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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. Mx of petroleum overdose
Class of drugs encompassing decongestants - amphetamines - cocaine.
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

2. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
Discobalt edetate
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

3. Sympathomimetics
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.
Munchausen's by proxy
Class of drugs encompassing decongestants - amphetamines - cocaine.
Severe illness - past history of injuries - 18 months or less - inconstent story.

4. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Bone scan for occult fracture
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Neurotoxins - procagulants. Rhabdomyolysins.

5. What are the special features that must be done to correct haemorrhagic shock.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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 -
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

6. What are the three features of anaphylaxis
Neurosurgery if trauma. Give mannitol.
Esmolol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes decreased cholinesterase activity.

7. Calcium channel blocker overdose antidote
Calcium chloride
Rash bronchospasm and hypotension.
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.
Notify if abuse CONSIDERED. CONSIDERED.

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

9. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes decreased cholinesterase activity.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

10. Opiates
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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
Stomach pumping.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

11. Displaced surgical neck of humerous
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Normally treated with sling alone. Seek advice.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Intubate - tracheostromy or nebulized adrenaline.

12. What is the most important treatment for anaphylaxis
Stomach pumping.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
IM adrenaline: vasopressor and bronchodilator.

13. What evidence should a doctor give about parental neglect
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Objective signs of growth - tidiness - weight -
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.

14. Anticholinergics
... blood sugars for hypoglycaemia
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

15. Which is better - activated charcoal or gastric lavage.
Antidote is naloxone.
CHARCOAL! except for lithium - iron - alcohol - lead.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Neurosurgery if trauma. Give mannitol.

16. What happens if charcoal is aspirated?
Nausea vomiting and anorexia.
Ceftriaxone
Cyanosis and irregular respiratory effort
It can cause fatal bronchioloitis obliterans

17. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidote is deferoxamine chelation. Charcoal is ineffective.

18. Calcium gluconate
Munchausen's by proxy
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Bone scan for occult fracture
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

19. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

20. When is reduction required in fracture?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Skin or vascular compromise

21. OSCE: how can i prevent accidents in my children
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
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
Give IM adrenaline - steroids - salbutamol - antihistamine.

22. 45; 70
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
It can cause fatal bronchioloitis obliterans
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.
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.

23. What is the most common caUse of acute laryngeal obstruction?
Croup.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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

24. What is an important point to note about anaphylaxis?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Ceftriaxone
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 -

25. what makes you suspicious of non-accidental injury.
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Flurescence in ultraviolet light.

26. What are the side effects of N-acety-p-benzoquinine?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Normally treated with sling alone. Seek advice.
IM adrenaline: vasopressor and bronchodilator.
Rash bronchospasm and hypotension.

27. Epinephrine
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Flumazenil
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

28. Acetaminophen
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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 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.
Blood glucose level for hypoglycaemia!!

29. Mx of critical asthma
Intubate - tracheostromy or nebulized adrenaline.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Blood glucose level for hypoglycaemia!!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

30. Ethylene glycol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

31. How may you detect semen?
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Flurescence in ultraviolet light.

32. Oedema causing laryngeal obstruction?
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.
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.
Intubate - tracheostromy or nebulized adrenaline.

33. When is gastric lavage indicated and contraindicated?
Esmolol
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Antidote is naloxone.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

34. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
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.
Rash bronchospasm and hypotension.

35. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Glucagon prefered - otherwise massive dose of adrenaline.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

36. What is a side effect of charcoal?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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 BAD constipation. Upsets fluid and electrolyte balance.
Antidotes are atropine sulfate and pralidoxime chloride.

37. Sympathomimetics
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Blood glucose level for hypoglycaemia!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. Amphetamine antidote
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Immobilize with plaster slab
Esmolol

39. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Blood glucose level for hypoglycaemia!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

40. Carbon monoxide
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Esmolol

41. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Esmolol

42. Mx raised intracranial pressure.
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
Neurosurgery if trauma. Give mannitol.
Cyanosis and irregular respiratory effort
Antidotes are atropine sulfate and pralidoxime chloride.

43. Organophosphates
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

44. Acetaminophen
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Intubate - tracheostromy or nebulized adrenaline.

45. Undisplaced radial shaft fracture
Immobilize with plaster slab
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
Collar and cuff. Check integrity of nerve.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

46. Ibuprofen
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 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
Class of drugs encompassing decongestants - amphetamines - cocaine.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

47. Ingesting Petrol. Cx?
Class of drugs encompassing decongestants - amphetamines - cocaine.
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
Intubate - tracheostromy or nebulized adrenaline.

48. Hydrocarbons
Esmolol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.

49. Middle Clavicle fracture management?
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 -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

50. Beta-blocker overdose antidote
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Glucagon prefered - otherwise massive dose of adrenaline.
Digoxin Fab
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.