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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. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
IM adrenaline: vasopressor and bronchodilator.
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.

2. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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
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

3. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Neurotoxins - procagulants. Rhabdomyolysins.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Skin or vascular compromise

4. Management of near drowning.
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
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
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Munchausen's by proxy

5. What is the first line investigation in a young child who has consumed alcohol?
Notify if abuse CONSIDERED. CONSIDERED.
... blood sugars for hypoglycaemia
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

6. Ethylene glycol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Antidote is naloxone.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

7. Undisplaced radial shaft fracture
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Collar and cuff. Check integrity of nerve.
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.

8. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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. When and how would you do whole bowel irrigation?
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidote is naloxone.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

10. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.

11. Benzodiazepine overdose antidote
Objective signs of growth - tidiness - weight -
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.
Flumazenil
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.

12. Tricyclic antidepressants
Calcium chloride
Aspiration pneumonia even if intubated.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

13. What is the most important treatment for anaphylaxis
Antidote is naloxone.
Glucagon prefered - otherwise massive dose of adrenaline.
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
IM adrenaline: vasopressor and bronchodilator.

14. Opiates
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Neurosurgery if trauma. Give mannitol.

15. What is a side effect of charcoal?
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
CHARCOAL! except for lithium - iron - alcohol - lead.
Notify if abuse CONSIDERED. CONSIDERED.

16. Indications of non-accidental injury
It can cause fatal bronchioloitis obliterans
Nausea vomiting and anorexia.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.

17. Management of septicaemia shock

18. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Skin or vascular compromise
Antidote is deferoxamine chelation. Charcoal is ineffective.

19. When is reduction required in fracture?
Blood glucose level for hypoglycaemia!!
Skin or vascular compromise
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!

20. Iron
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Abdo XRAY!!!! do it!
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.

21. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Digoxin Fab

22. What is the most important investigation in suspected alcohol poisoning in young person?
Ceftriaxone
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.
Blood glucose level for hypoglycaemia!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

23. 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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Bone scan for occult fracture

24. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nausea vomiting and anorexia.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

25. Amphetamine antidote
Esmolol
IM adrenaline: vasopressor and bronchodilator.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

26. Carbon monoxide
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
IM adrenaline: vasopressor and bronchodilator.

27. Lidocaine
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Croup.
Class of drugs encompassing decongestants - amphetamines - cocaine.

28. Mx of petroleum overdose
Bone scan for occult fracture
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Cyanosis and irregular respiratory effort
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

29. Signs of abuse from the history
Give IM adrenaline - steroids - salbutamol - antihistamine.
Croup.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

30. Epinephrine
Severe illness - past history of injuries - 18 months or less - inconstent story.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Normally treated with sling alone. Seek advice.

31. Mx of critical asthma
Severe illness - past history of injuries - 18 months or less - inconstent story.
Aspiration Pneumonia
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

32. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.

33. What is the antibiotic for Epiglottitis?
Ceftriaxone
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

34. 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 -
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
Bone scan for occult fracture
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

35. Calcium channel 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.
Calcium chloride
It can cause fatal bronchioloitis obliterans
Poisoning causes decreased cholinesterase activity.

36. How do snake bites damage?
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes decreased cholinesterase activity.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

37. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

38. Ethanol
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.

39. Ingesting Petrol. Cx?
Severe illness - past history of injuries - 18 months or less - inconstent story.
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Lead poisoning is defined as a serum level greater than ___ ug/dL.

40. Organophosphates
Poisoning causes decreased cholinesterase activity.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

41. Calcium gluconate
Ceftriaxone
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

42. What is gastric lavage?
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 -
Stomach pumping.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
IM adrenaline: vasopressor and bronchodilator.

43. Signs of psychological maltreatment?
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Flurescence in ultraviolet light.

44. OSCE: what must you say you would do if someone is poisoned?

45. Organophosphates
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 -
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Skin or vascular compromise

46. What is the most appropriate examination in a child with suspected lead ingestion?
Notify if abuse CONSIDERED. CONSIDERED.
Stomach pumping.
Abdo XRAY!!!! do it!
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

47. Ethylene glycol
Nausea vomiting and anorexia.
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Aspiration Pneumonia

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

49. Amiodarone
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

50. 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.
Poisoning causes decreased cholinesterase activity.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Discobalt edetate