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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. Carbon monoxide
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Neurosurgery if trauma. Give mannitol.
Discobalt edetate
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

2. Benzodiazepine overdose antidote
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.
Rash bronchospasm and hypotension.
Flumazenil
Neurotoxins - procagulants. Rhabdomyolysins.

3. Management of near drowning.
Bone scan for occult fracture
Cyanosis and irregular respiratory effort
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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

4. What are the special features that must be done to correct haemorrhagic shock.
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 sugars for hypoglycaemia
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

5. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Rash bronchospasm and hypotension.
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

6. Displaced surgical neck of humerous
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Normally treated with sling alone. Seek advice.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

7. Procainamide
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

8. Beta-blocker overdose antidote
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Digoxin Fab
Glucagon prefered - otherwise massive dose of adrenaline.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

9. 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 -
Antidote is deferoxamine chelation. Charcoal is ineffective.
It can cause fatal bronchioloitis obliterans
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

10. Sympathomimetics
Munchausen's by proxy
Calcium chloride
Class of drugs encompassing decongestants - amphetamines - cocaine.
Blood glucose level for hypoglycaemia!!

11. Anticholinergics
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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

12. Cyanide
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 -
Notify if abuse CONSIDERED. CONSIDERED.
Discobalt edetate
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

13. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Release NEUROTOXINS both have antivenom
Aspiration pneumonia even if intubated.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Neurotoxins - procagulants. Rhabdomyolysins.

14. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Flumazenil
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

15. What are the side effects of N-acety-p-benzoquinine?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Rash bronchospasm and hypotension.
Objective signs of growth - tidiness - weight -
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

16. What is the general management of poisoning?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

17. What are the terminal signs of acute laryngeal obstruction?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
It can cause fatal bronchioloitis obliterans
Cyanosis and irregular respiratory effort
Notify if abuse CONSIDERED. CONSIDERED.

18. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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

19. Acetaminophen
Skin or vascular compromise
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Intubate - tracheostromy or nebulized adrenaline.
Croup.

20. You must consider abuse in
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

21. Management of septicaemia shock

22. Lead
IM adrenaline: vasopressor and bronchodilator.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

23. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Rash bronchospasm and hypotension.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

24. Calcium channel blocker overdose antidote
Calcium chloride
Blood glucose level for hypoglycaemia!!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

25. Methanol
Calcium chloride
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

26. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Immobilize with plaster slab
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Cyanosis and irregular respiratory effort

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

28. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Release NEUROTOXINS both have antivenom
Rash bronchospasm and hypotension.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

29. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Glucagon prefered - otherwise massive dose of adrenaline.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

30. Ethylene glycol
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.
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 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.

31. Adenosine
Notify if abuse CONSIDERED. CONSIDERED.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

32. Amiodarone
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Release NEUROTOXINS both have antivenom
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.

33. What must you do before sending fracture to radiology?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Immobilize with plaster slab
CHARCOAL! except for lithium - iron - alcohol - lead.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

34. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

35. Sympathomimetics
Skin or vascular compromise
Poisoning causes decreased cholinesterase activity.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

36. Organophosphates
Immobilize with plaster slab
Munchausen's by proxy
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes decreased cholinesterase activity.

37. Signs of psychological maltreatment?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidote is naloxone.

38. Ingesting Petrol. Cx?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Croup.
'I WOULD CALL POISON HOTLINE'.
Aspiration Pneumonia

39. How do snake bites damage?
Esmolol
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

40. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

41. What is the antibiotic for Epiglottitis?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Ceftriaxone
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

42. What is the most common caUse of acute laryngeal obstruction?
Release NEUROTOXINS both have antivenom
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Discobalt edetate
Croup.

43. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
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

44. Epinephrine
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Munchausen's by proxy
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

45. What are the three features of anaphylaxis
Cyanosis and irregular respiratory effort
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Nausea vomiting and anorexia.
Sling for 3 weeks - fracture clinic at 7 days.

46. How may you detect semen?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Discobalt edetate
Immobilize with plaster slab
Flurescence in ultraviolet light.

47. Mx of petroleum overdose
Antidote is naloxone.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

48. Sodium Bicarbonate
Calcium chloride
Nausea vomiting and anorexia.
Release NEUROTOXINS both have antivenom
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

49. Lidocaine
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

50. What are the early symptoms of paracetamol overdose?
'I WOULD CALL POISON HOTLINE'.
Nausea vomiting and anorexia.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Munchausen's by proxy