FRCS Critical Care and Emergency 2

Question 1

During a cardiac arrest, the Resuscitation Council UK algorithm recommends administering adrenaline at what dose and frequency for a shockable rhythm?

Accepted Answer

1 mg IV after the third shock, then every 3-5 minutes

Answer

In a shockable rhythm (VF/pulseless VT), the Resuscitation Council UK recommends adrenaline 1 mg IV after the third shock (along with amiodarone 300 mg), then 1 mg every 3-5 minutes (alternate cycles). In non-shockable rhythms (PEA/asystole), adrenaline 1 mg is given as soon as IV access is obtained, then every 3-5 minutes.

Question 2

A patient develops tension pneumothorax. What is the immediate emergency treatment before chest drain insertion?

Accepted Answer

Needle decompression in the 2nd intercostal space, midclavicular line

Answer

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression — a large-bore cannula (14-16G) inserted in the 2nd intercostal space, midclavicular line (or 4th/5th intercostal space, anterior axillary line in ATLS). This converts the tension pneumothorax to a simple pneumothorax by releasing trapped air. A formal chest drain (intercostal tube) is then inserted as definitive management. CT should never delay treatment.

Question 3

What is the initial recommended dose of intravenous amiodarone for a patient in refractory ventricular fibrillation according to the ALS algorithm?

Accepted Answer

300 mg

Answer

Amiodarone 300 mg IV is given after the third shock in refractory VF/pulseless VT, along with adrenaline 1 mg. A further dose of 150 mg may be given after the fifth shock if VF persists. Amiodarone is a class III antiarrhythmic that prolongs the action potential duration and refractory period. It should be diluted in 5% dextrose for peripheral administration.

Question 4

A 60-year-old man is ventilated in ICU with the following settings: FiO2 0.6, PEEP 10 cmH2O, tidal volume 450 ml (6 ml/kg IBW). His plateau pressure is 35 cmH2O. What is the driving pressure?

Accepted Answer

25 cmH2O

Answer

Driving pressure = Plateau pressure - PEEP = 35 - 10 = 25 cmH2O. Driving pressure reflects the cyclical strain on the lung and is an independent predictor of mortality in ARDS. A driving pressure >15 cmH2O is associated with increased mortality. This patient's driving pressure of 25 cmH2O is concerning and may warrant reducing tidal volume or adjusting PEEP to improve lung compliance.

Question 5

Which vasopressor is recommended as first-line in the management of septic shock according to the Surviving Sepsis Campaign guidelines?

Accepted Answer

Noradrenaline (norepinephrine)

Answer

Noradrenaline is the first-line vasopressor for septic shock (SSC 2021 guidelines). It is a potent alpha-1 agonist causing vasoconstriction with mild beta-1 effects supporting cardiac output. Vasopressin (up to 0.03 units/min) can be added as a second agent to reduce noradrenaline requirements. Dopamine is associated with more arrhythmias. Adrenaline is second-line when additional inotropy is needed.

FRCS Part A Practice Test

FRCS Part A Practice Test

FRCS Critical Care and Emergency 2