Emergency and Toxicology – Set 2

What this deck covers

Emergency and Toxicology – Set 2 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Sleepy toddler after gastroenteritis
2. Earliest warning of volume loss
3. Mouth ulcers and a dry nappy
4. Slow refill on a warm ward
5. Thrown by a car outside school
6. Where a low systolic begins
7. Quiet and pale after a crash
8. Snoring after a trampoline fall
9. Kite, transformer and cola urine
10. The gap in a vomiting boy’s BP
11. First bolus finished, now what?
12. Railing blow, full neck veins
13. What the trauma tally leaves out
14. Crushed by a reversing tractor
15. Grey and grunting despite fluid
16. Grading and typing a collapse
17. Stable cyclist with a boggy scalp
18. Adjunct against bleeding death
19. Hot, mottled 3-week-old
20. Judging the effect of two boluses
21. Power line burn, normal first trace
22. Run over on the driveway
23. Is this girl’s systolic acceptable?
24. Handlebar injury, falling saturation
25. Fluid alone is not working
26. Usual face of paediatric sepsis
27. Upper-left pain after a crash
28. Reading a tiring girl’s blood gas
29. Normal reading after a van strike
30. Sweaty infant off her feeds
31. Before the trip to the scanner
32. Drip running after the shock settled
33. When the surgeon must step in
34. Roof fall, still cold after fluid
35. Reading a toddler’s head scan
36. When to hold the next bolus
37. Flushed girl with a central line
38. Toddler who chewed a lamp flex
39. Scooter handlebar, clear bedside scan
40. A trainee reaches for the buffer
41. Fence rail injury, steady pulse
42. Protecting the injured brain
43. Tiring toddler on adrenaline
44. Pleura or pericardium after a crash
45. Railway cable, aching thighs
46. Six children down on a pitch
47. Drip for a boy who fell off a frame
48. Parents ask about football
49. Pale but stable two days on
50. Forearm pain despite morphine

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Hypotensive (decompensated) shock, Nothing, unless it is measured on the foot, Compensated haemorrhagic shock, A wide pulse pressure from vasodilatation, Systolic blood pressure, A normal systolic pressure for age excludes shock, Hypotensive (decompensated) septic shock, 10 mL/kg of warmed crystalloid, then reassess, Only once the systolic pressure has fallen, Metabolic acidosis with a normal pCO2, He must be haemodynamically stable, Hyperdynamic response to fever, without shock, It corrects the respiratory part of her acidosis, Sodium bicarbonate 1 mmol/kg IV.

Clinical pearls from this deck

• Normal pressure plus signs of shock = compensated shock; do not wait for hypotension.
• First sign of shock: a rising heart rate. Last sign: a falling blood pressure.
• UK practice: 10 mL/kg, then look again.
• Capillary refill: press 5 seconds on the sternum; over 2 seconds is abnormal.
• <C>ABCDE: catastrophic bleeding, then airway with the neck protected.
• 70 + 2 x age: 74 at 2 years, 86 at 8 years; 90 only over 10 years.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all emergency and toxicology case decks · pediatric reference values.