FISDAP Medical Emergencies 2 — Questions and Answers
Question 1: A 55-year-old male presents with crushing chest pain radiating to his left jaw and diaphoresis. After administering aspirin and nitroglycerin, his BP drops to 80/50 mmHg. What is your next intervention?
- Administer a second dose of nitroglycerin
- Establish IV access and administer a fluid bolus (Correct answer)
- Administer morphine for pain control
- Apply a 12-lead ECG and wait for results
Correct answer: Establish IV access and administer a fluid bolus
Nitroglycerin-induced hypotension requires IV fluid bolus to restore adequate perfusion pressure before further NTG administration.
Question 2: During assessment of an unresponsive diabetic patient, you note a blood glucose of 28 mg/dL. The patient has no IV access and you are unable to establish one. What is the most appropriate next step?
- Administer oral glucose gel under the tongue
- Administer glucagon 1 mg IM (Correct answer)
- Transport immediately without intervention
- Administer dextrose 50% via IO access
Correct answer: Administer glucagon 1 mg IM
Glucagon 1 mg IM is the correct treatment for severe hypoglycemia when IV access cannot be established in an unresponsive patient.
Question 3: A 70-year-old female is found unresponsive with a history of COPD. She is breathing at 6/min with SpO2 of 78%. What ventilation approach is most appropriate?
- Apply a nasal cannula at 2 L/min to avoid hypoxic drive suppression
- Withhold oxygen due to risk of abolishing hypoxic drive
- Assist ventilations with BVM and 100% oxygen (Correct answer)
- Administer oxygen via simple face mask at 6 L/min
Correct answer: Assist ventilations with BVM and 100% oxygen
Respiratory failure (rate 6/min, SpO2 78%) requires assisted ventilation with BVM; concern for hypoxic drive does not override the need to correct life-threatening hypoxia.
Question 4: Which finding is MOST consistent with a right-sided tension pneumothorax?
- Tracheal deviation to the right, absent breath sounds on the left
- Tracheal deviation to the left, absent breath sounds on the right (Correct answer)
- Bilateral absent breath sounds and bradycardia
- Tracheal deviation to the left, crackles on the right
Correct answer: Tracheal deviation to the left, absent breath sounds on the right
Tension pneumothorax causes tracheal deviation away from the affected side; a right-sided tension shifts the trachea to the left with absent right-sided breath sounds.
Question 5: A patient with a known seizure disorder has been seizing for 12 minutes continuously. Which term best describes this presentation?
- Absence seizure
- Focal seizure
- Status epilepticus (Correct answer)
- Post-ictal state
Correct answer: Status epilepticus
Status epilepticus is defined as a single seizure lasting more than 5 minutes or recurrent seizures without recovery of consciousness between episodes.
Question 6: You are treating a 40-year-old with anaphylaxis who received epinephrine 1:1,000 IM 10 minutes ago. He remains hypotensive with urticaria and wheezing. What is the correct next action?
- Administer diphenhydramine IV and reassess
- Repeat epinephrine 1:1,000 IM and establish IV access for fluids (Correct answer)
- Administer epinephrine 1:10,000 IV push
- Apply CPAP for bronchospasm management
Correct answer: Repeat epinephrine 1:1,000 IM and establish IV access for fluids
Persistent anaphylaxis after initial epinephrine warrants a repeat IM dose of epinephrine 1:1,000 along with IV fluid resuscitation for hypotension.
Question 7: A patient presents with sudden-onset severe headache described as 'the worst headache of my life,' nausea, and photophobia. Vital signs are stable. What condition should you most suspect?
- Migraine with aura
- Hypertensive emergency
- Subarachnoid hemorrhage (Correct answer)
- Meningitis
Correct answer: Subarachnoid hemorrhage
A sudden thunderclap headache described as the worst of one's life is the classic presentation of subarachnoid hemorrhage until proven otherwise.
FISDAP Medical Emergencies 2
A 55-year-old male presents with crushing chest pain radiating to his left jaw and diaphoresis.
After administering aspirin and nitroglycerin, his BP drops to 80/50 mmHg.
What is your next intervention?