Quiz 138, December 17th, 2021

Welcome to the 138th FOAMed Quiz.

 

Source image: www.pixabay.com

Question 1

The use of the bougie at the first intubation attempt is gaining popularity since the 2018 BEAM trial paper was published.

Recently, the multicentre BOUGIE trial was published about the same topic.

1102 critically ill patients undergoing tracheal intubation were randomised to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546). In 60% of patients, the intubation was performed by a resident. Video laryngoscopy was used in 75%.

The primary outcome was successful intubation on the first attempt.

What did the authors find?

A: The first attempt success rate was significantly higher in the bougie group

B: The first attempt success rate was significantly higher in the stylet group

C: There was no difference in first attempt success rate between the groups

The correct answer is C.

This week First10EM covered the Bougie trial. 

Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (P = .27). 

In this trial, the stunning results of the BEAM trial could not be reproduced. However, this trial has its limitations. Notice the pretty low first pass success rates of about 80 %.

The BOUGIE trial: No difference between bougie and stylet?

Source image: www.nuemblog.com

Question 2

Cardiac arrest in pregnant patients is fortunately rare. A gestational age of > 20 weeks warrants resuscitative hysterotomy without delay.

Which of the following is associated with faster time to delivery in resuscitative hysterotomy?

A: Higher maternal survival

B: Higher neonatal survival

C: Neither higher maternal nor higher neonatal survival

D: Both higher maternal and higher neonatal survival

The correct answer is D.

Resuscitative hysterotomy was covered on NUEM last week.

Faster time to delivery is associated with both higher maternal and higher neonatal survival.

Case courtesy of Dr Mohammad Taghi Niknejad, Radiopaedia.org, rID: 87136

Question 3

This recently published multicenter RCT is about the treatment of intra-articular distal radius fractures after acceptable reduction.

90 patients with reduced intra-articular distal radius fractures were randomised to nonoperative treatment (continued cast immobilization) or to operative treatment (ORIF with a volar plate).

The primary outcome was a Patient-Rated Wrist Evaluation (PRWE) score after one year.

What did the authors find?

A: When treated operatively, patients had clinically relevant better functional outcomes after 12 months

B: When treated nonoperatively, patients had clinically relevant better functional outcomes after 12 months

C: There was no difference in functional outcomes

The correct answer is A.

This week JournalFeed discussed this article.

Patients operatively treated had significantly better functional outcomes measured with the PRWE at 6 weeks, 3 months, 6 months, and 1 year.

In the nonoperative group 28% received subsequent surgery.

Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 36509

Question 4

Whether or not to treat isolated subsegmental pulmonary embolism without proximal deep venous thrombosis is controversial. The CHEST, ACEP and ESC guidelines suggest or at least permit clinical surveillance instead of anti-coagulation.

This recently published paper is about the risk for recurrent venous thromboembolism in patients with isolated subsegmental pulmonary embolism without a proximal deep venous thrombosis who were not anticoagulated.

266 patients were analysed across Canada and Europe.

What was the rate of recurrent thromboembolic disease by 90 days in this cohort of patients with isolated subsegemental pulmonary embolism without proximal deep venous thrombosis who were not treated with anti-coagulation?

A: 1,1 %

B: 3,1 %

C: 10,1%

The correct answer is B.

The paper was covered on FOAMcast last week.

8 patients had recurrent venous thromboembolic disease (4 of these had proximal deep venous thrombosis and 4 had pulmonary embolism). This rate was higher than expected. No patients had a fatal recurrent pulmonary embolism.

Source image: www.pixabay.com

Question 5

Neutropenic fever is quite commonly encountered in the ED. Broad spectrum antibiotics are the mainstay of initial treatment and their administration shouldn’t be delayed.

What percentage of neutropenic fevers is caused by an infection?

A: 10-20%

B: 20-30%

C: 50-60%

D: 90-100%

The correct answer is B.

Neutropenic fever was covered on EMDocs this week.

20-30 percent of neutropenic fevers are caused by infection. These infections are mostly bacterial.

emDOCs Podcast – Episode 43: Oncologic Emergencies Part 2

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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