2018. QUIZ 2 WEEK 39

Question 1

What is the correct way to restrain an agitated patient using 4-point restraints?

A: Head raised 30 degrees. Both arms above the head. Tie restraints to the rails.

B: Head flat. One arm up above the head, one arm below the waist. Tie restraints to the bed.

C: Head raised 30 degrees. One arm up above the head, one arm below the waist. Tie restraints to the bed.

D: Head raised 30 degrees. Both arms below the waist. Tie restraints to the bed.

The correct answer is: C

A patient should be restrained using 4 or 5 point restraints. Elevate the bed 30 degrees. Tie restraints to the bed and not to the rails.

Emergency Medicine Cases has a great podcast about the emergency management of the agitated patient.

Question 2

According to a PECARN study published this year. Is urinalysis a sensitive and specific (>90 percent) test for urinary tract infection in infants below 60 days old?

A: Urinalysis is both sensitive and specific

B: Urinalysis sensitive, bot not specific

C: Urinalysis is specific, but not sensitive

D: Urinalysis in neither sensitive nor specific


The correct answer is: A

According to this study urinalysis is  both sensitive and specific for urinary tract infections in infants of 60 days and younger.

ALiEM did an interview with the lead author.

Question 3

In cyanide poisoning, is it true that cyanide initially binds to ferric iron (Fe3+) of cytochrome oxidase?

A: True

B: False


The correct answer is: B, this is false.

It looks like HCN binds to Copper (Cu2+) to inhibit cytochrome oxidase. Eventually binding to iron occurs as well.

The Tox and the Hound published this review about cyanide poisoning. They make me feel stupid (again), but it is so interesting.


Question 4

After an ultrasound guided median nerve block your 8-year old (30,4 kg or 67 lbs) patient begins to complain about a metallic taste in the mouth. The first sweat drops appear on your forehead. As a well trained doc you think ahead and you want to order Lipid Emulsion Therapy.  What would be the appropriate initial dose of Lipid Emulsion 20%?

A: 1.5 ml/kg (1.5 x 30.4 =) 45.6 ml

B: 0.5 ml/kg (0.5 x 30.4=) 15.2 ml

C: 1.5 mg/kg (1.5 x 30.4=) 45.6 mg

D: 0.5 mg/kg (0.5 x 30.4=) 15.2 mg

The correct answer is: A, 45.6 ml

The dose is in ml and it is 1,5 ml/kg, followed by an infusion of 0.25 ml/kg/min.


Pediatric EM Morsels has this excellent post on Local Anesthetic Systemic Toxicity and Lipid Emulsion Therapy

Although there is (and probably always will be) a lot of discussion about the use of Lipid Emulsion Therapy. I would probably use it in the crashing patient.  


Question 5

The Ottawa Subarachnoid Hemorrhage Rule has a high sensitivity for.. wait for it.. SAH! But, does the rule necessarily mandate furher workup when positive?

These are the components of the rule (you can find it on MdCalc)


A: Yes, further workup for SAH is necessary when the rule is positive
B: No, as this is a one sided rule, a positive rule does not necessarily mandate further workup

The correct answer is: B

This is a one sided rule.

Rebel EM discusses a 2017 validation study. They point out that this study was carried out at the same institutions the rule was designed. 

Well, that’s all for now. I hope to see you next week!