLINE'.
Severe illness - past history of injuries - 18 months or less - inconstent story.
It can cause fatal bronchioloitis obliterans

44. 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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Normally treated with sling alone. Seek advice.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

45. What is a side effect of charcoal?
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Give steroids for management of serum sickness. Must do coagulation screen!!!

46. Digoxin antedote
Croup.
Antidotes are atropine sulfate and pralidoxime chloride.
Digoxin Fab
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

47. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Release NEUROTOXINS both have antivenom
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Causes BAD constipation. Upsets fluid and electrolyte balance.

48. What is the most appropriate examination in a child with suspected lead ingestion?
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.
Discobalt edetate
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.
Abdo XRAY!!!! do it!

49. Legal requirement in childabuse
Glucagon prefered - otherwise massive dose of adrenaline.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Notify if abuse CONSIDERED. CONSIDERED.
Release NEUROTOXINS both have antivenom

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