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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. Mx of petroleum overdose
Blood glucose level for hypoglycaemia!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Objective signs of growth - tidiness - weight -
Neurotoxins - procagulants. Rhabdomyolysins.

2. A child has swallowed a battery. Mx
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 -
CHARCOAL! except for lithium - iron - alcohol - lead.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

3. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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 BAD constipation. Upsets fluid and electrolyte balance.
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

4. Which is better - activated charcoal or gastric lavage.
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.
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 -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
CHARCOAL! except for lithium - iron - alcohol - lead.

5. 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.
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 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
Calcium chloride

6. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

7. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes decreased cholinesterase activity.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Neurotoxins - procagulants. Rhabdomyolysins.

8. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Normally treated with sling alone. Seek advice.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Aspiration pneumonia even if intubated.
Objective signs of growth - tidiness - weight -

9. How do snake bites damage?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Neurotoxins - procagulants. Rhabdomyolysins.
Antidotes are atropine sulfate and pralidoxime chloride.
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.

10. What is gastric lavage?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Stomach pumping.
Immobilize with plaster slab
Normally treated with sling alone. Seek advice.

11. What is the antibiotic for Epiglottitis?
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.
Abdo XRAY!!!! do it!
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Ceftriaxone

12. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

13. Signs of psychological maltreatment?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

14. Mx severe croup
Antidotes are atropine sulfate and pralidoxime chloride.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Bone scan for occult fracture

15. Benzodiazepine overdose antidote
Flumazenil
Digoxin Fab
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Severe illness - past history of injuries - 18 months or less - inconstent story.

16. When and how would you do whole bowel irrigation?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Collar and cuff. Check integrity of nerve.
Glucagon prefered - otherwise massive dose of adrenaline.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

17. Cyanide
Discobalt edetate
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Immobilize with plaster slab
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

18. How may you detect semen?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Flurescence in ultraviolet light.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Discobalt edetate

19. Epinephrine
... blood sugars for hypoglycaemia
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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

20. Organophosphates
Poisoning causes decreased cholinesterase activity.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

21. Amiodarone
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
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 -
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
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.

22. What are the early symptoms of paracetamol overdose?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Nausea vomiting and anorexia.
Cyanosis and irregular respiratory effort
Calcium chloride

23. Procainamide
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

24. Methanol
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Class of drugs encompassing decongestants - amphetamines - cocaine.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.

25. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

26. 45; 70
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Stomach pumping.
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

27. Sympathomimetics
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
CHARCOAL! except for lithium - iron - alcohol - lead.
Aspiration pneumonia even if intubated.
Class of drugs encompassing decongestants - amphetamines - cocaine.

28. What must you do before sending fracture to radiology?
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.
Antidote is naloxone.
Immobilize with plaster slab
CHARCOAL! except for lithium - iron - alcohol - lead.

29. Calcium gluconate
Discobalt edetate
Antidotes are atropine sulfate and pralidoxime chloride.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Neurosurgery if trauma. Give mannitol.

30. Beta-blocker overdose antidote
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Blood glucose level for hypoglycaemia!!
Give steroids for management of serum sickness. Must do coagulation screen!!!
Glucagon prefered - otherwise massive dose of adrenaline.

31. What is the most appropriate examination in a child with suspected lead ingestion?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
IM adrenaline: vasopressor and bronchodilator.
Abdo XRAY!!!! do it!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

32. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Flumazenil
Give steroids for management of serum sickness. Must do coagulation screen!!!

33. Mx of snake bit
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.
Poisoning causes decreased cholinesterase activity.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

34. Tricyclic antidepressants
Cyanosis and irregular respiratory effort
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 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
Class of drugs encompassing decongestants - amphetamines - cocaine.

35. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes BAD constipation. Upsets fluid and electrolyte balance.

36. 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 -
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.
It can cause fatal bronchioloitis obliterans
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

37. Atropine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
... blood sugars for hypoglycaemia
Cyanosis and irregular respiratory effort

38. What is the most important treatment for anaphylaxis
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Aspiration pneumonia even if intubated.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

39. Funnel web and red back
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
IM adrenaline: vasopressor and bronchodilator.

40. What is the most common caUse of acute laryngeal obstruction?
Blood glucose level for hypoglycaemia!!
Croup.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

41. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Flurescence in ultraviolet light.
Aspiration Pneumonia

42. What are the three features of anaphylaxis
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Notify if abuse CONSIDERED. CONSIDERED.

43. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

44. What is the first line investigation in a young child who has consumed alcohol?
Esmolol
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.
... blood sugars for hypoglycaemia
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

45. Ethylene glycol
Munchausen's by proxy
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.
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

46. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
'I WOULD CALL POISON HOTLINE'.
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

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

48. Acetaminophen
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.
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.

49. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Aspiration pneumonia even if intubated.
Skin or vascular compromise
Munchausen's by proxy

50. Salicylates
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.