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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. Organophosphates
Poisoning causes decreased cholinesterase activity.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Immobilize with plaster slab
Intubate - tracheostromy or nebulized adrenaline.

2. Sympathomimetics
Antidotes are atropine sulfate and pralidoxime chloride.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Give IM adrenaline - steroids - salbutamol - antihistamine.
IM adrenaline: vasopressor and bronchodilator.

3. Mx severe croup
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Release NEUROTOXINS both have antivenom

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

5. Mx of snake bit
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Flurescence in ultraviolet light.
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.

6. Theophylline
Esmolol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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 causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

7. Mx raised intracranial pressure.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Neurosurgery if trauma. Give mannitol.
Discobalt edetate

8. What is the general management of poisoning?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Objective signs of growth - tidiness - weight -
Croup.

9. When is reduction required in fracture?
Release NEUROTOXINS both have antivenom
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Skin or vascular compromise
Aspiration pneumonia even if intubated.

10. Ethanol
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Flurescence in ultraviolet light.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

11. Amphetamine antidote
Esmolol
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

12. 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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Ceftriaxone
Give steroids for management of serum sickness. Must do coagulation screen!!!

13. 20
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

14. Funnel web and red back
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidote is naloxone.
Sling for 3 weeks - fracture clinic at 7 days.
Release NEUROTOXINS both have antivenom

15. What is one of the technicalities of childabuse.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Munchausen's by proxy
Antidote is naloxone.

16. Tricyclic antidepressants overdose
Munchausen's by proxy
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 -
Antidote is naloxone.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

17. What are the three features of anaphylaxis
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Abdo XRAY!!!! do it!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Calcium chloride

18. Acetaminophen
Glucagon prefered - otherwise massive dose of adrenaline.
Immobilize with plaster slab
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Neurosurgery if trauma. Give mannitol.

19. What investigations should you do in suspected child abuse
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Bone scan for occult fracture

20. Anticholinergics
Normally treated with sling alone. Seek advice.
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.

21. Atropine
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
CHARCOAL! except for lithium - iron - alcohol - lead.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

22. 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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.

23. Management of near drowning.
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Munchausen's by proxy
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

24. Amiodarone
Neurosurgery if trauma. Give mannitol.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
Normally treated with sling alone. Seek advice.

25. Middle Clavicle fracture management?
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!

26. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Immobilize with plaster slab
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

27. Procainamide
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.
Intubate - tracheostromy or nebulized adrenaline.
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.
Nausea vomiting and anorexia.

28. What is the most important investigation in suspected alcohol poisoning in young person?
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.
Blood glucose level for hypoglycaemia!!
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

29. What evidence should a doctor give about parental neglect
Aspiration Pneumonia
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.
Objective signs of growth - tidiness - weight -
Class of drugs encompassing decongestants - amphetamines - cocaine.

30. What is the most important treatment for anaphylaxis
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nausea vomiting and anorexia.
IM adrenaline: vasopressor and bronchodilator.
Give steroids for management of serum sickness. Must do coagulation screen!!!

31. Legal requirement in childabuse
Intubate - tracheostromy or nebulized adrenaline.
Notify if abuse CONSIDERED. CONSIDERED.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

32. Ethylene glycol
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Rash bronchospasm and hypotension.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Discobalt edetate

33. Ethylene glycol
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

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

35. Benzodiazepine overdose antidote
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Flumazenil
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

36. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Release NEUROTOXINS both have antivenom
Aspiration pneumonia even if intubated.

37. Beta-blocker overdose antidote
Causes BAD constipation. Upsets fluid and electrolyte balance.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Objective signs of growth - tidiness - weight -
Glucagon prefered - otherwise massive dose of adrenaline.

38. Lead
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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 causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Digoxin Fab

39. Indications of non-accidental injury
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.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

40. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Flurescence in ultraviolet light.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

41. What is the first line investigation in a young child who has consumed alcohol?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Cyanosis and irregular respiratory effort
Aspiration pneumonia even if intubated.
... blood sugars for hypoglycaemia

42. Iron
Calcium chloride
Objective signs of growth - tidiness - weight -
Esmolol
Antidote is deferoxamine chelation. Charcoal is ineffective.

43. Cyanide
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

44. Mx of critical asthma
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
'I WOULD CALL POISON HOTLINE'.
Aspiration Pneumonia

45. Carbon monoxide
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

46. What else is in the management of snake bite?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Munchausen's by proxy
Give steroids for management of serum sickness. Must do coagulation screen!!!

47. Anticholinergics
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Objective signs of growth - tidiness - weight -
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

48. What happens if charcoal is aspirated?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
It can cause fatal bronchioloitis obliterans

49. What is gastric lavage?
Antidotes are atropine sulfate and pralidoxime chloride.
Objective signs of growth - tidiness - weight -
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.
Stomach pumping.

50. OSCE: What are the five princples of discharging a patient with a fracture?
Abdo XRAY!!!! do it!
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.