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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. Acetaminophen
Intubate - tracheostromy or nebulized adrenaline.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration pneumonia even if intubated.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

2. Oedema causing laryngeal obstruction?
Croup.
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Intubate - tracheostromy or nebulized adrenaline.

3. Amiodarone
Glucagon prefered - otherwise massive dose of adrenaline.
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.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes decreased cholinesterase activity.

4. What investigations should you do in suspected child abuse
Poisoning causes decreased cholinesterase activity.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Bone scan for occult fracture
Glucagon prefered - otherwise massive dose of adrenaline.

5. You must consider abuse in
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

6. Anticholinergics
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
Flumazenil
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

7. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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
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. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Severe illness - past history of injuries - 18 months or less - inconstent story.

9. What is gastric lavage?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flurescence in ultraviolet light.
Stomach pumping.
Digoxin Fab

10. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Cyanosis and irregular respiratory effort
Glucagon prefered - otherwise massive dose of adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

11. Theophylline
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
... blood sugars for hypoglycaemia
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

12. 20
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Release NEUROTOXINS both have antivenom
Lead poisoning is defined as a serum level greater than ___ ug/dL.

13. What are the other treatments for anaphylaxis?
Aspiration Pneumonia
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

14. Opiates
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.
Antidote is naloxone.
Blood glucose level for hypoglycaemia!!

15. When and how would you do whole bowel irrigation?
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

16. Lidocaine
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Abdo XRAY!!!! do it!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

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

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18. Management of near drowning.
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) 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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Munchausen's by proxy

19. What is the most important treatment for anaphylaxis
Neurosurgery if trauma. Give mannitol.
Poisoning causes decreased cholinesterase activity.
Sling for 3 weeks - fracture clinic at 7 days.
IM adrenaline: vasopressor and bronchodilator.

20. 45; 70
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
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

21. Amphetamine antidote
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Give steroids for management of serum sickness. Must do coagulation screen!!!
Esmolol
Severe illness - past history of injuries - 18 months or less - inconstent story.

22. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

23. Methanol
Sling for 3 weeks - fracture clinic at 7 days.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Croup.

24. Tricyclic antidepressants overdose
Stomach pumping.
Esmolol
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

25. Indications of non-accidental injury
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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 decreased cholinesterase activity.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

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

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27. Iron
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Aspiration pneumonia even if intubated.
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 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

28. Sodium Bicarbonate
Antidotes are atropine sulfate and pralidoxime chloride.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

29. Anticholinergics
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Skin or vascular compromise
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.

30. 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 -
Release NEUROTOXINS both have antivenom
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Give steroids for management of serum sickness. Must do coagulation screen!!!

31. Anticholinergics
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 decreased cholinesterase activity.
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.

32. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
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.
Skin or vascular compromise
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

33. When is reduction required in fracture?
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
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.
Normally treated with sling alone. Seek advice.

34. what makes you suspicious of non-accidental injury.
Normally treated with sling alone. Seek advice.
Calcium chloride
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of drugs encompassing decongestants - amphetamines - cocaine.

35. Carbon monoxide
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Immobilize with plaster slab
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

36. What is one of the technicalities of childabuse.
CHARCOAL! except for lithium - iron - alcohol - lead.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Flumazenil
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

37. Ethanol
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Release NEUROTOXINS both have antivenom
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. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

39. Digoxin antedote
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Glucagon prefered - otherwise massive dose of adrenaline.
Antidotes are atropine sulfate and pralidoxime chloride.
Digoxin Fab

40. When is gastric lavage indicated and contraindicated?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

41. Mx of critical asthma
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

42. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Aspiration pneumonia even if intubated.

43. 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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Notify if abuse CONSIDERED. CONSIDERED.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

44. What is the first line investigation in a young child who has consumed alcohol?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
... blood sugars for hypoglycaemia
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

45. Organophosphates
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes decreased cholinesterase activity.
Skin or vascular compromise
Give IM adrenaline - steroids - salbutamol - antihistamine.

46. What is the most common caUse of acute laryngeal obstruction?
'I WOULD CALL POISON HOTLINE'.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Croup.
Nausea vomiting and anorexia.

47. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Intubate - tracheostromy or nebulized adrenaline.
'I WOULD CALL POISON HOTLINE'.

48. Methanol
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

49. Tricyclic antidepressants
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Ceftriaxone
Discobalt edetate

50. Ethylene glycol
Immobilize with plaster slab
It can cause fatal bronchioloitis obliterans
Sling for 3 weeks - fracture clinic at 7 days.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.