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Welcome to the 163th FOAMed Quiz
Question 1
A 6-year-old boy fell with his right side on the curb while cycling and presents with abdominal pain. You decide to perform a FAST exam (Focussed Assessment with Sonography for Trauma).
Which statement about pediatric FAST is true?
A: Pediatric FAST is as sensitive as adult FAST in detection of traumatic solid organ injuries
B: The most sensitive view for detection of free intra-abdominal fluid is the suprapubic view
C: A limited amount of pelvic free fluid is never physiologic in pediatric patients
The correct answer is B
ALiEM discussed pediatric FAST in their PEM POCUS series this week.
Pediatric FAST is less sensitive than adult FAST in detection of traumatic solid organ injuries, because intra-abdominal injury in children is less likely to result in hemoperitoneum. The suprapubic view is the most sensitive, whereas in adults the RUQ view is the most sensitive for detection of free intra-abdominal fluid. A limited amount of pelvic free fluid can be physiologic in children (both boys and girls).
PEM POCUS Series: Pediatric Focused Assessment with Sonography for Trauma (FAST)
Question 2
Early seizures are common after spontaneous intracerebral hemorrhage (SIH). The clinical value of these seizures is unknown, but it is thought they might be associated with haematoma expansion and worse neurological outcomes. At of this moment, routine prophylactic anti-epileptic treatment is not recommended.
In the recently published PEACH trial, 50 adult patients (42 included in analysis) who presented with spontaneous intracerebral hemorrhage within 24 hours after onset were randomly assigned to levetiracetam (intravenous 500 mg every 12 hours) or placebo.
The primary outcome was the occurrence of at least one clinical seizure within 72 hours of inclusion or at least one electrographic seizure recorded on continuous EEG.
What did the authors find?
A: The incidence of seizures was statistically significant higher in the placebo group
B: The incidence of seizures was statistically significant higher in the levetiracetam group
C: The incidence of seizures did not differ between the groups
The correct answer is A.
The PEACH trial was covered on First10EM and EMCrit last week.
Clinical or electrographic seizure was observed in three (16%) of 19 patients in the levetiracetam group versus ten (43%) of 23 patients in the placebo group (p=0.043).
However, there were no clinical seizures observed and the difference is entirely based on non-clinical seizures detected on EEG.
Furthermore, the authors were planning on including 102 patients and ended up with only 42.
The PEACH trial of seizure prophylaxis for head bleeds: Not such a peach
Question 3
‘’The armor phenomenon’’ refers to the theoretical protective factor of obesity for abdominal injury in trauma.
This recently published systematic review and meta-analysis looked at whether obesity was indeed a protective factor in penetrating abdominal trauma.
9 studies were included for quantitative analysis, including 5,013 patients sustaining penetrating thoracoabdominal injuries, of which 29.6% were obese.
What did the authors find?
A: Obese patients had a lower morbidity and mortality following penetrating thoracoabdominal injuries
B: Obese patients had a higher morbidity and mortality following penetrating thoracoabdominal injuries
C: The morbidity and mortality did not differ between obese and non-obese patients
The correct answer is B.
UMEM covered the paper briefly last week.
Obese patients suffered more respiratory complications and were at an increased risk of death during their admission.
Question 4
Which of the following ECG abnormalities is caused by hypercalcemia?
A: Long QTc interval
B: Short PR interval
C: Widened QRS complex
The correct answer is C.
RebelEM covered hypercalcemia on their podcast last week.
Hypercalcemia causes shortening of the QTc interval, prolonging of the PR interval and can cause widening of the QRS complex.
Question 5
During CPR, pulse checks should be as short as possible. Cardiac POCUS has been used but there have been concerns about longer duration of interruption of compressions.
Another way of using POCUS for pulse checks is to check for carotid pulse using doppler.
In this recently published paper 25 cardiac arrest patients and 155 pulse checks were analyzed.
The average time for carotid pulse identification using POCUS was compared to the manual carotid identification time.
What did the authors find?
A: The time for carotid pulse identification using POCUS was shorter than the time for manual carotid pulse identification
B: The time for carotid pulse identification using POCUS was longer than the time for manual carotid pulse identification
C: There was no difference
The correct answer is A
The average time to carotid pulse identification per patient using POCUS was 1.62 (1.14-2.14) seconds compared to 3.50 (2.99-4.99) seconds in manual carotid identification.
This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen, Jeroen van Brakel, Noortje Geerts and Renée Deckers
Reviewed and edited by Rick Thissen
