Quiz 128, September 3th, 2021

Welcome to the 128th FOAMed Quiz.

 

Source image: http://hqmeded-ecg.blogspot.com

Question 1

Intoxication with which of the following drugs will not cause the ECG shown above?

A: Flecainide

B: Procainamide

C: Lidocaine

D: Propranolol

The correct answer is D.

Sodium channel blockade was covered on dr. Smith’s ECG blog last week.

This ECG is characteristic for sodium channel blockade (wide QRS, tall R in aVR). Flecainide, Procainamide and Lidocaine are all class I (sodium blocking) antiarrhythmics.

Source image: www.pixabay,com

Question 2

Oral ondansetron is frequently prescribed to children presenting with gastro-enteritis in the emergency department (ED). This recently published observational study is about the effectiveness of ondansetron in children 3 to 48 months old with gastroenteritis and ≥3 episodes of vomiting in the 24 hours preceding ED presentation.

What do you think the authors found?

Children who received oral ondansetron:

A: Were less likely to receive intravenous fluids at the index visit

B: Were less likely to be hospitalization at the index visit

C: Had reduced episodes of vomiting

D: Had reduced frequency of intravenous fluid resuscitation

The correct answer is A.

The paper was covered on JournalFeed last week.

This study was a planned secondary analysis of 2 trials conducted in 10 US and 6 Canadian institutions. 794 children were included. Children administered oral ondansetron were less likely to receive intravenous fluids at the index visit. There were no differences in the frequencies of intravenous fluid administration within the first 72 hour, hospitalization at the index visit or episodes of vomiting and diarrhea.

Source image: www.emra.org

Question 3

What distinguishes phlegmasia cerulea dolens from uncomplicated deep venous thrombosis?

A: The presence of arterial occlusion

B: The presence of total or near total venous occlusion

C: The presence of compartment syndrome

D: The presence of bacterial infection

The correct answer is B

Phlegmasia cerulea dolens was covered on AliEM last week.

In phlegmasia cerulea dolens there is near-total or total occlusion of the deep venous system, causing severe venous congestion. This leads to limb ischemia and eventually loss of the limb. It can be complicated by compartment syndrome and gangrene.

Management includes elevation of the limb, anticoagulation and often catheter-directed thrombolysis or thrombectomy.

SAEM Clinical Image Series: Pulseless and Painful Blue Leg

Source image: www.pixabay.com

 Question 4

This recently published RCT is about Ketamine (5 mg/kg) versus a combination of Midazolam (5 mg) and Haloperidol (5 mg) for intramuscular treatment of patients with severe psychomotor agitation.

80 patients were randomized equally to the 2 study arms.

The primary outcome was time from medication administration to adequate sedation (RASS ≤ -1).

What did the authors find?

A: Patients in the Ketamine group had a shorter time to adequate sedation

B: Patients in the Midazolam and Haloperidol group had a shorter time to adequate sedation

C: There was no difference between the two groups

The correct answer is A.

The paper was covered on RebelEM last week.

Time to adequate sedation was 5.8 minutes in the Ketamine group versus 14.7 minutes in the Midazolam and Haloperidol group.

The proportion of patients requiring rescue medications was similar in both arms.

This is consistent with the results of previous trial. I would like to see how Ketamine holds up to Droperidol.

Rapid Agitation Control With Ketamine in the Emergency Department

Source image: www.aliem.com

Question 5

Your 76 year old patient comes in after a fall. You suspect her of having an acetabulum fracture, but plain pelvis radiography is inconclusive. Which of the following views might help visualising the acetabulum?

A: Frog view

B: Judet view

C: Pelvic inlet / outlet view

The correct answer is B

AliEM covered imaging in pelvic trauma last week.

The frog view can be helpful in suspected Legg-Calvé-Perthes or slipped femoral epiphysis. A pelvic inlet / outlet view is helpful in visualization of the pelvic brim and the SI joints.

The Judet view (also oblique pelvis view) is an additional projection to the pelvic series when there is suspicion of an acetabular fracture.

EMRad: Radiologic Approach to the Traumatic Hip/Pelvis

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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