FACEM Clinical Procedures and Protocols 3

Question 1

When performing a lumbar puncture, which maneuver best confirms correct needle placement in the subarachnoid space before fluid collection?

Accepted Answer

Free flow of CSF upon stylet removal

Answer

Free flow of CSF upon stylet removal confirms placement in the subarachnoid space; aspiration with a syringe can cause nerve root trauma and collapse the space.

Question 2

A patient requires cardioversion for unstable atrial flutter. What is the appropriate initial synchronized energy setting using a biphasic defibrillator?

Accepted Answer

50–100 J

Answer

Atrial flutter is very sensitive to cardioversion and typically converts with 50–100 J biphasic, making it the appropriate starting energy.

Question 3

During intraosseous access placement in the proximal tibia, needle insertion should occur at which specific site?

Accepted Answer

2 cm below the tibial tuberosity on the anteromedial flat surface

Answer

The proximal tibial IO site is 2 cm below the tibial tuberosity on the flat anteromedial surface, avoiding the growth plate and epiphysis in children.

Question 4

In a patient with massive pulmonary embolism and cardiac arrest, which intervention is an absolute contraindication to thrombolysis?

Accepted Answer

Active internal bleeding from an organ

Answer

Active internal bleeding from an organ is an absolute contraindication to thrombolysis; CPR alone is not an absolute contraindication in arrest from PE.

Question 5

When using a Seldinger technique for arterial line insertion, after initial arterial puncture and guidewire advancement, resistance is felt. What is the most appropriate next step?

Accepted Answer

Withdraw the guidewire and re-flush, confirming pulsatile flow before reattempting

Answer

Resistance to wire advancement suggests vessel wall or valve obstruction; withdrawing and confirming pulsatile flow before reattempting prevents vessel injury.

(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 3