NZREX Emergency Medicine — Questions and Answers
Question 1: A patient is found unresponsive. After ensuring scene safety, what is the correct first step in BLS?
- Check for responsiveness by calling out and tapping the shoulders (Correct answer)
- Open the airway with head-tilt chin-lift
- Start chest compressions immediately
- Call for help first before approaching
Correct answer: Check for responsiveness by calling out and tapping the shoulders
The BLS sequence (per Resuscitation Council NZ) begins with: check scene safety → check responsiveness → call for help → open airway → check breathing → start CPR if no normal breathing. Responsiveness is checked before airway manoeuvres.
Question 2: What is the recommended compression-to-ventilation ratio for adult CPR when performed by a single rescuer?
- 30:2 (Correct answer)
- 15:2
- 5:1
- 100:0 (compressions only always)
Correct answer: 30:2
The recommended ratio for adult CPR is 30 chest compressions to 2 rescue breaths. Continuous compressions (without ventilation) are acceptable if the rescuer is unwilling or unable to perform rescue breaths.
Question 3: A 22-year-old is brought by ambulance after a paracetamol overdose taken 2 hours ago. He is alert and stable. What is the most important early intervention?
- N-acetylcysteine (NAC) administration after risk assessment using the Rumack-Matthew nomogram (Correct answer)
- Activated charcoal if within 1 hour of ingestion
- Gastric lavage
- Liver transplant assessment
Correct answer: N-acetylcysteine (NAC) administration after risk assessment using the Rumack-Matthew nomogram
NAC is the antidote for paracetamol toxicity. The decision to treat is based on the serum paracetamol level plotted on the Rumack-Matthew nomogram at >4 hours post-ingestion. Activated charcoal may be considered if within 1 hour of ingestion.
Question 4: Which of the following findings would most support a diagnosis of tension pneumothorax requiring immediate needle decompression?
- Absent breath sounds on the right, tracheal deviation to the left, haemodynamic instability (Correct answer)
- Absent breath sounds on the right with normal blood pressure
- Dull percussion on the right with pleuritic chest pain
- Bilateral crackles with oxygen desaturation
Correct answer: Absent breath sounds on the right, tracheal deviation to the left, haemodynamic instability
Tension pneumothorax causes absent ipsilateral breath sounds, tracheal deviation away from the affected side, and haemodynamic instability (tachycardia, hypotension). It is a clinical diagnosis requiring immediate needle decompression — do not wait for X-ray.
Question 5: A patient presents in septic shock. Which intervention has the strongest evidence for improving survival?
- Early administration of appropriate IV antibiotics (Correct answer)
- IV crystalloid 30 mL/kg bolus alone
- Vasopressors as the first intervention
- Immediate blood transfusion
Correct answer: Early administration of appropriate IV antibiotics
Early appropriate antibiotics (within 1 hour of sepsis recognition) are the most evidence-based intervention in septic shock. The Surviving Sepsis Campaign bundles emphasise early antibiotics, IV fluids, vasopressors as needed, and source control.
Question 6: Which of the following is the correct management of status epilepticus not responding to two doses of benzodiazepine?
- IV levetiracetam, valproate, or phenytoin (second-line antiepileptic) (Correct answer)
- A third dose of diazepam
- Immediate surgical intervention
- Oral carbamazepine
Correct answer: IV levetiracetam, valproate, or phenytoin (second-line antiepileptic)
Refractory status epilepticus (failing two benzodiazepine doses) requires second-line IV antiepileptic therapy — levetiracetam, sodium valproate, or phenytoin/fosphenytoin — followed by anaesthesia/intubation if seizures continue.
NZREX Emergency Medicine
A patient is found unresponsive.
After ensuring scene safety, what is the correct first step in BLS?