Clinical Procedures and Protocols Flashcards
7 cards from real FACEM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Clinical Procedures and Protocols flashcards as text
When performing a needle cricothyrotomy in an adult with a 'can't intubate, can't oxygenate' scenario, what is the maximum safe time for oxygenation before CO2 retention becomes critical?
Answer: 10 minutes
Needle cricothyrotomy provides adequate oxygenation for approximately 30–45 minutes but CO2 cannot be cleared effectively, making it a bridge to definitive airway within ~10 minutes before hypercarbia becomes critical.
During procedural sedation with ketamine, which adverse effect requires the provider to be most prepared to manage?
Answer: Laryngospasm
Laryngospasm is the most serious airway complication of ketamine sedation and providers must be prepared with suction, jaw thrust, and CPAP or intubation equipment.
A patient requires emergency pericardiocentesis. Which ultrasound-guided approach is now preferred over the blind subxiphoid technique?
Answer: Apical approach
The apical approach is preferred under ultrasound guidance as it allows the shortest path to the largest effusion and avoids major coronary vessels.
When inserting a thoracostomy tube for haemothorax, which intercostal space and anatomical landmark is the standard insertion site?
Answer: 5th intercostal space, mid-axillary line
The 5th intercostal space at the mid-axillary line ('safe triangle') avoids the diaphragm and neurovascular bundle while providing optimal drainage.
In a patient with suspected elevated intracranial pressure requiring RSI, which agent is preferred to blunt the haemodynamic response to laryngoscopy?
Answer: Fentanyl given 3 minutes prior
Fentanyl (3 mcg/kg) given 3 minutes before laryngoscopy blunts the sympathetic surge that can transiently raise ICP during RSI.
Which complication is most specific to subclavian central venous access compared with internal jugular or femoral routes?
Answer: Pneumothorax
Pneumothorax is the complication most uniquely associated with subclavian access due to the proximity of the lung apex and the non-compressible nature of the site.
For a patient in refractory ventricular fibrillation after 3 defibrillation attempts, what is the correct dose of IV amiodarone as per ACLS guidelines?
Answer: 300 mg IV bolus
300 mg IV bolus of amiodarone is given after the third defibrillation attempt in refractory VF/pulseless VT, with a second dose of 150 mg available.