Welcome to the 143th FOAMed Quiz.
Question 1
The discussion about normal saline versus balanced fluids in critically ill patients is ever ongoing. The 2018 SMART trial suggested a reduction of renal dysfunction in favor of balanced fluids. The 2021 BASICS trial did not find any difference in mortality between normal saline and balanced fluids.
The PLUS trial was recently published. 5037 critically ill (ICU) patients were randomized to either normal saline or Plasma-Lyte. The primary outcome was death from any cause within 90 days of randomization.
What did the authors find?
A: Mortality was significantly higher in the normal saline group
B: Mortality was significantly higher in the Plasma-Lyte group
C: Mortality was equal in both groups
The correct answer is C.
First10EM covered the PLUS trial last week.
There was no difference in the primary outcome of all cause mortality (21.8% vs 22.0%).
The ongoing saga of normal saline versus balanced fluids
Question 2
Much can be said about the best induction agent for emergency endotracheal intubation.
The recently published EvK trial is about ketamine versus etomidate in emergency tracheal intubation.
801 critically ill inpatients requiring emergency intubation were randomly assigned to receive etomidate or ketamine for sedation prior to intubation.
The primary outcome was 7 day survival. Secondary endpoints included 28 day survival.
What did the authors find?
A: 7 day survival was significantly lower in the etomidate arm than in the ketamine arm
B: 21 day survival was significantly lower in the etomidate arm than in the ketamine arm
C: 7 day survival was significantly lower in the ketamine arm than in the etomidate arm
D: 21 day survival was significantly lower in the ketamine arm than in the etomidate arm
The correct answer is A.
The EvK trial was covered on JournalFeed this week.
The 7 day survival was significantly lower in the etomidate arm than in the ketamine arm (77.3% versus 85.1%). 28 day survival rates for the two groups were not significantly different (etomidate 64.1%, ketamine 66.8%).
Question 3
A 49 year old, otherwise healthy, man visits your ED. He complains of a local red swollen left elbow. His vital signs are normal. You suspect septic olecranon bursitis.
According to this recently published retrospective cohort study, would it be appropriate to treat the patient with antibiotics only (without aspiration of incision and drainage)?
A: Yes, antibiotics alone is an appropriate approach
B: No, antibiotics alone only resolves the symptoms in 20 percent of patients
The correct answer is A.
This week Skeptic Guide to EM covered treatment of septic bursitis.
This retrospective study included 190 cases of septic olecranon bursitis over eight years time. 147 patients were discharged on empiric antibiotics (no aspiration or drainage), of which 134 had follow up data available. 88% of them had no need for further intervention and healed.
Question 4
Vomiting and nausea are among the most frequently encountered and difficult to treat complaints in the emergency department.
Match the correct drug and mechanism of action.
A: Metoclopramide
B: Ondansetron
C: Erytromycin
D: Domperidon
1: D2-dopamine antagonist
2: Motilin receptor agonist
3: Central and peripheral dopamine receptor antagonist, 5-HT4 agonist, and a weak 5-HT3 antagonist
4: 5-HT3 antagonist
The correct answer is A-3, B-4, C-2, D-1.
This week’s Taming the SRU blog was about gastroparesis, cyclic vomiting syndrome and cannabinoid hyperemesis syndrome.
Drugs that act as antagonists of D2-dopamine receptors have antiemetic properties, drugs that act as motilin receptor agonist or 5-HT4 agonist have prokinetic properties and drugs that act as 5-HT3 antagonist suppress the vomiting reflex.
Question 5
What is the name of the lead placement used to increase accuracy for detection of epsilon waves in arrhythmogenic right ventricular dysplasia (ARVD)?
A: Lewis lead placement
B: Fontaine lead placement
C: V4R lead placement
The correct answer is B.
LITFL covered Fontaine lead placement this week.
Fontaine bipolar precordial leads (F-ECG) can be used to increase the sensitivity of epsilon wave detection in ARVD.
Fontaine lead
This quiz was written by Sophie Nieuwendijk, Maartje van Iwaarden, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen and Joep Hermans
Reviewed and edited by Rick Thissen
