Welcome to the last FOAMed Quiz of 2018!
Question 1
In a patient with suspected cirrhosis and a massive GI bleed, which of the following drugs is proven most beneficial if given immediately in the Emergency Department?
A: Octreotide
B: Pantoprazol
C: Ceftriaxone
The correct answer is C
Too often we just rush to administer Pantoprazole and then consider Octreotide, while forgetting antibiotics. But when you take a look at the evidence, there is absolutely no support for Pantoprazole (at least in the ED) and Octreotide is very debatable, while the evidence for cephalosporins is pretty solid.
This video from the EMU series of EM cases is about acute upper GI bleeds.
Question 2
Which clinical decision tool for children with head trauma has the highest sensitivity for clinically significant TBI?
A: CHALISE
B: PECARN
C: CATCH
The correct answer is B
‘’The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision tool has been validated numerous times by external studies and has repeatedly been shown to have a sensitivity nearing 100% for clinically significant TBI when any of the six factors are present.’’ Both CHALISE (Children’s Head injury Algorithm for the prediction of Important Clinical Events) and CATCH (Canadian Assessment of Tomography for Childhood Head Injury) have lower sensitivities.
Taming the SRU published this short post on PECARN vs. other clinical decision tools.
Question 3
According to this recently published paper, what would be true about achieving local pain control in cutaneous procedures (like suturing)?
A: Local pain control can be achieved without the use of subcutaneous lidocaine if lidocaine is dripped on the skin prior to the procedure
B: Pain associated with injecting lidocaine can be reduced by dripping lidocaine on the skin
C: Dripping lidocaine onto the skin does not influence pain perception of the patient
Answer B is correct
It seems squirting a couple of ml’s onto the skin prior to injecting lidocaine subcutaneously decreases pain perception. This is most likely due to the touch and temperature effects on the transmission of pain signals through A-delta and C fibers and most likely has nothing to do with the pharmacokinetics of lidocaine.
This short post appeared on SinaiEM.
Question 4
In a recently published paper in JAMA Pediatrics regarding concussion, the authors found that most children ages 5-7 years with concussion recovered within
A: 1 week
B: 2 weeks
C: 4-6 weeks
D: 8-12 weeks
Answer B is correct
Younger children recover quite quickly. However, approximately 80% of children ages 8-12 years, regardless of sex, as well as boys ages 13-18 years recover within approximately 4 weeks. Most girls ages 13-18 years improve by 12 weeks but are not yet at baseline.
SinaiEM covers concussion in children this week.
Question 5
Your patient presents with a red right leg. Which of the following symptoms makes the diagnosis cellulitis less likely?
A: Fever
B: Lymphangitis
C: Lymphadenopathy
D: Itchy rash
The correct answer is D
This post on emDocs is a nice overview on cellulitis. This very frequently encountered disease is a little more complicated than often assumed.