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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. What happens if charcoal is aspirated?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes decreased cholinesterase activity.
It can cause fatal bronchioloitis obliterans
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

2. OSCE: What are the five princples of discharging a patient with a fracture?
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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

3. What is the most important treatment for anaphylaxis
Aspiration Pneumonia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Objective signs of growth - tidiness - weight -
IM adrenaline: vasopressor and bronchodilator.

4. 20
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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
Nausea vomiting and anorexia.

5. Tricyclic antidepressants
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

6. Opiates
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Antidote is naloxone.

7. Calcium channel blocker overdose antidote
Blood glucose level for hypoglycaemia!!
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.
Calcium chloride
Give steroids for management of serum sickness. Must do coagulation screen!!!

8. Cyanide
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
Discobalt edetate
Munchausen's by proxy

9. Beta-blocker overdose antidote
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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 -
It can cause fatal bronchioloitis obliterans
Glucagon prefered - otherwise massive dose of adrenaline.

10. What is the most appropriate examination in a child with suspected lead ingestion?
Give IM adrenaline - steroids - salbutamol - antihistamine.
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
Abdo XRAY!!!! do it!
Aspiration Pneumonia

11. Indications of non-accidental injury
Abdo XRAY!!!! do it!
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidote is naloxone.
Blood glucose level for hypoglycaemia!!

12. Mx of snake bit
Objective signs of growth - tidiness - weight -
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.
Cyanosis and irregular respiratory effort
Collar and cuff. Check integrity of nerve.

13. Iron
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Neurotoxins - procagulants. Rhabdomyolysins.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidote is deferoxamine chelation. Charcoal is ineffective.

14. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

15. Digoxin antedote
Neurosurgery if trauma. Give mannitol.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Digoxin Fab

16. What are the side effects of N-acety-p-benzoquinine?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Discobalt edetate
Rash bronchospasm and hypotension.

17. Epinephrine
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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
Neurosurgery if trauma. Give mannitol.

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

19. A child has swallowed a battery. Mx
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

20. Oedema causing laryngeal obstruction?
Esmolol
Sling for 3 weeks - fracture clinic at 7 days.
Intubate - tracheostromy or nebulized adrenaline.
Blood glucose level for hypoglycaemia!!

21. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Blood glucose level for hypoglycaemia!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Flurescence in ultraviolet light.

22. What psychiatric disease defined as childabuse?

23. What must you do before sending fracture to radiology?
Bone scan for occult fracture
Class of drugs encompassing decongestants - amphetamines - cocaine.
Digoxin Fab
Immobilize with plaster slab

24. Undisplaced surgical neck of humerous?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Sling for 3 weeks - fracture clinic at 7 days.

25. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -

26. What are the three features of anaphylaxis
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

27. Funnel web and red back
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Release NEUROTOXINS both have antivenom
Antidote is deferoxamine chelation. Charcoal is ineffective.

28. Undisplaced radial shaft fracture
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
Collar and cuff. Check integrity of nerve.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

29. What are the other treatments for anaphylaxis?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Calcium chloride
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give IM adrenaline - steroids - salbutamol - antihistamine.

30. 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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

31. Signs of abuse from the history
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Notify if abuse CONSIDERED. CONSIDERED.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

32. Mx raised intracranial pressure.
IM adrenaline: vasopressor and bronchodilator.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Neurosurgery if trauma. Give mannitol.
Rash bronchospasm and hypotension.

33. Anticholinergics
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

34. You must consider abuse in
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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

35. How do snake bites damage?
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.
Blood glucose level for hypoglycaemia!!
Esmolol

36. Which is better - activated charcoal or gastric lavage.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
CHARCOAL! except for lithium - iron - alcohol - lead.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
'I WOULD CALL POISON HOTLINE'.

37. What is the general management of poisoning?
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
Abdo XRAY!!!! do it!
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

38. What investigations should you do in suspected child abuse
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Bone scan for occult fracture
Sling for 3 weeks - fracture clinic at 7 days.

39. Anticholinergics
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Sling for 3 weeks - fracture clinic at 7 days.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

40. 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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Collar and cuff. Check integrity of nerve.

41. What is the first line investigation in a young child who has consumed alcohol?
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.
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

42. Methanol
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Calcium 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.
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 antibiotic for Epiglottitis?
Ceftriaxone
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Esmolol

44. Acetaminophen
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
CHARCOAL! except for lithium - iron - alcohol - lead.

45. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Intubate - tracheostromy or nebulized adrenaline.
Discobalt edetate
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

46. Middle Clavicle fracture management?
Skin or vascular compromise
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

47. Management of septicaemia shock

48. 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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Immobilize with plaster slab
Causes BAD constipation. Upsets fluid and electrolyte balance.

49. 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
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes decreased cholinesterase activity.

50. Ingesting Petrol. Cx?
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Discobalt edetate
Aspiration Pneumonia