Board Review 12/17/2012. Poisonings and Environmental Exposures. Test Question. What topic should we do for January Board Review? Adolescent Disorders of the eye Sports Medicine and Physical Fitness. Poisoning basics…. Poison Control Centers. Multiple VERY helpful resources
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What topic should we do for January Board Review?
A 4 year old is brought in by her parents because 20 minutes ago they found her playing with an empty bottle of grandmas atenolol which they knew previously had approximately 15 pills in it. You have a high suspicion that she ingested the medicine. She is anxious appearing but awake and alert with a heart rate of 70 and BP of 82/39. Which of the following would be the most appropriate action at this time?
A 3yo boy is brought to the ER at 7AM after his parents found him unresponsive in bed. The last time they saw him was at 2AM while they were cleaning up from a cocktail party. On exam he has diaphoresis and moans to painful stimuli. His vitals are T96.4, HR145, RR20, BP 83/34, Sp02 98%. His pupils are mid-sized and sluggish. Of the following, what is the MOST important test to obtain at this time?
Your 3yo child loves blueberry soda. You found him in the garage with an empty bottle of Windex. Upon arrival to the ER the child is lethargic and minimally responsive to painful stimuli. An ABG shows 7.11/30/60/12. All of the following are possible treatment modalities for this child, EXCEPT:
A2yo boy is brought to the emergency department by his father after they had spent several hours in the garage while the father worked on the car. The father reports that approximately 30 minutes ago he heard the child coughing and found him with an open bottle of lighter fluid in his hands. On exam, the child is awake and alert; temperature is 37.0°C, HR is 120 beats/min, RR is 24 breaths/min, BP is 90/60 mm Hg, and 02 sat 98%. Of the following, the MOST appropriate next step is to:
You are called by the mother of a 3-year-old girl because the child appears confused and is pale and sweating. The mother thinks the child may have taken some of her grandmothers imipramine. You advise her to call 911 to have her taken to the ER. Of the following, what is the most appropriate action to take in the ER?
A 16yo girl is brought to the ER by her parents after she admitted to taking two handfulls of acetaminophen (500mg) because her boyfriend broke up with her. Which of the following is the MOST important piece of information you must obtain in order to determine your next course of action?
A 7 yo boy is brought to the ER due to altered mental status. He was well when he came home from school, but when he came inside for dinner after playing outside with friends he complained of abdominal pain and had an episode of NBNB emesis. Over the next 30 min he became increasingly lethargic. In the ER, he is unresponsive and drooling. Temp is 98.8, HR is 50, RR is 36, BP is 100/60. Sp02 is 82% on room air. Pupils are small and sluggish. Breath sounds are coarse bilaterally with increased WOB. You suspect a toxin exposure. What is the most appropriate treatment?
A 2-year-old boy is brought to the emergency department after his father found him with the leaf from a foxglove plant in his mouth. He has had one episode of emesis and is complaining of abdominal pain. On physical examination, his heart rate is 140 beats/min, respiratory rate is 24 breaths/min, blood pressure is 100/60 mm Hg, and oxygen saturation is 100%. His pupils are 4 mm and briskly reactive to 2 mm. The remainder of his examination findings are normal. After administering activated charcoal, what is the most appropriate next step?
A 2 year old boy is brought to the ER because he has been difficult to arouse for an hour. The child is somnolent and responsive only to pain. His temperature is 101.5, HR 130, RR 56, and BP 90/60. ABG reveals pH 7.28/CO2 20/HCO3 15. The patient and his mom have been staying with grandma for the holidays. Mom is healthy, but the grandma takes a few different medications. The most likely explanation for this child’s findings is
You are admitting a patient to the PICU with findings suspicious for Aspirin toxicity. The patient was initially awake upon presentation and was already given activated charcoal. The initial salicylate level was 80mg/dL. You know that aside from supportive care, the next BEST step to enhance salicylate elimination is…
A 5 year old boy is brought to the ED for 2 days of HA, nausea, and vomiting. He is afebrile and does not have diarrhea. Everyone at home, including the dog, has the same symptoms. On PE, he is mildly irritable but alert and oriented, and his mucous membranes appear bright red. His lung exam is clear, but he does have some mild increased WOB. Sats are 100% on RA. What is the MOST appropriate next step?
A 3 year old boy was admitted for inpatient observation after presenting to the ER with a suspected corrosive ingestion. The patient was initially stable with no mucosal burns in his oropharynx. In fact, his examination on admit was normal except for fussiness. 48 hours later, the patient begins with gross hematemesis. Which agent was MOST likely ingested?
A 2-year-old boy is brought to the emergency department after his mother found him with an open bottle of toilet bowl cleaner. She reports that he had spilled some on his shirt and had some on his face, but she does not know if he drank any of it. The child is awake and alert, and his vital signs are normal. He is drooling slightly, but examination of his oropharynx reveals no lesions.
Of the following, the MOST appropriate next step is to
What is the BEST method to screen for ALL types of environmental exposure in your general pediatrics patients?
What are the two MOST COMMON microbiologic WATER contaminants of concern for children?