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

2. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Aspiration pneumonia even if intubated.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Discobalt edetate

3. Anticholinergics
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.
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.
Rash bronchospasm and hypotension.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

4. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
IM adrenaline: vasopressor and bronchodilator.
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!!

5. What is the antibiotic for Epiglottitis?
Ceftriaxone
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.
Collar and cuff. Check integrity of nerve.
CHARCOAL! except for lithium - iron - alcohol - lead.

6. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

7. Methanol
Ceftriaxone
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Aspiration Pneumonia

8. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

9. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Notify if abuse CONSIDERED. CONSIDERED.
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.

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

11. Sympathomimetics
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
Calcium chloride
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

12. Epinephrine
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Digoxin Fab
Stomach pumping.

13. Theophylline
Aspiration pneumonia even if intubated.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Causes BAD constipation. Upsets fluid and electrolyte balance.

14. Anticholinergics
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Cyanosis and irregular respiratory effort

15. Tricyclic antidepressants overdose
Normally treated with sling alone. Seek advice.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

16. What are the early symptoms of paracetamol overdose?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Glucagon prefered - otherwise massive dose of adrenaline.
Nausea vomiting and anorexia.
'I WOULD CALL POISON HOTLINE'.

17. When is gastric lavage indicated and contraindicated?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Notify if abuse CONSIDERED. CONSIDERED.

18. Carbon monoxide
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Give IM adrenaline - steroids - salbutamol - antihistamine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

19. Procainamide
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
Intubate - tracheostromy or nebulized adrenaline.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

20. Iron
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
Poisoning causes decreased cholinesterase activity.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

21. Legal requirement in childabuse
Skin or vascular compromise
Notify if abuse CONSIDERED. CONSIDERED.
'I WOULD CALL POISON HOTLINE'.
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.

22. Carbon monoxide
Blood glucose level for hypoglycaemia!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidotes are atropine sulfate and pralidoxime chloride.

23. Mx of critical asthma
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Collar and cuff. Check integrity of nerve.

24. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Objective signs of growth - tidiness - weight -

25. What are the side effects of N-acety-p-benzoquinine?
Intubate - tracheostromy or nebulized adrenaline.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Ceftriaxone
Rash bronchospasm and hypotension.

26. What is a side effect of charcoal?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidotes are atropine sulfate and pralidoxime chloride.
Causes BAD constipation. Upsets fluid and electrolyte balance.

27. OSCE: how can i prevent accidents in my children
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 -
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab

28. 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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

29. Amiodarone
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

30. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
'I WOULD CALL POISON HOTLINE'.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

31. Mx severe croup
Antidotes are atropine sulfate and pralidoxime chloride.
Bone scan for occult fracture
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Digoxin Fab

32. Organophosphates
Digoxin Fab
Poisoning causes decreased cholinesterase activity.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

33. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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.

34. Calcium channel blocker overdose antidote
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.
Aspiration pneumonia even if intubated.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Calcium chloride

35. Tricyclic antidepressants
Severe illness - past history of injuries - 18 months or less - inconstent story.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

36. Mx of snake bit
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.
... blood sugars for hypoglycaemia
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

37. Organophosphates
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

38. What is the most appropriate examination in a child with suspected lead ingestion?
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Abdo XRAY!!!! do it!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

39. What are the terminal signs of acute laryngeal obstruction?
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.
Ceftriaxone
Cyanosis and irregular respiratory effort
Severe illness - past history of injuries - 18 months or less - inconstent story.

40. What else is in the management of snake bite?
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
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

41. Opiates
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Munchausen's by proxy
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

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

43. Opiates
Antidote is naloxone.
Nausea vomiting and anorexia.
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

44. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Croup.
Collar and cuff. Check integrity of nerve.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

45. 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 -
Blood glucose level for hypoglycaemia!!
Antidote is naloxone.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

46. Adenosine
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
Antidote is naloxone.
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.

47. Funnel web and red back
Release NEUROTOXINS both have antivenom
Give steroids for management of serum sickness. Must do coagulation screen!!!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

48. What evidence should a doctor give about parental neglect
Neurotoxins - procagulants. Rhabdomyolysins.
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Objective signs of growth - tidiness - weight -

49. Iron
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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

50. Benzodiazepine overdose antidote
... blood sugars for hypoglycaemia
Class of drugs encompassing decongestants - amphetamines - cocaine.
Flumazenil
IM adrenaline: vasopressor and bronchodilator.