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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. 45; 70
Antidotes are atropine sulfate and pralidoxime chloride.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

2. What are the side effects of N-acety-p-benzoquinine?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
IM adrenaline: vasopressor and bronchodilator.
Rash bronchospasm and hypotension.

3. Carbon monoxide
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
Aspiration pneumonia even if intubated.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.

4. What are the other treatments for anaphylaxis?
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
IM adrenaline: vasopressor and bronchodilator.

5. What is the most common caUse of acute laryngeal obstruction?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Croup.
Cyanosis and irregular respiratory effort

6. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

7. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Aspiration pneumonia even if intubated.
Neurotoxins - procagulants. Rhabdomyolysins.
Class of drugs encompassing decongestants - amphetamines - cocaine.

8. Mx raised intracranial pressure.
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

9. Undisplaced surgical neck of humerous?
Discobalt edetate
Sling for 3 weeks - fracture clinic at 7 days.
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

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

11. What must you do before sending fracture to radiology?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Immobilize with plaster slab
Stomach pumping.
Antidotes are atropine sulfate and pralidoxime chloride.

12. What is the general management of poisoning?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

13. Funnel web and red back
Release NEUROTOXINS both have antivenom
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
Rash bronchospasm and hypotension.
Normally treated with sling alone. Seek advice.

14. A child has swallowed a battery. Mx
Discobalt edetate
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Objective signs of growth - tidiness - weight -
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

15. Legal requirement in childabuse
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
Ceftriaxone
Calcium chloride
Notify if abuse CONSIDERED. CONSIDERED.

16. Sympathomimetics
Blood glucose level for hypoglycaemia!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Munchausen's by proxy

17. Salicylates
Nausea vomiting and anorexia.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

18. Calcium channel blocker overdose antidote
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Abdo XRAY!!!! do it!
CHARCOAL! except for lithium - iron - alcohol - lead.
Calcium chloride

19. What evidence should a doctor give about parental neglect
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.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

20. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Abdo XRAY!!!! do it!
Collar and cuff. Check integrity of nerve.
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.

21. What psychiatric disease defined as childabuse?

22. Management of septicaemia shock

23. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
... blood sugars for hypoglycaemia
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

24. How do snake bites damage?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.
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

25. Ethylene glycol
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
'I WOULD CALL POISON HOTLINE'.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

26. Sympathomimetics
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Immobilize with plaster slab

27. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Release NEUROTOXINS both have antivenom
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

28. Displaced surgical neck of humerous
Calcium chloride
Normally treated with sling alone. Seek advice.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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

29. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Release NEUROTOXINS both have antivenom
Stomach pumping.

30. Methanol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

31. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

32. Acetaminophen
Abdo XRAY!!!! do it!
Skin or vascular compromise
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

33. Mx of critical asthma
Intubate - tracheostromy or nebulized adrenaline.
Bone scan for occult fracture
Causes BAD constipation. Upsets fluid and electrolyte balance.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

34. What is one of the technicalities of childabuse.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Munchausen's by proxy

35. Organophosphates antidotes
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
Antidotes are atropine sulfate and pralidoxime chloride.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

36. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
CHARCOAL! except for lithium - iron - alcohol - lead.
Ceftriaxone
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

37. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Calcium chloride
Antidote is naloxone.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

38. Management of near drowning.
Neurotoxins - procagulants. Rhabdomyolysins.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Stomach pumping.
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

39. OSCE: how can i prevent accidents in my children
Normally treated with sling alone. Seek advice.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

40. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Aspiration Pneumonia

41. What are the early symptoms of paracetamol overdose?
Calcium chloride
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Nausea vomiting and anorexia.

42. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Objective signs of growth - tidiness - weight -
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.

43. what makes you suspicious of non-accidental injury.
Rash bronchospasm and hypotension.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Aspiration Pneumonia
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

44. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Normally treated with sling alone. Seek advice.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

45. Ingesting Petrol. Cx?
Esmolol
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Aspiration Pneumonia

46. Iron
Nausea vomiting and anorexia.
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Immobilize with plaster slab

47. Tricyclic antidepressants overdose
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Calcium chloride
Intubate - tracheostromy or nebulized adrenaline.

48. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Aspiration pneumonia even if intubated.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

49. Hydrocarbons
Intubate - tracheostromy or nebulized adrenaline.
Discobalt edetate
Antidote is naloxone.
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.

50. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.