Quiz 127, August 27th, 2021

Welcome to the 127th FOAMed Quiz.

 

Source image: www.pixabay.com

Question 1

As part of the RECOVERY platform a randomised controlled trial was started about non-invasive ventilation for hospitalised patients with COVID-19. This trial is called the RECOVERY – Respiratory Support or RECOVERY-RS trial.

1272 adult hospitalised patients with COVID-19, deemed at risk for treatment escalation (invasive ventilation), were randomized to either High Flow Nasal Oxygen (HFNO), Continuous Positive Airway Pressure (CPAP) or conventional oxygen.

The primary outcome was a composite of tracheal intubation and mortality at 30 days post randomisation.

What did the authors find?

A: CPAP was significantly superior to conventional oxygen therapy

B: HFNO was significantly superior to conventional oxygen therapy

C: Both CPAP and HFNO were significantly superior to conventional oxygen therapy

D: Neither CPAP nor HFNO were significantly superior to conventional oxygen therapy

The correct answer is A.

The pre-print RECOVERY-RS trial was covered on criticalcarereviews.com, RebelEM, St. Emlyns and the Bottom line this week.

CPAP was significantly superior to conventional oxygen therapy. HFNO was not. The difference was mainly due to reduction in need for intubation, not due to a difference in mortality.

Keep in mind this trial was not blinded (obviously) and there was quite some crossover between the groups.

Source image: tamingthesru.com

Question 2

Your patient comes in with submandibular swelling. He has a fever and difficulty swallowing. You suspect he has Ludwig’s Angina. Which of the following is NOT part of the ED management of Ludwig’s Angina?

A: Broad Spectrum Antibiotics

B: Dexamethasone

C: Surgical debridement of any necrotic tissue and drainage of any abscess

D: Placing a Laryngeal Mask (LMA) when a compromised airway is suspected

The correct answer is D.

First10EM covered Ludwig’s Angina last week.

Whenever Ludwig’s Angina progresses to cause a compromised airway, a supraglottic airway is a poor choice as it can get displaced as swelling progresses. Due to swelling, cricothyroidotomy can be very challenging.

Ludwig’s Angina: A Rapid Review

Source image: www.huidziekten.nl

Question 3

Injuries caused by which of the following animals are most likely to cause necrotising fasciitis?

A: Cat

B: Caterpillar

C: Catfish

The correct answer is C.

Taming the SRU covered necrotising fasciitis last week.

Noodling is the art of catching a catfish with bare hands. Injuries sustained while practising this activity are known to progress to necrotising fasciitis. Most often, severe infections follow wounds caused by the fins of catfish.

Of course a bite from a cat can cause necrotising fasciitis as well, but it is less common.

Question 4

Source image: aliem.com

Your 32 year old patient presents with palpitations and dizzyness. He has a heartrate of over 200 per minute, blood pressure of 90/60 mmHg and is diaphoretic. His ECG is show above.

Which of the following is the most suitable intervention?

A: Adenosine

B: Amiodarone

C: Diltiazem

D: Electric Cardioversion

The correct answer is D.

Aliem covered atrial fibrillation in Wolff Parkinson White syndrome last week.

Atrial fibrillation in patients with WPW (fast, broad and irregular) is fortunately quite uncommon. 

Treatment with AV nodal blocking drugs (like adenosine, calcium-channel blockers and beta-blockers) can increase conduction via the accessory pathway, which can lead to degeneration into unstable ventricular arrhythmias and VF.

Diagnosis on Sight: “I have a rapid heart rate”

Question 5

Source image: www.safestroke.eu

 

The ABCD2 score is used to stratify the risk of stroke in patients presenting with TIA.

The Canadian TIA Score is a new tool for this purpose. In this paper published in february 2021, the Canadian TIA Score was compared to the ABCD2 score.

7607 patients were analysed in 13 hospitals in the country of risk scores, Canada.

What did the authors find?

A: The Canadian TIA Score stratified the risk of stroke within seven days as low more accurately than the ABCD2 score

B: The ABCD2 score stratified the risk of stroke within seven days as low more accurately than the Canadian TIA Score

C: The Canadian TIA Score and ABCD2 score stratified the risk of stroke as low within seven days equally accurate

The correct answer is A.

RebelEM covered the Canadian TIA Score this week.

The Canadian TIA Score stratified the risk of stroke within seven days as low more accurately than the ABCD2 score.

Rebellion21: Canadian TIA Risk Score vs ABCD2

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This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen and Joep Hermans

Reviewed and edited by Rick Thissen