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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. When is gastric lavage indicated and contraindicated?
Calcium chloride
Discobalt edetate
Neurotoxins - procagulants. Rhabdomyolysins.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

2. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Skin or vascular compromise
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

3. Funnel web and red back
Esmolol
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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
Release NEUROTOXINS both have antivenom

4. Ingesting Petrol. Cx?
IM adrenaline: vasopressor and bronchodilator.
Aspiration Pneumonia
Causes BAD constipation. Upsets fluid and electrolyte balance.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

5. Opiates
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.
Discobalt edetate
Antidote is naloxone.
Flumazenil

6. Signs of abuse from the history
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

7. Carbon monoxide
Severe illness - past history of injuries - 18 months or less - inconstent story.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

8. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Flurescence in ultraviolet light.
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. Digoxin antedote
It can cause fatal bronchioloitis obliterans
Digoxin Fab
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

10. What is the most appropriate examination in a child with suspected lead ingestion?
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.
Rash bronchospasm and hypotension.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

11. 45; 70
Flurescence in ultraviolet light.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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
Release NEUROTOXINS both have antivenom

12. Iron
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidote is naloxone.

13. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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

14. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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
Rash bronchospasm and hypotension.

15. Middle Clavicle fracture management?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Aspiration Pneumonia
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

16. Methanol
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.
Intubate - tracheostromy or nebulized adrenaline.
Skin or vascular compromise
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.

17. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Class of drugs encompassing decongestants - amphetamines - cocaine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Bone scan for occult fracture

18. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
... blood sugars for hypoglycaemia
Release NEUROTOXINS both have antivenom
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.

19. Lead
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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 -
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

20. Which is better - activated charcoal or gastric lavage.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
CHARCOAL! except for lithium - iron - alcohol - lead.

21. Methanol
... blood sugars for hypoglycaemia
Bone scan for occult fracture
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Causes BAD constipation. Upsets fluid and electrolyte balance.

22. When is reduction required in fracture?
Sling for 3 weeks - fracture clinic at 7 days.
Skin or vascular compromise
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

23. What are the other treatments for anaphylaxis?
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Blood glucose level for hypoglycaemia!!
Give IM adrenaline - steroids - salbutamol - antihistamine.

24. What psychiatric disease defined as childabuse?

25. How may you detect semen?
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Flurescence in ultraviolet light.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

26. Legal requirement in childabuse
Croup.
Flurescence in ultraviolet light.
Notify if abuse CONSIDERED. CONSIDERED.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

27. You must consider abuse in
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Skin or vascular compromise
Antidotes are atropine sulfate and pralidoxime chloride.
Severe illness - past history of injuries - 18 months or less - inconstent story.

28. OSCE: how can i prevent accidents in my children
Esmolol
Rash bronchospasm and hypotension.
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

29. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

30. Procainamide
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

31. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Calcium chloride
IM adrenaline: vasopressor and bronchodilator.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

32. Indications of non-accidental injury
Sling for 3 weeks - fracture clinic at 7 days.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

33. What is an important point to note about anaphylaxis?
Collar and cuff. Check integrity of nerve.
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!!!
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 -

34. 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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Bone scan for occult fracture
Aspiration pneumonia even if intubated.

35. Mx of snake bit
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidote is naloxone.
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.
IM adrenaline: vasopressor and bronchodilator.

36. Opiates
Antidotes are atropine sulfate and pralidoxime chloride.
Blood glucose level for hypoglycaemia!!
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Sling for 3 weeks - fracture clinic at 7 days.

37. How do snake bites damage?
Digoxin Fab
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidote is naloxone.
Neurotoxins - procagulants. Rhabdomyolysins.

38. Salicylates
Stomach pumping.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

39. Signs of psychological maltreatment?
Sling for 3 weeks - fracture clinic at 7 days.
Normally treated with sling alone. Seek advice.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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. What is gastric lavage?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Stomach pumping.
Give steroids for management of serum sickness. Must do coagulation screen!!!

41. Ibuprofen
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidote is naloxone.
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

42. Amphetamine antidote
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.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Esmolol
Release NEUROTOXINS both have antivenom

43. Ethylene glycol
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
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.

44. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
IM adrenaline: vasopressor and bronchodilator.

45. Acetaminophen
Discobalt edetate
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
IM adrenaline: vasopressor and bronchodilator.

46. Calcium gluconate
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes decreased cholinesterase activity.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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 -

47. Organophosphates
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration pneumonia even if intubated.
It can cause fatal bronchioloitis obliterans

48. What are the side effects of N-acety-p-benzoquinine?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Glucagon prefered - otherwise massive dose of adrenaline.
Rash bronchospasm and hypotension.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

49. A child has swallowed a battery. Mx
Severe illness - past history of injuries - 18 months or less - inconstent story.
Collar and cuff. Check integrity of nerve.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

50. What is the most common caUse of acute laryngeal obstruction?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Croup.