FACEM FACEM Critical Care and Resuscitation 2 — Questions and Answers
Question 1: Which ventilation strategy is recommended for patients with ARDS on mechanical ventilation?
- High tidal volume (10–12 mL/kg IBW)
- Low tidal volume (6 mL/kg IBW) with permissive hypercapnia (Correct answer)
- Pressure control ventilation with PEEP 15 cmH2O
- High-frequency oscillatory ventilation
Correct answer: Low tidal volume (6 mL/kg IBW) with permissive hypercapnia
Lung-protective ventilation using low tidal volumes of 6 mL/kg ideal body weight with permissive hypercapnia is the evidence-based standard for ARDS management.
Question 2: What is the most common reversible cause of pulseless electrical activity (PEA) in the emergency setting?
- Hypokalemia
- Tension pneumothorax (Correct answer)
- Hypermagnesemia
- Hypothermia
Correct answer: Tension pneumothorax
Tension pneumothorax is one of the most common and immediately reversible causes of PEA arrest, addressed by the '4 H's and 4 T's' framework.
Question 3: When managing diabetic ketoacidosis (DKA), when should insulin infusion be initiated?
- Immediately upon diagnosis
- After fluid resuscitation and potassium ≥3.5 mmol/L (Correct answer)
- When blood glucose is below 14 mmol/L
- Only after bicarbonate has normalised
Correct answer: After fluid resuscitation and potassium ≥3.5 mmol/L
Insulin should only be started after initial fluid resuscitation and once potassium is ≥3.5 mmol/L to prevent life-threatening hypokalemia from insulin-driven cellular uptake.
Question 4: Which drug is used for rapid sequence intubation (RSI) as the preferred induction agent in hemodynamically unstable patients?
- Propofol
- Thiopentone
- Ketamine (Correct answer)
- Midazolam
Correct answer: Ketamine
Ketamine is the preferred induction agent in hemodynamically unstable patients due to its sympathomimetic properties, which help maintain blood pressure during RSI.
Question 5: In hyperkalemia with ECG changes, what is the first drug that should be given?
- Sodium bicarbonate
- Calcium gluconate or calcium chloride (Correct answer)
- Insulin with dextrose
- Salbutamol nebuliser
Correct answer: Calcium gluconate or calcium chloride
Calcium (gluconate or chloride) is given first in hyperkalemia with ECG changes to membrane-stabilise the myocardium and prevent fatal arrhythmias, acting within minutes.
Question 6: What is the recommended initial fluid bolus volume in adult septic shock resuscitation according to current guidelines?
- 20 mL/kg crystalloid
- 30 mL/kg crystalloid (Correct answer)
- 10 mL/kg colloid
- 1 L 5% dextrose
Correct answer: 30 mL/kg crystalloid
The Surviving Sepsis Campaign recommends an initial crystalloid fluid bolus of 30 mL/kg within the first 3 hours of septic shock resuscitation.
FACEM FACEM Critical Care and Resuscitation 2
Which ventilation strategy is recommended for patients with ARDS on mechanical ventilation?