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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
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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. Mx of petroleum overdose
Antidotes are atropine sulfate and pralidoxime chloride.
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
Collar and cuff. Check integrity of nerve.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

2. 20
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Ceftriaxone
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

3. Signs of abuse from the history
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Release NEUROTOXINS both have antivenom
Glucagon prefered - otherwise massive dose of adrenaline.

4. Oedema causing laryngeal obstruction?
Calcium chloride
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

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

6. Organophosphates
Poisoning causes decreased cholinesterase activity.
Neurosurgery if trauma. Give mannitol.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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

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

8. What is the most common caUse of acute laryngeal obstruction?
Discobalt edetate
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.
Croup.

9. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.

10. Management of near drowning.
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 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
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

11. What is one of the technicalities of childabuse.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is naloxone.

12. Ibuprofen
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
Discobalt edetate
Sling for 3 weeks - fracture clinic at 7 days.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

13. When is reduction required in fracture?
Cyanosis and irregular respiratory effort
Skin or vascular compromise
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 temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

14. Management of septicaemia shock

15. Beta-blocker overdose antidote
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Glucagon prefered - otherwise massive dose of adrenaline.
Discobalt edetate

16. Anticholinergics
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Collar and cuff. Check integrity of nerve.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

17. What are the other treatments for anaphylaxis?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Aspiration Pneumonia
Give IM adrenaline - steroids - salbutamol - antihistamine.
Bone scan for occult fracture

18. Organophosphates
Calcium chloride
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
... blood sugars for hypoglycaemia

19. What are the side effects of N-acety-p-benzoquinine?
Aspiration Pneumonia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Rash bronchospasm and hypotension.
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

20. Sympathomimetics
Give steroids for management of serum sickness. Must do coagulation screen!!!
Neurotoxins - procagulants. Rhabdomyolysins.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

21. Opiates
Discobalt edetate
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Rash bronchospasm and hypotension.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

22. Indications of non-accidental injury
Esmolol
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Rash bronchospasm and hypotension.

23. Displaced surgical neck of humerous
Stomach pumping.
Normally treated with sling alone. Seek advice.
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 -
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

24. Mx severe croup
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Normally treated with sling alone. Seek advice.
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.

25. 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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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
It can cause fatal bronchioloitis obliterans

26. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Bone scan for occult fracture
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
Cyanosis and irregular respiratory effort

27. Methanol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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
Digoxin Fab
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.

28. Undisplaced surgical neck of humerous?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Sling for 3 weeks - fracture clinic at 7 days.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

29. Ethylene glycol
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Intubate - tracheostromy or nebulized adrenaline.

30. Amphetamine antidote
... blood sugars for hypoglycaemia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Esmolol
Flurescence in ultraviolet light.

31. Undisplaced radial shaft fracture
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.
Collar and cuff. Check integrity of nerve.
Stomach pumping.
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

32. Tricyclic antidepressants overdose
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Munchausen's by proxy
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

33. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Aspiration Pneumonia

34. Cyanide
Antidotes are atropine sulfate and pralidoxime chloride.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Discobalt edetate

35. Calcium channel blocker overdose antidote
Munchausen's by proxy
Calcium chloride
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

36. What is the general management of poisoning?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

37. 45; 70
... blood sugars for hypoglycaemia
Calcium chloride
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
Normally treated with sling alone. Seek advice.

38. Funnel web and red back
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Release NEUROTOXINS both have antivenom
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

39. How may you detect semen?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Flurescence in ultraviolet light.

40. Middle Clavicle fracture management?
Cyanosis and irregular respiratory effort
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Skin or vascular compromise

41. Benzodiazepine overdose antidote
Flumazenil
Calcium chloride
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
'I WOULD CALL POISON HOTLINE'.

42. Salicylates
Collar and cuff. Check integrity of nerve.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
It can cause fatal bronchioloitis obliterans
Digoxin Fab

43. What evidence should a doctor give about parental neglect
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Objective signs of growth - tidiness - weight -
Class of drugs encompassing decongestants - amphetamines - cocaine.

44. 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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Skin or vascular compromise
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

45. Ethylene glycol
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
CHARCOAL! except for lithium - iron - alcohol - lead.

46. What is an important point to note about anaphylaxis?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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 -

47. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Aspiration pneumonia even if intubated.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

48. What is the most important investigation in suspected alcohol poisoning in young person?
Abdo XRAY!!!! do it!
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Croup.
Blood glucose level for hypoglycaemia!!

49. What is gastric lavage?
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
Stomach pumping.
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
Neurotoxins - procagulants. Rhabdomyolysins.

50. OSCE: What are the five princples of discharging a patient with a fracture?
Esmolol
Glucagon prefered - otherwise massive dose of adrenaline.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.