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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. Calcium channel blocker overdose antidote
Calcium chloride
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Normally treated with sling alone. Seek advice.

2. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

3. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Digoxin Fab
... blood sugars for hypoglycaemia

4. Benzodiazepine overdose antidote
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Flumazenil
Skin or vascular compromise

5. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Glucagon prefered - otherwise massive dose of adrenaline.

6. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
It can cause fatal bronchioloitis obliterans
Discobalt edetate
Antidote is deferoxamine chelation. Charcoal is ineffective.

7. Mx severe croup
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.
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

8. Signs of abuse from the history
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Digoxin Fab
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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

9. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Immobilize with plaster slab
Glucagon prefered - otherwise massive dose of adrenaline.

10. Mx of petroleum overdose
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Calcium chloride

11. Methanol
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 antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Antidote is naloxone.
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 is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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 -

13. Sodium Bicarbonate
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Normally treated with sling alone. Seek advice.

14. Ethylene glycol
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.
Calcium chloride
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidotes are atropine sulfate and pralidoxime chloride.

15. What is the general management of poisoning?
Neurosurgery if trauma. Give mannitol.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.

16. Organophosphates antidotes
Flurescence in ultraviolet light.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Immobilize with plaster slab
Antidotes are atropine sulfate and pralidoxime chloride.

17. Cyanide
Discobalt edetate
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give steroids for management of serum sickness. Must do coagulation screen!!!

18. What are the early symptoms of paracetamol overdose?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.

19. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.
Flurescence in ultraviolet light.

20. Salicylates
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Flumazenil
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.

21. Undisplaced surgical neck of humerous?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Collar and cuff. Check integrity of nerve.
Sling for 3 weeks - fracture clinic at 7 days.
Immobilize with plaster slab

22. What is one of the technicalities of childabuse.
IM adrenaline: vasopressor and bronchodilator.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

23. Legal requirement in childabuse
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
IM adrenaline: vasopressor and bronchodilator.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Notify if abuse CONSIDERED. CONSIDERED.

24. Theophylline
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 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 BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

25. Oedema causing laryngeal obstruction?
CHARCOAL! except for lithium - iron - alcohol - lead.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

26. Ibuprofen
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
Aspiration Pneumonia
Cyanosis and irregular respiratory effort
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

27. What evidence should a doctor give about parental neglect
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Objective signs of growth - tidiness - weight -
Sling for 3 weeks - fracture clinic at 7 days.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

28. Tricyclic antidepressants
... blood sugars for hypoglycaemia
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
Skin or vascular compromise
Bone scan for occult fracture

29. Iron
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

30. Displaced surgical neck of humerous
Calcium chloride
Aspiration Pneumonia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Normally treated with sling alone. Seek advice.

31. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
'I WOULD CALL POISON HOTLINE'.
Collar and cuff. Check integrity of nerve.

32. 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!!
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Croup.

33. Anticholinergics
Esmolol
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

34. What is gastric lavage?
Flumazenil
... blood sugars for hypoglycaemia
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Stomach pumping.

35. What are the side effects of N-acety-p-benzoquinine?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Rash bronchospasm and hypotension.
Digoxin Fab
Give steroids for management of serum sickness. Must do coagulation screen!!!

36. Atropine
Skin or vascular compromise
Antidotes are atropine sulfate and pralidoxime chloride.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

37. Acetaminophen
Release NEUROTOXINS both have antivenom
Calcium chloride
Stomach pumping.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

38. When is reduction required in fracture?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Collar and cuff. Check integrity of nerve.
Skin or vascular compromise
'I WOULD CALL POISON HOTLINE'.

39. Signs of psychological maltreatment?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

40. Ethanol
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

41. What happens if charcoal is aspirated?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidote is deferoxamine chelation. Charcoal is ineffective.
It can cause fatal bronchioloitis obliterans

42. Iron
Sling for 3 weeks - fracture clinic at 7 days.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
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.

43. What psychiatric disease defined as childabuse?

44. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Release NEUROTOXINS both have antivenom
Nausea vomiting and anorexia.

45. Procainamide
Notify if abuse CONSIDERED. CONSIDERED.
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.
Aspiration Pneumonia
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

46. Funnel web and red back
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Release NEUROTOXINS both have antivenom
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Class of drugs encompassing decongestants - amphetamines - cocaine.

47. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

48. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

49. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Flumazenil
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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

50. How may you detect semen?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Flurescence in ultraviolet light.