FFICM Emergency Response Procedures 3 — Questions and Answers
Question 1: A patient with known anaphylaxis to penicillin develops urticaria, stridor, and hypotension 10 minutes after receiving IV amoxicillin. What is the correct first-line dose of epinephrine?
- 0.1 mg IV push (1:10,000)
- 0.5 mg IM (1:1,000) into the anterolateral thigh (Correct answer)
- 1 mg IV push (1:1,000)
- 0.3 mg subcutaneously (1:1,000)
Correct answer: 0.5 mg IM (1:1,000) into the anterolateral thigh
Epinephrine 0.3–0.5 mg IM (1:1,000) into the anterolateral thigh is the first-line treatment for anaphylaxis, providing faster absorption than subcutaneous injection.
Question 2: When performing an emergency surgical airway (cricothyrotomy) in a 'can't intubate, can't oxygenate' scenario, the incision is made through which structure?
- Thyrohyoid membrane
- Cricothyroid membrane (Correct answer)
- Cricotracheal ligament
- Tracheal rings 2–3
Correct answer: Cricothyroid membrane
The cricothyroid membrane, located between the thyroid and cricoid cartilages, is the target for emergency cricothyrotomy due to its superficial position and minimal overlying vasculature.
Question 3: In a hospital lockdown scenario involving an active shooter, which protocol should ICU staff immediately implement?
- Evacuate all patients via the nearest stairwell
- Lock unit doors, silence alarms, and shelter in place (Correct answer)
- Move to the hospital command center for briefing
- Continue normal operations until security clears the area
Correct answer: Lock unit doors, silence alarms, and shelter in place
During an active shooter event, ICU staff should lock unit access doors, silence overhead announcements, keep patients and staff away from windows/doors, and shelter in place.
Question 4: A mechanically ventilated patient has an unexpected extubation during patient transport within the hospital. The patient is apneic and SpO2 is falling. What is the IMMEDIATE first step?
- Call for the rapid response team and wait
- Apply a non-rebreather mask at 15 L/min O2
- Perform bag-mask ventilation with 100% FiO2 (Correct answer)
- Reintubate immediately with a video laryngoscope
Correct answer: Perform bag-mask ventilation with 100% FiO2
Bag-mask ventilation with 100% FiO2 is the immediate bridge to oxygenate and ventilate the patient while preparing for definitive reintubation.
Question 5: During a critical care transfer of a septic patient, the transport team notices the vasopressor infusion pump alarms 'occlusion.' The patient's BP drops to 60/40 mmHg. What is the immediate intervention?
- Switch to a manual BP cuff and reassess in 5 minutes
- Administer a bolus of 0.5 mg IV epinephrine
- Troubleshoot the pump occlusion while giving a manual push-dose vasopressor (Correct answer)
- Stop the transfer and return to the ICU
Correct answer: Troubleshoot the pump occlusion while giving a manual push-dose vasopressor
Push-dose vasopressor (e.g., phenylephrine 100–200 mcg IV or epinephrine 10–20 mcg IV) maintains perfusion pressure while troubleshooting the pump, ensuring no gap in vasopressor support.
Question 6: Which document in the hospital emergency operations plan specifically assigns roles and responsibilities for ICU staff during a declared disaster?
- Hospital Incident Command System (HICS) chart (Correct answer)
- Joint Commission Environment of Care standards
- HIPAA emergency provisions manual
- CMS Conditions of Participation survey
Correct answer: Hospital Incident Command System (HICS) chart
The Hospital Incident Command System (HICS) chart defines the organizational structure, roles, and responsibilities for all hospital staff during emergencies and declared disasters.
Question 7: During CPR in an ICU patient with a suspected pulmonary embolism causing PEA arrest, which intervention has the strongest evidence for improving survival?
- Immediate surgical embolectomy
- Systemic thrombolysis with alteplase 100 mg IV over 2 hours
- Empiric systemic thrombolysis with alteplase 50 mg IV bolus during CPR (Correct answer)
- IVC filter placement within 30 minutes
Correct answer: Empiric systemic thrombolysis with alteplase 50 mg IV bolus during CPR
Empirical thrombolysis with alteplase 50 mg IV bolus during CPR for suspected massive PE is supported by guidelines when the patient is in refractory arrest and PE is the suspected cause.
FFICM Emergency Response Procedures 3
A patient with known anaphylaxis to penicillin develops urticaria, stridor, and hypotension 10 minutes after receiving IV amoxicillin.
What is the correct first-line dose of epinephrine?