FACEM Emergency Response Procedures 3 — Questions and Answers
Question 1: A patient presents 6 hours after a crush injury to the lower limb that is now released. Which life-threatening complication requires IMMEDIATE anticipatory management?
- Fat embolism syndrome
- Hyperkalemia-induced cardiac arrest (Correct answer)
- Compartment syndrome of the arm
- Pulmonary contusion
Correct answer: Hyperkalemia-induced cardiac arrest
Crush syndrome releases potassium from injured myocytes, causing potentially lethal hyperkalemia which can precipitate cardiac arrest upon reperfusion.
Question 2: When treating organophosphate poisoning, what is the clinical endpoint for atropine dosing in emergency response?
- Heart rate greater than 100 bpm
- Drying of secretions and clearing of bronchospasm (Correct answer)
- Pupil dilation to 4 mm
- Resolution of miosis
Correct answer: Drying of secretions and clearing of bronchospasm
The endpoint of atropine therapy in organophosphate poisoning is drying of excessive secretions and resolution of bronchospasm, not pupillary response or heart rate.
Question 3: During a fire in the emergency department, the RACE acronym guides staff response. What does the letter 'C' stand for?
- Call for backup
- Confine the fire (Correct answer)
- Clear all corridors
- Check for casualties
Correct answer: Confine the fire
In the RACE acronym (Rescue, Alarm, Confine, Extinguish/Evacuate), 'C' stands for Confine, meaning close doors and windows to prevent fire spread.
Question 4: A hospital experiences an internal disaster with structural damage to one wing. Under which hospital emergency phase should patient evacuation to alternate care sites be considered?
- Standby phase
- Response phase (Correct answer)
- Recovery phase
- Mitigation phase
Correct answer: Response phase
The response phase is when active emergency operations are underway, including patient evacuation to alternate care sites when the facility is compromised.
Question 5: In a nerve agent exposure, which antidote combination is given FIRST to a symptomatic casualty?
- Diazepam and atropine
- Atropine and pralidoxime (Correct answer)
- Physostigmine and pralidoxime
- Diazepam and pralidoxime
Correct answer: Atropine and pralidoxime
Atropine (for muscarinic effects) and pralidoxime (to reactivate acetylcholinesterase before aging) are the primary antidotes given together for nerve agent exposure.
Question 6: Which physiological finding would place a patient in the RED (immediate) category under START triage?
- Respiratory rate of 22, radial pulse present, follows commands
- Respiratory rate of 32, no radial pulse, does not follow commands (Correct answer)
- No respirations after repositioning airway
- Ambulatory with minor laceration
Correct answer: Respiratory rate of 32, no radial pulse, does not follow commands
A respiratory rate >30, absent radial pulse, or inability to follow commands places a patient in the red (immediate) category under START triage.
Question 7: During an active shooter event in the ED, which response framework uses 'Run, Hide, Fight' as core guidance for healthcare staff?
- FEMA shelter-in-place protocol
- ALICE training methodology
- LOCKDOWN plus protocol
- DHS/FBI active shooter guidance (Correct answer)
Correct answer: DHS/FBI active shooter guidance
The Department of Homeland Security and FBI recommend 'Run, Hide, Fight' as the core active shooter response for civilian settings including healthcare facilities.
FACEM Emergency Response Procedures 3
A patient presents 6 hours after a crush injury to the lower limb that is now released.
Which life-threatening complication requires IMMEDIATE anticipatory management?