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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. Benzodiazepine overdose antidote
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flumazenil
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

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

3. Sympathomimetics
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.
Release NEUROTOXINS both have antivenom
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of drugs encompassing decongestants - amphetamines - cocaine.

4. Opiates
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Collar and cuff. Check integrity of nerve.
Antidote is naloxone.
Sling for 3 weeks - fracture clinic at 7 days.

5. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Immobilize with plaster slab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

6. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidotes are atropine sulfate and pralidoxime chloride.
Neurotoxins - procagulants. Rhabdomyolysins.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

7. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Normally treated with sling alone. Seek advice.

8. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Sling for 3 weeks - fracture clinic at 7 days.

9. Mx severe croup
Objective signs of growth - tidiness - weight -
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Sling for 3 weeks - fracture clinic at 7 days.

10. Mx of petroleum overdose
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

11. Management of near drowning.
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.

12. Tricyclic antidepressants
Collar and cuff. Check integrity of nerve.
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
Immobilize with plaster slab
Nausea vomiting and anorexia.

13. Iron
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Glucagon prefered - otherwise massive dose of adrenaline.

14. Amphetamine antidote
Esmolol
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
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 -
... blood sugars for hypoglycaemia

15. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Munchausen's by proxy
Aspiration pneumonia even if intubated.
Cyanosis and irregular respiratory effort
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

16. Lidocaine
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
... blood sugars for hypoglycaemia
'I WOULD CALL POISON HOTLINE'.

17. What is the antibiotic for Epiglottitis?
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Ceftriaxone

18. What are the three features of anaphylaxis
'I WOULD CALL POISON HOTLINE'.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Rash bronchospasm and hypotension.

19. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime 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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

20. Organophosphates
Nausea vomiting and anorexia.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

21. Acetaminophen
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Immobilize with plaster slab
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

22. Ethanol
Immobilize with plaster slab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
IM adrenaline: vasopressor and bronchodilator.

23. What are the special features that must be done to correct haemorrhagic shock.
Skin or vascular compromise
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 3 weeks - fracture clinic at 7 days.

24. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Stomach pumping.
Croup.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

25. Theophylline
Stomach pumping.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and 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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

26. Funnel web and red back
Discobalt edetate
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Release NEUROTOXINS both have antivenom

27. What is gastric lavage?
Stomach pumping.
Intubate - tracheostromy or nebulized adrenaline.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.

28. Salicylates
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

29. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
... blood sugars for hypoglycaemia
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Glucagon prefered - otherwise massive dose of adrenaline.

30. What are the other treatments for anaphylaxis?
Ceftriaxone
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Give IM adrenaline - steroids - salbutamol - antihistamine.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

31. When and how would you do whole bowel irrigation?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Rash bronchospasm and hypotension.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

32. Opiates
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

33. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Neurotoxins - procagulants. Rhabdomyolysins.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Severe illness - past history of injuries - 18 months or less - inconstent story.

34. Undisplaced surgical neck of humerous?
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.
Sling for 3 weeks - fracture clinic at 7 days.
Ceftriaxone

35. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Cyanosis and irregular respiratory effort
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

36. Epinephrine
Croup.
Bone scan for occult fracture
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

37. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flurescence in ultraviolet light.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

38. 45; 70
Poisoning causes decreased cholinesterase activity.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.

39. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
It can cause fatal bronchioloitis obliterans

40. Ibuprofen
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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 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
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.

41. When is reduction required in fracture?
Skin or vascular compromise
Give steroids for management of serum sickness. Must do coagulation screen!!!
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

42. Which is better - activated charcoal or gastric lavage.
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
Release NEUROTOXINS both have antivenom
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

43. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Abdo XRAY!!!! do it!
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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

44. what makes you suspicious of non-accidental injury.
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 -
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Normally treated with sling alone. Seek advice.

45. Methanol
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.
Digoxin Fab
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

46. How may you detect semen?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
Flurescence in ultraviolet light.
Calcium chloride

47. Ethylene glycol
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 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.
Aspiration Pneumonia
Antidote is deferoxamine chelation. Charcoal is ineffective.

48. Atropine
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Glucagon prefered - otherwise massive dose of adrenaline.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
It can cause fatal bronchioloitis obliterans

49. Carbon monoxide
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Calcium chloride

50. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Bone scan for occult fracture