NZREX Emergency Medicine

Question 1

A patient is found unresponsive. After ensuring scene safety, what is the correct first step in BLS?

Accepted Answer

Check for responsiveness by calling out and tapping the shoulders

Answer

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?

Accepted Answer

30:2

Answer

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?

Accepted Answer

N-acetylcysteine (NAC) administration after risk assessment using the Rumack-Matthew nomogram

Answer

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?

Accepted Answer

Absent breath sounds on the right, tracheal deviation to the left, haemodynamic instability

Answer

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?

Accepted Answer

Early administration of appropriate IV antibiotics

Answer

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.

NZREX Practice Test

NZREX Practice Test

NZREX Emergency Medicine