2018. QUIZ 11. WEEK 48

Question 1

You treat a patient with a chemical burn. The causative agent is not yet known. Which of the following is the least preferred solution to irrigate the burn?

A: Water

B: Normal Saline

C: Hypertonic Saline

D: Diphoterine Solution

The correct answer is A, Water

The problem with water is that it is hypotonic and so enhances penetration of the acid or base in the tissue. Normal Saline does not carry this side-effect and Hypertonic Saline might even ‘extract’ some chemical from the tissue. Diphoterine carries these advantages plus some additional ones. Of course irrigation with water is better than doing nothing.

The Resus Room Podcast cover day 2 of the joint Faculty of Prehospital Care and BASICS conference 2018. This podcast is all about chemical burns, resuscitative hysterotomy, amputation and mental toughness.

Chemicals, amputation and more…

Question 2

What is the most effective technique in reduction of a nursemaid’s elbow?

A: Supination and flexion of the elbow

B: Hyper-pronation

C: Hyper-extension of the elbow

The correct answer is B

A recent meta-analysis in Annals of Emergency Medicine
found that hyperpronation is more effective than supination and flexion of the elbow. Hyper-extension of the elbow will not reduce a subluxation of the radial head and is considered torture.

SinaiEM discusses nursemaid’s elbow reduction in their recent post.

Question 3

The half life of Carbon Monoxide is 30 minutes in an hyperbaric oxygen tank and 90 minutes with a non rebreather mask. What is the half life of Carbon Monoxide on room air?

A: approximately 180 minutes

B: approximately 240 minutes

C: approximately 300 minutes

The correct answer is C, 300 minutes

Therefore: in a patient with suspected CO-poisoning always give oxygen. Treatment with hyperbaric oxygen is not supported by evidence in children but might be beneficial if available. Pediatric EM Morsels posted about CO-poisoning recently. A couple of PEARLS in this post: Never forget co-intoxication with cyanide. And be aware of potential myocardial injury in cases of CO-intoxication.

Carbon Monoxide Poisoning in Children

Question 4

Which of the following is not a diagnostic criteria of Acute Liver Failure (ALF)?

A: INR < 1,5

B: No pre-existent liver injury

C: Signs of neurologic dysfunction / encephalopathy

D: Ammonia > 100 µmol/l

The correct answer is answer D

Ammonia is not part of the diagnostic criteria for Acute Liver Injury. Although diagnostic criteria vary a little throughout the world, they all include acute onset, hepatic encephalopathy, and an elevated prothrombin time/international normalized ratio (INR).

emDOCs published this great post on Acute Liver Failure recently.

Question 5

Which of the following is true regarding Hereditary AngioEdema (HAE)?

A: Obtaining C4 and tryptase levels during an acute event is not helpful

B: Gastrointestinal and cutaneous symptoms are much more common than laryngeal involvement

C: In cases of upper airway compromise due to HAE, edema of the face is almost always present

D: Antihistamines are effective in HAE

The correct answer is B

Edema of the face is estimated to precede upper airway compromise in about 15-30 percent of cases. Antihistamines are not effective in HAE (it is bradykinin mediated, not histamine mediated), although differentiation between HAE and anaphylaxis can be really difficult so when in doubt just give antihistamines. Obtaining C4 and tryptase levels during an acute event can be very helpful. Gastrointestinal and cutaneous symptoms are much more common than laryngeal involvement and consist of crampy, severe abdominal pain accompanied by nausea, vomiting, and diarrhea.

Taming the SRU published this great post about Hereditary Angioedema.

Thanks for joining us again!

Eefje and Rick, the FOAMed Quiz Crew