Quiz 137, December 10th, 2021

Welcome to the 137th FOAMed Quiz.


Source image: www.pixabay.com

Question 1

Calcium plays an important role in cardiac physiology.

The COCA trial is about empiric administration of calcium in patients with out of hospital cardiac arrest that received at least one dose of epinephrine.

383 patients were randomised to receive 5 mmol calcium chloride or placebo immediately after the first and second dose of epinephrine. The primary outcome was return of spontaneous circulation (ROSC).

What did the authors find?

A: The rate of ROSC was higher in the calcium group compared to the placebo group

B: The rate of ROSC was higher in the placebo group compared to the calcium group

C: There was no significant difference in ROSC between both groups

The correct answer is B

This week First10EM covered the COCA trial.

The COCA trial was stopped early because after enrolling 383 patients it seemed that administering calcium was harmful. Return of spontaneous circulation occured in 19% of the calcium group and in 27% of the placebo group.

Calcium for of out hospital cardiac arrest: the COCA trial

Source image: www.dontforgetthebubbles.com

Question 2

An eight-year old child is presented to your ED after enduring chemical eye injury. His mother brought the glass polisher which has caused the injury.

Overall, alkali substances are responsible for the more severe chemical injuries compared to acides.

Which acid compound is an exception to this rule?

A: Sulphuric acid

B: Acetic acid

C: Hydrochloric acid

D: Hydrofluoric acid

The correct answer is D.

This week Don’t Forget The Bubbles discussed chemical eye injuries.

Acid burns are often well-demarcated and superficial, whereas alkali substances cause extensive and penetrating eye injuries due to their ability to saponify fatty acids.

Hydrofluoric acid however, penetrates very quickly into the anterior chamber and causes vast injury


How to manage chemical eye injuries

Case courtesy of Dr Hani Makky Al Salam, Radiopaedia.org, rID: 13087

Question 3

Standard care of ischemic stroke patients includes IV treatment (IVT) before endovascular treatment (EVT).

Recent evidence suggests EVT alone is non-inferior compared to the combination of treatments (DEVT trial).

This recently published paper is about endovascular treatment alone versus IV alteplase plus endovascular treatment (EVT) in a European population.

539 patients that were eligible for IVT and EVT were randomised to receive either both therapies or EVT alone.

The primary end point was functional outcome on the modified Rankin scale at 90 days.

What did the authors find?

A: EVT alone was superior to EVT plus IVT

B: EVT alone was non-inferior to EVT plus IVT

C: EVT alone was neither superior, nor non-inferior to EVT plus IVT

The correct answer is C.

This week, JournalFeed discussed this paper .

The median score on the modified Rankin scale at 90 days was 3 with EVT alone and 2 with alteplase plus EVT.

EVT alone was neither superior, nor non-inferior to EVT plus IVT. Mortality and the incidence of symptomatic intracerebral bleeding was not significantly different.

It is still too soon to stop using IV-alteplase before EVT in ischemic stroke.

Would you like to receive an e-mail every time a quiz is published? Please leave your e-mail address here:

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