PALS MC Pediatric Poisoning/Overdose

Pediatric Poisoning/Overdose

A 4-year-old child is brought to the emergency department after ingesting an unknown medication. The child appears lethargic and has shallow breathing, with signs of respiratory depression. Their oxygen saturation is dropping despite supplemental oxygen. Pupils are pinpoint, and the child has minimal response to stimuli. Their heart rate is low-normal, and blood pressure is on the lower end of normal limits, with delayed capillary refill. Immediate intervention is required to manage the suspected opioid overdose or toxic ingestion.

What addresses the most immediate threat in poisoning?

A 4-year-old is brought to the ED after ingesting an unknown medication. They are lethargic with shallow breathing. What is your first priority?

Ensure airway patency and provide oxygen.

Obtain a detailed history of the ingested substance.

Administer activated charcoal.

Administer naloxone 0.1 mg/kg IV.

What antidote is used for opioid-induced respiratory depression?

The child’s SpO2 is 85% despite oxygen. Bag-mask ventilation is initiated. What is the next step?

Perform endotracheal intubation.

Administer epinephrine 0.01 mg/kg IV.

Administer atropine 0.02 mg/kg IV.

Administer naloxone 0.1 mg/kg IV.

What test evaluates the need for treatment in acetaminophen overdose?

The child’s parents mention ingestion of acetaminophen. The child appears stable. What lab test is most critical to order?

Serum creatinine.

Liver function tests (LFTs).

Arterial blood gas (ABG).

Serum acetaminophen level.

What medication prevents liver injury in acetaminophen overdose?

The serum acetaminophen level indicates potential toxicity. What is the next appropriate treatment?

Administer activated charcoal orally.

Administer N-acetylcysteine (NAC) IV.

Administer epinephrine 0.01 mg/kg IV.

Start continuous renal replacement therapy (CRRT).

What prevents aspiration in a patient with altered mental status?

The child develops vomiting and altered mental status. What is the next best intervention?

Place the child in a prone position.

Administer antiemetic medication.

Administer activated charcoal orally.

Secure the airway to prevent aspiration.

What is the most common cause of bradycardia in children?

A 3-year-old presents after ingesting an unknown substance and is bradycardic. What is your first intervention?

Administer atropine 0.02 mg/kg IV.

Administer naloxone 0.1 mg/kg IV.

Provide oxygen and ventilation support.

Perform chest compressions.

What type of poisoning causes pinpoint pupils and respiratory depression?

A child presents with pinpoint pupils, decreased respiratory rate, and altered mental status. What is the likely cause of poisoning?

Acetaminophen overdose.

Opioid ingestion.

Salicylate poisoning.

Organophosphate poisoning.

How should naloxone-induced symptoms be managed?

After administering naloxone, the child becomes agitated and tachycardic. What is the most appropriate next step?

Administer a second dose of naloxone.

Administer a sedative immediately.

Provide supportive care and monitor closely.

Initiate mechanical ventilation.

What treats both acidosis and salicylate elimination?

The child develops metabolic acidosis following suspected salicylate poisoning. What is the next appropriate intervention?

Administer sodium bicarbonate IV.

Administer magnesium sulfate IV.

Perform gastric lavage.

Administer N-acetylcysteine (NAC).

What helps prevent future poisoning incidents?

Post-treatment, the child remains stable. What is the most important step in discharge planning?

Prescribe a one-week course of antibiotics.

Schedule a follow-up appointment with a neurologist.

Provide poison prevention education to the family.

Advise the family to dispose of all medications immediately.

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