The Child Involved in Accident or Injury

Question 1

What general considerations might you have for a patient suspected of poisoning/overdose?

Answer 1

• Resuscitate patient (ABCDE)
  
  • Call Poisons hotline 131126
• Remove poison if indicated (GI decontamination)
  
  • Only if likely to succeed and benefit to patient more than potential damage
  • If conscious state depressed, likely to cause aspiration
• Administer an antidote if one exists

Question 2

How might you establish the severity of a poisoning?

Answer 2

• Established and expected effects
• Quantity of poison
• Preparation of poison
• Interval since exposure

Question 3

When might you consider use of activated charcoal in a poisoning? When is it contraindicated?

Answer 3

• “Universal antidote” - adsorbs most poisons
• Does not work for heavy metals, corrosives or pesticides
• Contraindicated if decreased conscious state or ileus
  
  • Aspiration can cause fatal bronchiolitis obliterans

Question 4

When might you consider gastric lavage in a poisoning? When is it contraindicated?

Answer 4

• Only efficacious if performed under 60 min from ingestion
• Psychologically traumatic, risk of aspiration with decreased conscious state
• Contraindicated for corrosives, hydrocarbons or petrochemicals

Question 5

In a poisoning, when is a whole bowel irrigation useful? What is used for it?

Answer 5

• Polyethylene glycol with electrolytes
• Useful in delayed presentations and when the above are ineffective/contraindicated

Question 6

What is the antidote for amphetamine poisoning?

Answer 6

Esmolol for tachyarrhythmias, labetalol for hypertension

Question 7

What is the antidote for benzodiazepine poisoning?

Answer 7

Flumazenil

Question 8

What is the antidote for beta-blocker poisoning?

Answer 8

Isoprenaline

Question 9

What is the antidote for calcium-channel blocker poisoning?

Answer 9

Calcium chloride

Question 10

What is the antidote for carbon monoxide poisoning?

Answer 10

100% O2

Question 11

What is the antidote for cyanide poisoning?

Answer 11

• Hydroxycobalamin (chelator) OR sodium nitrate AND
• Sodium thiosulfate (detoxifier)

Question 12

What is the antidote for digoxin poisoning?

Answer 12

Digoxin FAb

Question 13

What is the antidote for ergotamine poisoning?

Answer 13

• Sodium nitroprusside (against vasoconstriction)
• Heparin (against coagulopathy)

Question 14

What is the antidote for acute lead poisoning?

Answer 14

Dimercaprol then EDTA (only latter if mild)

Question 15

What is the antidote for heparin poisoning?

Answer 15

Protamine sulfate

Question 16

What is the antidote for acute iron poisoning?

Answer 16

Desferrioxamine (care with anaphylaxis)

Question 17

What is the antidote for acute methanol/ethylene glycol poisoning?

Answer 17

Ethanol in 5% glucose

Question 18

What is the antidote for opiate poisoning?

Answer 18

Naloxone

Question 19

What is the antidote for organophosphate poisoning?

Answer 19

Atropine or pralidoxine

Question 20

What is the antidote for paracetamol poisoning?

Answer 20

N-acetyl-cysteine

Question 21

What is the antidote for acute tricyclic poisoning?

Answer 21

Na₂CO₃

Question 22

What is the management of someone with paracetamol toxicity?

Answer 22

• Activated charcoal - if presenting within 4 hours of ingestion and conscious
• Gastric lavage - if < 1 hour after ingestion
• nAC - according to nomogram or if dose ingested > 150 mg/kg (lethal dose)

Question 23

What are the components of management of a person with tricyclic overdose?

Answer 23

• Monitor ECG for QT prolongation, arrhythmias
• Alkalinisation of blood (sodium bicarbonate)
• Anticonvulsant therapy (diazepam)
• Antidysrhythmia therapy (phenytoin)
• Vasopressor (noradrenaline)

Question 24

What are the major biochemical effects of salicylate overdose?

Answer 24

Respiratory alkalosis then metabolic acidosis. Hyperkalaemia

Question 25

What important structures are at risk in a supracondylar fracture?

Answer 25

* Median, radial, ulnar nerves * Brachial artery

Question 26

What kind of supracondylar fracture can be managed in ED, and how? Which require orthopaedic consult?

Answer 26

* Type I - aligned fractures * Above elbow backslab in 90deg flexion * Sling 3 weeks with GP-follow up at this time * Type II - angulated and type III - displaced require orthopaedic consultation

Question 27

What is a Monteggia fracture?

Answer 27

Dislocation of the radial head proximally and ulnar fracture

Question 28

What is a Galeazzi fracture?

Answer 28

Fracture of the distal third of the radius with a disruption of the distal radioulnar joint