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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. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Glucagon prefered - otherwise massive dose of adrenaline.
Antidotes are atropine sulfate and pralidoxime chloride.
Immobilize with plaster slab

2. What are the early symptoms of paracetamol overdose?
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
Flurescence in ultraviolet light.
Nausea vomiting and anorexia.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

3. Management of near drowning.
Flurescence in ultraviolet light.
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
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. Iron
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Sling for 3 weeks - fracture clinic at 7 days.
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
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

5. What is the most important investigation in suspected alcohol poisoning in young person?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidote is naloxone.
Blood glucose level for hypoglycaemia!!
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

6. What is the antibiotic for Epiglottitis?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ceftriaxone
Intubate - tracheostromy or nebulized adrenaline.

7. Anticholinergics
'I WOULD CALL POISON HOTLINE'.
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

8. Organophosphates
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Stomach pumping.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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

9. A child has swallowed a battery. Mx
Stomach pumping.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidote is deferoxamine chelation. Charcoal is ineffective.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

10. What is the first line investigation in a young child who has consumed alcohol?
IM adrenaline: vasopressor and bronchodilator.
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
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
... blood sugars for hypoglycaemia

11. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.

12. What investigations should you do in suspected child abuse
Esmolol
Discobalt edetate
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Bone scan for occult fracture

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

14. Displaced surgical neck of humerous
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Normally treated with sling alone. Seek advice.
Aspiration pneumonia even if intubated.
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

15. Carbon monoxide
Objective signs of growth - tidiness - weight -
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Collar and cuff. Check integrity of nerve.
Stomach pumping.

16. Sympathomimetics
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Munchausen's by proxy

17. Beta-blocker overdose antidote
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Glucagon prefered - otherwise massive dose of adrenaline.

18. Benzodiazepine overdose antidote
IM adrenaline: vasopressor and bronchodilator.
Skin or vascular compromise
'I WOULD CALL POISON HOTLINE'.
Flumazenil

19. What is the most appropriate examination in a child with suspected lead ingestion?
'I WOULD CALL POISON HOTLINE'.
Objective signs of growth - tidiness - weight -
Abdo XRAY!!!! do it!
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

20. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Rash bronchospasm and hypotension.

21. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Intubate - tracheostromy or nebulized adrenaline.
Blood glucose level for hypoglycaemia!!
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.

22. Organophosphates antidotes
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidotes are atropine sulfate and pralidoxime chloride.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

23. Signs of psychological maltreatment?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Sling for 3 weeks - fracture clinic at 7 days.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

24. Methanol
Antidotes are atropine sulfate and pralidoxime chloride.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

25. Tricyclic antidepressants overdose
Flumazenil
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

26. Amphetamine antidote
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
CHARCOAL! except for lithium - iron - alcohol - lead.
Esmolol

27. Lidocaine
'I WOULD CALL POISON HOTLINE'.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

28. Amiodarone
Discobalt edetate
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.
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.

29. Salicylates
Intubate - tracheostromy or nebulized adrenaline.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

30. Ibuprofen
Blood glucose level for hypoglycaemia!!
Glucagon prefered - otherwise massive dose of adrenaline.
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
... blood sugars for hypoglycaemia

31. Tricyclic antidepressants
Antidotes are atropine sulfate and pralidoxime 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
Croup.
Esmolol

32. What is the general management of poisoning?
Ceftriaxone
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

33. What must you do before sending fracture to radiology?
Aspiration pneumonia even if intubated.
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
Blood glucose level for hypoglycaemia!!
Immobilize with plaster slab

34. Acetaminophen
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is naloxone.

35. Funnel web and red back
Neurosurgery if trauma. Give mannitol.
Poisoning causes decreased cholinesterase activity.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Release NEUROTOXINS both have antivenom

36. Undisplaced radial shaft fracture
Aspiration Pneumonia
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Collar and cuff. Check integrity of nerve.
Class of drugs encompassing decongestants - amphetamines - cocaine.

37. 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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Flurescence in ultraviolet light.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

38. What are the special features that must be done to correct haemorrhagic shock.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

39. What are the side effects of N-acety-p-benzoquinine?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Rash bronchospasm and hypotension.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

40. When is gastric lavage indicated and contraindicated?
Poisoning causes decreased cholinesterase activity.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

41. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Release NEUROTOXINS both have antivenom
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.

42. 45; 70
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Digoxin Fab
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

43. Mx raised intracranial pressure.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Croup.
Neurosurgery if trauma. Give mannitol.

44. Anticholinergics
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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 -

45. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Digoxin Fab
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

46. Calcium channel blocker overdose antidote
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.
Calcium chloride
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Give steroids for management of serum sickness. Must do coagulation screen!!!

47. Opiates
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Release NEUROTOXINS both have antivenom

48. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Release NEUROTOXINS both have antivenom
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Glucagon prefered - otherwise massive dose of adrenaline.

49. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Croup.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

50. What is a side effect of charcoal?
It can cause fatal bronchioloitis obliterans
Poisoning causes decreased cholinesterase activity.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema