FACEM Clinical Procedures and Protocols 2 — Questions and Answers
Question 1: 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?
- 10 minutes (Correct answer)
- 30–45 minutes
- 5 minutes
- 2 hours
Correct 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.
Question 2: During procedural sedation with ketamine, which adverse effect requires the provider to be most prepared to manage?
- Laryngospasm (Correct answer)
- Hypotension
- Bradycardia
- Hypothermia
Correct 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.
Question 3: A patient requires emergency pericardiocentesis. Which ultrasound-guided approach is now preferred over the blind subxiphoid technique?
- Apical approach (Correct answer)
- Parasternal long-axis approach
- Subcostal approach
- Suprasternal approach
Correct 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.
Question 4: When inserting a thoracostomy tube for haemothorax, which intercostal space and anatomical landmark is the standard insertion site?
- 5th intercostal space, mid-axillary line (Correct answer)
- 2nd intercostal space, mid-clavicular line
- 7th intercostal space, posterior axillary line
- 4th intercostal space, mid-clavicular line
Correct 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.
Question 5: In a patient with suspected elevated intracranial pressure requiring RSI, which agent is preferred to blunt the haemodynamic response to laryngoscopy?
- Fentanyl given 3 minutes prior (Correct answer)
- Succinylcholine
- Midazolam
- Atropine
Correct 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.
Question 6: Which complication is most specific to subclavian central venous access compared with internal jugular or femoral routes?
- Pneumothorax (Correct answer)
- Arterial puncture
- Line-associated thrombosis
- Catheter-related bloodstream infection
Correct 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.
Question 7: For a patient in refractory ventricular fibrillation after 3 defibrillation attempts, what is the correct dose of IV amiodarone as per ACLS guidelines?
- 300 mg IV bolus (Correct answer)
- 150 mg IV over 10 minutes
- 5 mg/kg IV push
- 1 mg/kg IV bolus
Correct 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.
FACEM Clinical Procedures and Protocols 2
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?