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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. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

2. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
'I WOULD CALL POISON HOTLINE'.
Antidotes are atropine sulfate and pralidoxime chloride.
Aspiration Pneumonia

3. Carbon monoxide
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Blood glucose level for hypoglycaemia!!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

4. What is the first line investigation in a young child who has consumed alcohol?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Aspiration pneumonia even if intubated.
... blood sugars for hypoglycaemia

5. What are the three features of anaphylaxis
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes decreased cholinesterase activity.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

6. Anticholinergics
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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 medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

7. Iron
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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 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.

8. Opiates
It can cause fatal bronchioloitis obliterans
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

9. Amphetamine antidote
Esmolol
Aspiration Pneumonia
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Intubate - tracheostromy or nebulized adrenaline.

10. What is the most important treatment for anaphylaxis
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
IM adrenaline: vasopressor and bronchodilator.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

11. When is gastric lavage indicated and contraindicated?
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Neurosurgery if trauma. Give mannitol.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

12. What is the most common caUse of acute laryngeal obstruction?
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.
Blood glucose level for hypoglycaemia!!
Release NEUROTOXINS both have antivenom

13. Mx of petroleum overdose
Rash bronchospasm and hypotension.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

14. Signs of psychological maltreatment?
Skin or vascular compromise
Antidote is naloxone.
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
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.

15. Epinephrine
It can cause fatal bronchioloitis obliterans
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

16. Ingesting Petrol. Cx?
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 -
Aspiration Pneumonia
Ceftriaxone
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

17. Salicylates
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

18. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Rash bronchospasm and hypotension.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil

19. 20
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.
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
Antidote is naloxone.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

20. Sympathomimetics
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

21. Funnel web and red back
Objective signs of growth - tidiness - weight -
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Release NEUROTOXINS both have antivenom

22. Signs of abuse from the history
Normally treated with sling alone. Seek advice.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Discobalt edetate
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

23. Anticholinergics
Normally treated with sling alone. Seek advice.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Collar and cuff. Check integrity of nerve.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

24. What happens if charcoal is aspirated?
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

25. Indications of non-accidental injury
Croup.
Neurosurgery if trauma. Give mannitol.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.

26. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Munchausen's by proxy
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

27. Digoxin antedote
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Immobilize with plaster slab
... blood sugars for hypoglycaemia
Digoxin Fab

28. Methanol
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 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.
Flurescence in ultraviolet light.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

29. Opiates
Antidote is naloxone.
Munchausen's by proxy
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

30. Ethanol
Collar and cuff. Check integrity of nerve.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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 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.

31. Mx of snake bit
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give steroids for management of serum sickness. Must do coagulation screen!!!

32. What evidence should a doctor give about parental neglect
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.
Objective signs of growth - tidiness - weight -
Abdo XRAY!!!! do it!
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

33. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Antidote is naloxone.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

34. Acetaminophen
It can cause fatal bronchioloitis obliterans
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

35. Mx raised intracranial pressure.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Neurosurgery if trauma. Give mannitol.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

36. What is the most important investigation in suspected alcohol poisoning in young person?
Skin or vascular compromise
Digoxin Fab
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Blood glucose level for hypoglycaemia!!

37. What must you do before sending fracture to radiology?
Poisoning causes decreased cholinesterase activity.
Munchausen's by proxy
Immobilize with plaster slab
Release NEUROTOXINS both have antivenom

38. How may you detect semen?
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
Flurescence in ultraviolet light.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil

39. Ethylene glycol
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
... blood sugars for hypoglycaemia
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.
Ceftriaxone

40. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
It can cause fatal bronchioloitis obliterans
Nausea vomiting and anorexia.
Neurotoxins - procagulants. Rhabdomyolysins.

41. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
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.
It can cause fatal bronchioloitis obliterans

42. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Collar and cuff. Check integrity of nerve.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

43. What investigations should you do in suspected child abuse
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Digoxin Fab
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Bone scan for occult fracture

44. What are the terminal signs of acute laryngeal obstruction?
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
Cyanosis and irregular respiratory effort
Croup.
CHARCOAL! except for lithium - iron - alcohol - lead.

45. OSCE: What are the five princples of discharging a patient with a fracture?
'I WOULD CALL POISON HOTLINE'.
Immobilize with plaster slab
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

46. Legal requirement in childabuse
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Notify if abuse CONSIDERED. CONSIDERED.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

47. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Bone scan for occult fracture
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

48. Management of septicaemia shock

49. Amiodarone
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of drugs encompassing decongestants - amphetamines - cocaine.
Discobalt edetate
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.

50. Benzodiazepine overdose antidote
Causes BAD constipation. Upsets fluid and electrolyte balance.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.
Flumazenil