Quiz 90, November 12th, 2020

Welcome to the 90th FOAMed Quiz. 

Nicole, Joep and Rick

Source image: www.rebelem.com

Question 1

The effectiveness of sodium bicarbonate (SB) on mortality in patients with cardiac arrest is widely debated. The ACLS and ALS guidelines state that routine use of SB is not recommended.

This recently published systematic review compared intravenous SB administration in cardiac arrest to no intravenous SB administration in cardiac resuscitation. Their primary outcomes were return of spontaneous circulation (ROSC) and survival to discharge.

What did the authors find?

A: Use of Sodium Bicarbonate in cardiac arrest was associated with increased ROSC and survival to discharge compared to no use of Sodium Bicarbonate

B: Use of Sodium Bicarbonate in cardiac arrest was not associated with increased or decreased ROSC and survival to discharge compared to no use of Sodium Bicarbonate

C: Use of Sodium Bicarbonate in cardiac arrest was associated with decreased ROSC and survival to discharge compared to no use of Sodium Bicarbonate

The correct answer is B

Muhammad Durrani covered this systematic review on the effectiveness of Sodium Bicarbonate administration on mortality in cardiac arrest patients this week on REBEL EM.

Six observational studies were included. Administration of Sodium Bicarbonate was not associated with increase or decrease in ROSC or survival to discharge in cardiac resuscitation, in line with current ACLS guidelines.

These findings need to be interpreted cautiously due to the small amount of included studies, poor statistical quality with high heterogeneity and risk of bias and confounders.

Effectiveness of Sodium Bicarbonate Administration on Mortality in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

Source image: www.pixabay.com

Question 2

Lung-protective ventilation proved to be beneficial in the ICU, especially in acute respiratory distress syndrome (ARDS). Invasive mechanical ventilation will often be started in the ED. This recently published paper is about the association between the use of lung-protective ventilation in the ED and outcomes among invasively patients. Lung-protective ventilation was defined by use of tidal volumes ≤ 8 mL/kg predicted body weight.

What did the investigators find about lung-protective ventilation in the ED?

A: Lung-protective ventilation in the ED is associated with lower hospital mortality and better overall outcomes

B: Lung-protective ventilation in the ED is associated with lower hospital mortality but overall outcomes did not improve

C: Lung-protective ventilation in the ED is associated with better overall outcomes but did not improve mortality rates

D: Lung-protective ventilation in the ED did not improve mortality and overall outcomes are the same for invasive ventilation

The correct answer is A

Clay Smith covered Low Tidal Volume in the ED in this weeks Spoon Feed

The authors of this retrospective study included 4.174 patients of which 58.4% received lung-protective ventilation in the ED. The use of lung-protective ventilation was associated with decreased odds of hospital death (adjusted odds ratio: 0.91 [95% CI] 0.84-0.96) compared to patients who received higher tidal volumes. There was a decreased incidence of ARDS, lower hospital length of stay, and decreased total costs.

Source image: www.ultrasoundgel.org

Question 3

Your
 75 year old patient presents with left lower quadrant abdominal pain for 2 days. Vital signs are normal. The labs show leukocytosis and elevated CRP. You suspect diverticulitis and you wonder whether Point Of Care UltraSound (POCUS) could help you in your workup.

This recently published paper is about POCUS in diverticulitis. What was the sensitivity of POCUS for diverticulitis according to this paper?

A: 62%

B: 72%

C: 82%

D: 92%

The correct answer is D

This recently published paper was covered on the Ultrasound Podcast last week.

The researchers included 452 patients. 36% had a diagnosis of diverticulitis based on CT scan. Of the 452 patients, there were 13 false-positive (3%) and 10 false-negative (2%) point-of-care ultrasonographic examinations leading to a stunning sensitivity of 92% and specificity of 97%.

Keep in mind these ultrasound exams were performed by experienced ultrasonographers and this was a single centre study.

It almost sounds too good to be true and I wonder whether these results will be reproducible.

Source image: radiopaedia.org/

Question 4

What is the name of the fracture shown above?

A: Bennett’s fracture

B: Rolando’s fracture

C: Epibasal fracture of the thumb

The correct answer is A

BrownEM covered minor hand injury last week.

Bennett’s fracture is an intra-articular fracture of the base of the thumb generally and consists of two parts.

Rolando’s fracture is a comminuted version of Bennett’s and usually consists of 3 parts.

An epibasal fracture is, like a Bennett’s fracture, a two parts fracture of the base of metacarpal 1, but runs extra-articular.

Question 5

Source image: emergencymedicinecases.com/


You review an ECG without knowing the clinical context. The tall R-wave in V1 puzzles you and you decide to look into it.

Which of the following entities is NOT a cause of a tall R-wave in V1?

A: Posterior MI

B: Arrhythmogenic right ventricular dysplasia (ARVD)

C: Pulmonary Embolism

D: Dextrocardin

The correct answer is B

EM cases covered the causes of a tall R-wave in V1 this week.

The differential for tall R-wave in V1 can be remembered by the mnemonic R-WAVED.
RBBB
WPW left sided pathway
Acute MI – posterior
Ventricular hypertrophy or HCM
Embolism, pulmonary
Dextrocardia

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This quiz was written by Nicole van Groningen and Joep Hermans

Reviewed and edited by Rick Thissen