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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. Acetaminophen
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Esmolol
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

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

3. Mx raised intracranial pressure.
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
Digoxin Fab
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.
Neurosurgery if trauma. Give mannitol.

4. Ethanol
Discobalt edetate
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Class of drugs encompassing decongestants - amphetamines - cocaine.

5. 20
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

6. What are the special features that must be done to correct haemorrhagic shock.
Glucagon prefered - otherwise massive dose of adrenaline.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

7. What is the most important treatment for anaphylaxis
CHARCOAL! except for lithium - iron - alcohol - lead.
Aspiration Pneumonia
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.

8. Organophosphates
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Release NEUROTOXINS both have antivenom
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

9. Calcium channel blocker overdose antidote
Calcium chloride
IM adrenaline: vasopressor and bronchodilator.
It can cause fatal bronchioloitis obliterans
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

10. OSCE: how can i prevent accidents in my children
Notify if abuse CONSIDERED. CONSIDERED.
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
It can cause fatal bronchioloitis obliterans
Blood glucose level for hypoglycaemia!!

11. Displaced surgical neck of humerous
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.
Blood glucose level for hypoglycaemia!!
Normally treated with sling alone. Seek advice.

12. What investigations should you do in suspected child abuse
Antidotes are atropine sulfate and pralidoxime chloride.
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

13. Management of near drowning.
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 causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Notify if abuse CONSIDERED. CONSIDERED.
It can cause fatal bronchioloitis obliterans

14. Hydrocarbons
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
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
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 -

15. Sodium Bicarbonate
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Discobalt edetate

16. Sympathomimetics
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

17. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Normally treated with sling alone. Seek advice.
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

18. Benzodiazepine overdose antidote
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Flumazenil
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
IM adrenaline: vasopressor and bronchodilator.

19. What is an important point to note about anaphylaxis?
Bone scan for occult fracture
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 -
Severe illness - past history of injuries - 18 months or less - inconstent story.
Aspiration pneumonia even if intubated.

20. Mx severe croup
Objective signs of growth - tidiness - weight -
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Discobalt edetate

21. How may you detect semen?
Flurescence in ultraviolet light.
Flumazenil
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.

22. Signs of abuse from the history
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Cyanosis and irregular respiratory effort
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

23. What psychiatric disease defined as childabuse?

24. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Intubate - tracheostromy or nebulized adrenaline.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

25. What must you do before sending fracture to radiology?
Digoxin Fab
Immobilize with plaster slab
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Give IM adrenaline - steroids - salbutamol - antihistamine.

26. Legal requirement in childabuse
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Notify if abuse CONSIDERED. CONSIDERED.
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.

27. Signs of psychological maltreatment?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
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.

28. Anticholinergics
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

29. What is the most important investigation in suspected alcohol poisoning in young person?
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
Blood glucose level for hypoglycaemia!!

30. What is a side effect of charcoal?
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
'I WOULD CALL POISON HOTLINE'.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Causes BAD constipation. Upsets fluid and electrolyte balance.

31. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

32. What is one of the technicalities of childabuse.
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.
Antidote is naloxone.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

33. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
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 causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

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

35. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Antidotes are atropine sulfate and pralidoxime chloride.
Croup.

36. Carbon monoxide
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Blood glucose level for hypoglycaemia!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

37. Ingesting Petrol. Cx?
Aspiration Pneumonia
Causes BAD constipation. Upsets fluid and electrolyte balance.
Digoxin Fab
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 -

38. Amphetamine antidote
Esmolol
Aspiration pneumonia even if intubated.
Abdo XRAY!!!! do it!
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

39. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
... blood sugars for hypoglycaemia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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.

40. Undisplaced radial shaft fracture
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Collar and cuff. Check integrity of nerve.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

41. Mx of petroleum overdose
Antidote is naloxone.
Blood glucose level for hypoglycaemia!!
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

42. Indications of non-accidental injury
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

43. What are the terminal signs of acute laryngeal obstruction?
Skin or vascular compromise
Immobilize with plaster slab
Cyanosis and irregular respiratory effort
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

44. Procainamide
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

45. Mx of snake bit
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.
Aspiration pneumonia even if intubated.
Severe illness - past history of injuries - 18 months or less - inconstent story.

46. Amiodarone
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Blood glucose level for hypoglycaemia!!
Collar and cuff. Check integrity of nerve.

47. Beta-blocker overdose antidote
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Glucagon prefered - otherwise massive dose of adrenaline.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Flumazenil

48. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

49. What is the antibiotic for Epiglottitis?
Antidotes are atropine sulfate and pralidoxime chloride.
Blood glucose level for hypoglycaemia!!
Ceftriaxone
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

50. Digoxin antedote
IM adrenaline: vasopressor and bronchodilator.
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Bone scan for occult fracture