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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.
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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. 45; 70
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 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 even if intubated.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

2. Indications of non-accidental injury
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Ceftriaxone
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.

3. Hydrocarbons
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 3 weeks - fracture clinic at 7 days.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

4. Mx of petroleum overdose
Class of drugs encompassing decongestants - amphetamines - cocaine.
Normally treated with sling alone. Seek advice.
Neurosurgery if trauma. Give mannitol.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

5. Middle Clavicle fracture management?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Antidote is naloxone.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

6. What is the first line investigation in a young child who has consumed alcohol?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Calcium chloride
... blood sugars for hypoglycaemia

7. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Cyanosis and irregular respiratory effort
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Rash bronchospasm and hypotension.

8. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Cyanosis and irregular respiratory effort

9. Carbon monoxide
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Aspiration Pneumonia
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

10. What happens if charcoal is aspirated?
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
It can cause fatal bronchioloitis obliterans

11. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
IM adrenaline: vasopressor and bronchodilator.
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.

12. You must consider abuse in
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Skin or vascular compromise
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

13. Mx of snake bit
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

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

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15. Undisplaced surgical neck of humerous?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Aspiration Pneumonia
Sling for 3 weeks - fracture clinic at 7 days.

16. Which is better - activated charcoal or gastric lavage.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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

17. What is the most common caUse of acute laryngeal obstruction?
Flumazenil
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Croup.
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 -

18. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.

19. What is a side effect of charcoal?
Aspiration pneumonia even if intubated.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Normally treated with sling alone. Seek advice.
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.

20. What is one of the technicalities of childabuse.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
It can cause fatal bronchioloitis obliterans
'I WOULD CALL POISON HOTLINE'.

21. Salicylates
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

22. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

23. Organophosphates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes decreased cholinesterase activity.
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 causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

24. Calcium channel blocker overdose antidote
Flurescence in ultraviolet light.
Collar and cuff. Check integrity of nerve.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Calcium chloride

25. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

26. Atropine
Neurosurgery if trauma. Give mannitol.
Blood glucose level for hypoglycaemia!!
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

27. Ethylene glycol
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

28. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are atropine sulfate and pralidoxime chloride.
Abdo XRAY!!!! do it!
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

29. Digoxin antedote
Digoxin Fab
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Cyanosis and irregular respiratory effort

30. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Normally treated with sling alone. Seek advice.
'I WOULD CALL POISON HOTLINE'.
Aspiration pneumonia even if intubated.
Severe illness - past history of injuries - 18 months or less - inconstent story.

31. Amphetamine antidote
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Esmolol
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

32. what makes you suspicious of non-accidental injury.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Flurescence in ultraviolet light.

33. Legal requirement in childabuse
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
Bone scan for occult fracture
Notify if abuse CONSIDERED. CONSIDERED.

34. Tricyclic antidepressants
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Abdo XRAY!!!! do it!
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
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

35. Lidocaine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

36. OSCE: What are the five princples of discharging a patient with a fracture?
Collar and cuff. Check integrity of nerve.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

37. A child has swallowed a battery. Mx
Neurosurgery if trauma. Give mannitol.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
... blood sugars for hypoglycaemia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. What are the three features of anaphylaxis
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

39. Ibuprofen
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Flumazenil

40. What is the antibiotic for Epiglottitis?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Nausea vomiting and anorexia.
Ceftriaxone
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

41. Ingesting Petrol. Cx?
Cyanosis and irregular respiratory effort
Munchausen's by proxy
Aspiration Pneumonia
Abdo XRAY!!!! do it!

42. Ethylene glycol
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidotes are atropine sulfate and pralidoxime chloride.
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.

43. What evidence should a doctor give about parental neglect
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Objective signs of growth - tidiness - weight -
Bone scan for occult fracture
Immobilize with plaster slab

44. OSCE: how can i prevent accidents in my children
Antidote is naloxone.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
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

45. What is the most important investigation in suspected alcohol poisoning in young person?
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.
Blood glucose level for hypoglycaemia!!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

46. Sympathomimetics
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

47. Sodium Bicarbonate
Calcium chloride
Munchausen's by proxy
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

48. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Give IM adrenaline - steroids - salbutamol - antihistamine.

49. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Croup.

50. How may you detect semen?
Flurescence in ultraviolet light.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent