NZREX Emergency and Acute Medicine 2 β Questions and Answers
Question 1: In NZ resuscitation guidelines, what is the recommended compression-to-ventilation ratio for adult CPR?
- 30 compressions to 2 ventilations (Correct answer)
- 15 compressions to 2 ventilations
- 5 compressions to 1 ventilation
- Continuous compressions with no ventilations
Correct answer: 30 compressions to 2 ventilations
NZ follows the ANZCOR (Australian and New Zealand Committee on Resuscitation) guidelines recommending 30 chest compressions to 2 ventilations for adult CPR. Compressions should be at a rate of 100-120 per minute with a depth of approximately 5 cm.
Question 2: A patient in a NZ ED presents with diabetic ketoacidosis (DKA). What are the key management priorities?
- IV fluid resuscitation, IV insulin infusion, potassium replacement, and monitoring of blood glucose, ketones, and electrolytes (Correct answer)
- Oral hypoglycaemics and a sugary drink
- Subcutaneous insulin bolus only
- Dietary modification and discharge home
Correct answer: IV fluid resuscitation, IV insulin infusion, potassium replacement, and monitoring of blood glucose, ketones, and electrolytes
DKA management in NZ involves aggressive IV fluid resuscitation (0.9% saline initially), IV insulin infusion (fixed rate), careful potassium replacement (as insulin drives K+ intracellularly), and regular monitoring of blood glucose, ketones, electrolytes, and acid-base status.
Question 3: In NZ, what is the initial management of a tension pneumothorax?
- Immediate needle decompression in the 2nd intercostal space, midclavicular line (or 4th/5th ICS, anterior axillary line), followed by chest drain insertion (Correct answer)
- Chest X-ray first to confirm the diagnosis
- Oral antibiotics and observation
- CT scan of the chest before any intervention
Correct answer: Immediate needle decompression in the 2nd intercostal space, midclavicular line (or 4th/5th ICS, anterior axillary line), followed by chest drain insertion
Tension pneumothorax is a clinical diagnosis requiring immediate treatment. Needle decompression should be performed urgently (2nd ICS, midclavicular line, or 4th/5th ICS, anterior axillary line) followed by definitive management with a chest drain (intercostal catheter).
Question 4: What is the NZ approach to managing acute upper gastrointestinal bleeding?
- ABCDE assessment, IV access with fluid resuscitation, blood transfusion if needed, IV proton pump inhibitor, and urgent endoscopy within 24 hours (Correct answer)
- Oral antacids and review in one week
- Barium swallow investigation first
- Observation only if the patient is haemodynamically stable
Correct answer: ABCDE assessment, IV access with fluid resuscitation, blood transfusion if needed, IV proton pump inhibitor, and urgent endoscopy within 24 hours
NZ management of acute upper GI bleeding includes ABCDE assessment, establishing IV access (two large-bore cannulae), fluid resuscitation, blood transfusion if haemoglobin is critically low, IV proton pump inhibitor (pantoprazole/omeprazole), and urgent endoscopy within 24 hours.
Question 5: In NZ emergency medicine, what is the FAST assessment in trauma?
- Focused Assessment with Sonography for Trauma β a bedside ultrasound looking for free fluid in the abdomen, pelvis, and pericardium (Correct answer)
- First Aid Surgical Treatment
- Fast Acting Sedation Technique
- Functional Assessment of Spinal Trauma
Correct answer: Focused Assessment with Sonography for Trauma β a bedside ultrasound looking for free fluid in the abdomen, pelvis, and pericardium
FAST (Focused Assessment with Sonography for Trauma) is a bedside ultrasound examination used in NZ EDs to rapidly detect free fluid (blood) in the peritoneal cavity (four views), pelvis, and pericardium in trauma patients.
Question 6: What is the NZ protocol for managing suspected meningitis in the emergency department?
- Do not delay antibiotics β give IV ceftriaxone/benzylpenicillin immediately if bacterial meningitis is suspected, then investigate with CT/LP (Correct answer)
- Wait for lumbar puncture results before starting antibiotics
- Oral antibiotics and discharge home
- IV steroids alone without antibiotics
Correct answer: Do not delay antibiotics β give IV ceftriaxone/benzylpenicillin immediately if bacterial meningitis is suspected, then investigate with CT/LP
In NZ, if bacterial meningitis is suspected, IV antibiotics (ceftriaxone 2g or benzylpenicillin) must be given immediately β do not delay for CT or lumbar puncture. Dexamethasone should also be given before or with the first antibiotic dose. Investigation follows.
NZREX Emergency and Acute Medicine 2
In NZ resuscitation guidelines, what is the recommended compression-to-ventilation ratio for adult CPR?