الخميس، 25 أبريل 2013

MCQs In Pediatric Emergencies

Q 1:

Parenteral calcium is used as an antidote for which of the following situations?

(A) Verapamil overdoses
(B) Hyperkalemia
(C) Cocaine intoxication
(D) Verapamil overdoses and hyperkalemia


Th e correct answer is :

 D

Parenteral calcium is used to reverse the cardiac effects of calcium-channel blocker overuse and hyperkalemia.

Q 2:



A 4-year-old girl is brought to the emergency department after sticking a hair pin in a household
electrical outlet. The mother reports that she heard the child scream, and when she investigated,
smoke was coming from the outlet and the child was crying, holding her right hand. There was a
black imprint on her fingers in the shape of the hair pin. She washed the fingers with soap and
water and drove the child to the emergency department for further evaluation. On physical
examination, the child is tearful but awake and alert. Her right index finger and thumb have
erythematous burn imprints with small blisters surrounded by soot. She has no other burns or
other findings of note on the remainder of her examination.
Of the following, it is MOST important to evaluate this patient for

A. arrhythmias
B. compartment syndrome
C. immunization status
D. myoglobinuria
E. skin grafting

Answer

C


The girl in the vignette has a surface thermal burn related to contact with the heated hair pin,
and the presence of soot on her finger is evidence of flash contact. She has no clinical features
or risk factors for rhabdomyolysis, myoglobinuria, compartment syndrome, or arrhythmias. The
wound is small and should not require skin grafting. Therefore, other than ascertaining her
tetanus immunization status and providing wound care, no further evaluation is indicated


Pediatric electrical injuries typically are related to contact with household, low-voltage sources such as
electric cords or wall outlets. The primary determinant of tissue damage following electrical
exposure is current strength, which is directly proportional to voltage and inversely related to
tissue resistance. Because voltage is the only variable commonly known, electrical exposures
are classified as low- (<1,000 V) and high- (>1,000 V) voltage. Standard household electricity in
the United States is 110 V; utility power lines carry in excess of 14,000 V.

The most common injury following contact with electricity is burns. Excluding lightening
injuries, electrical burns may occur from any of the following mechanisms: electrothermal
heating from direct contact with the electrical source, arc exposure in which the body becomes
part of the electrical circuit, flash contact in which the current arc strikes the skin but does not
enter the body, and flame burns that result when clothing or other objects combust in the
presence of electrical current. Oral burns due to chewing on an electrical cord
usually are electrothermal. Arc exposure can be associated with deep tissue burns and internal
organ involvement as the current flows through body; the extent of injury may be
underestimated by the appearance of the skin wounds. Flash contact is characterized by
surface burns accompanied by soot, as described for the girl in the vignette.

Although both high- and low-voltage exposures can lead to injuries in a variety of organ
systems, high-voltage exposures are responsible for most significant injuries. The most
commonly affected organ is the skin, with burns resulting as described previously. Arrhythmias,
including asystole and ventricular fibrillation, may occur, usually at the time of contact. Deep
thermal injuries to bone and muscle may occur after arc exposure and lead to compartment
syndrome or rhabdomyolysis with subsequent renal damage. Risk factors for these more
serious injuries include extensive full-thickness burns, cardiac arrest, or high-voltage exposure.
It is rare for children exposed to household current to sustain injuries other than burns.

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