Welcome to the 183th FOAMed Quiz.
Question 1
Not a lot is known about the effectiveness of addition of corticosteroid to an NSAID in renal colic.
In this paper from August 2022, 120 patients with renal colic were randomized to receive just ketorolac or ketorolac + dexamethasone (60 patients in either group).
The primary outcome was pain intensity based on the visual analog scale (VAS), which was assessed at baseline and after 30 and 60 min of treatment.
What did the authors find?
A: Patients in the ketorolac and dexamethasone group had significantly lower pain score at 30 and 60 minutes
B: Patients in the ketorolac and dexamethasone group had significantly lower pain score at 30 minutes, but not at 60 minutes
C: Patients in the ketorolac and dexamethasone group had significantly lower pain score at 60 minutes, but not at 30 minutes
D: Patients in the ketorolac and dexamethasone group did not have significantly lower pain score at 30 and 60 minutes
The correct answer is B.
The paper was mentioned on EMOttawa last week.
There were no differences in baseline pain scores between the groups. Differences in VAS scores were significantly lower in the intervention group after 30 min of drug administration (VAS 3,5 vs VAS 5. P = 0.009). There was no difference at 60 minutes. Furthermore, decreased opioid requirements and decreased an antiemetic need were noted in the intervention group.
Question 2
!hich of the following statements is true about the management of patient with acetaminophen overdose?
A: A normal ALT and AST, 8 hours after ingestion of acetaminophen practically rules out severe intoxication
B: The Rumack-Matthew nomogram can be used in single dose and chronic acetaminophen intoxication
C: An mildly elevated INR within 24 hours of acetaminophen ingestion does not reflect severe liver toxicity
D: The typical threshold for toxicity is ingestion of 400 mg/kg acetaminophen for the acute one time dose
The correct answer is C.
Acetaminophen intoxication was covered on EM cases last week.
Liver enzymes are usually normal in the first 12 hours after an overdose.
The Rumack-Matthew nomogram should be used in single dose intoxications only.
While elevated INR on day 3 or later is a reliable sign of severe liver toxicity, mild elevations of INR on day 1 do not reflect severe liver toxicity.
The typical threshold for toxicity is 200 mg/kg acetaminophen for the acute one time dose
Ep 180 Acetaminophen Poisoning – Pitfalls in Assessment and Management
Question 3
The gradient between the arterial CO2 pressure (PaCO2) and the end tidal CO2 (ETCO2) is approximately 0.5 kPa (3.8 mmHg) under normal physiological conditions.
Which of the following can produce an elevated PaCO2 – ETCO2 gradient?
A: Pulmonary embolism
B: Hyperthermia
C: Hypothermia
D: Hyperventilation
The correct answer is A
The PaCO2 – ETCO2 gradient was covered on DFTB last week.
Normally, the PaCO2 – ETCO2 gradient is fairly stable and under 0.5 kPa. However, if something happens to ventilation (COPD) of perfusion (PE, shock, pulmonary hypertension) this will cause an V/Q imbalance and will cause the PaCO2 – ETCO2 gradient to rise.
The PaCO2-ETCO2 Gradient
Question 4
Traumatic injury of the spinal cord can result in shock. At or above which level of injury is the patient at risk for neurogenic shock?
At or above C5
At or above T4
At or above T6
At or above T8
The correct answer is C.
Neurogenic shock was covered by emDOCs this week.
Trauma is the most common cause of neurogenic shock. It occurs in 19.3% of cervical spine injuries and 7% of thoracic spine injuries. When the injury occurs at or above T6, the patient is at risk due the disruption of sympathetic innervation to the heart and peripheral vessels.
Neurogenic Shock: Definition, Identification, and Management in the ED
This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Nicole van Groningen, Jeroen van Brakel, Noortje Geerts and Renée Deckers
Reviewed and edited by Rick Thissen
