FACEM Clinical Procedures and Protocols 2

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?

Accepted Answer

10 minutes

Answer

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?

Accepted Answer

Laryngospasm

Answer

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?

Accepted Answer

Apical approach

Answer

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?

Accepted Answer

5th intercostal space, mid-axillary line

Answer

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?

Accepted Answer

Fentanyl given 3 minutes prior

Answer

Fentanyl (3 mcg/kg) given 3 minutes before laryngoscopy blunts the sympathetic surge that can transiently raise ICP during RSI.

(FACEM) Fellowship of the Australasian College for Emergency Medicine Practice Test

(FACEM) Fellowship of the Australasian College for Emergency Medicine Practice Test

FACEM Clinical Procedures and Protocols 2