Quiz 134, November 19th, 2021

Welcome to the 134th FOAMed Quiz.

 

Source image: www.pixabay.com

Question 1

A 25 year old male presents to your ED after being stung by a stingray in his right lower extremity.

Immersion in which liquid is part of the pain management?

A: Vinegar

B: Urine

C: Cold water

D: Warm water

The correct answer is D.

This week NUEM Blog covered stingray stings.

Stingray venom is heat-labile, so the pain is best reduced by immersion of the affected limb in water heated to the warmest temperature tolerated.

Case courtesy of Dr Goran Mitrovic, Radiopaedia.org, rID: 37422

Question 2

Prior studies have shown that patients admitted with a COPD exacerbation, have a high prevalence of pulmonary embolism (PE).

In this randomized clinical trial, usual care (n=367) was compared to usual care plus active strategy for diagnosing PE (D-dimer testing and, if positive, CTa) (n=370) in COPD exacerbations requiring hospitalization. The primary outcome was a composite including readmission for COPD, or death within 90 days after randomization.

What did the authors find?

A: The addition of an active strategy to exclude PE in patients admitted with a COPD exacerbation did not significantly improve a composite health outcome

B: The addition of an active strategy to exclude PE in patients admitted with a COPD exacerbation did significantly improve a composite health outcome

The correct answer is A.

This week JournalFeed discussed this paper about active exclusion of PE in hospitalized COPD patients.

The primary composite outcome occurred in about 29% of both the control group and the intervention group.

In patients hospitalized for a COPD exacerbation, addition of an active strategy for the diagnosis of PE plus usual care compared to usual care alone did not significantly improve outcome of nonfatal new or recurrent venous thromboembolism (VTE), readmission for COPD, or death at 90 days.

Keep in mind patients were excluded if PE was initially suspected. Furthermore, the trial was underpowered to detect individual outcomes (like non-fatal PE).

Source image: www.rebelem.com

Question 3

In the Netherlands we are used to pre-charging of the defibrillator before each rhythm check in cardiac arrest.

Last month, this Danish pre- post implementation (of pre-charging the defibrillator) trial was published. 178 patients (523 defibrillation procedures) with cardiac arrest who had at least one shock were included.

What did the authors find?

A: The total hands-off fraction per cardiac arrest was reduced after implementation of the pre-charge method

B: An increase in unindicated shocks (non-shockable rhythms or personnel) was registered

C: Patients who received only post-charge defibrillations had an increased odds ratio for return of spontaneous circulation

The correct answer is A.

The paper was covered on Rebel-EM last week.

The total hands-off fraction per cardiac arrest was reduced after implementation of the pre-charge method (16.5% vs. 20.4%).

No increase in shocks to non-shockable rhythms or personnel was registered.

Patients who received only pre-charge defibrillations had am increased odds ratio for return of spontaneous circulation (aOR 2.91).

Pre-Charging the Defibrillator Before Rhythm Checks in Cardiac Arrest

Source image: www.emdocs.net

Question 4

Your patient presents 30 minutes after ingesting hydrochloric acid.

Which of the following is a good idea in the management of this patient?

A: Provide anti-emetics as needed

B: Induce emesis

C: Attempt neutralization of the ingested agent by drinking sodium bicarbonate

D: Administer activated charcoal

The correct answer is A.

Ingestion of caustic agents was covered on EMDocs last week.

Supportive care is the mainstay of treatment. You can provide symptomatic treatment with pain medications and anti-emetics as needed. Do not induce emesis.

Source image: www.aliem.com

Question 5

Which of the following arrhythmias is likely to respond to adenosine?

A: Atrial fibrillation

B: Atrial flutter

C: Ventricular tachycardia (VT) originating from the left ventricular outflow tract (LVOT)

D: Ventricular tachycardia originating from the right ventricular outflow tract (RVOT)

The correct answer is D.

VT versus AVRT was covered on dr. Smith’s ECG blog last week.

Yes, some VT’s are adenosine sensitive. They typically originate from the RVOT and occur in patients with apparently normal hearts.

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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