PC Emergency Procedures & Response 2 — Questions and Answers
Question 1: A patient with diabetes presents with a foot ulcer showing signs of necrotizing fasciitis. What is the most critical initial action?
- Apply topical antibiotics and recheck in 24 hours
- Immediate surgical consultation for emergent debridement (Correct answer)
- Start oral antibiotics and elevate the limb
- Obtain wound culture and await results before treatment
Correct answer: Immediate surgical consultation for emergent debridement
Necrotizing fasciitis is a surgical emergency requiring immediate debridement, as delays significantly increase mortality and limb loss.
Question 2: During a podiatric procedure, a patient develops bradycardia with a heart rate of 42 bpm and becomes diaphoretic. What should be done first?
- Administer atropine 0.5 mg IV
- Call for emergency services (911) and stop the procedure (Correct answer)
- Apply supplemental oxygen and monitor
- Administer epinephrine 1 mg IV
Correct answer: Call for emergency services (911) and stop the procedure
Symptomatic bradycardia with diaphoresis during an office procedure requires immediately stopping the procedure and activating emergency medical services.
Question 3: A patient experiences a vasovagal syncope episode in the chair. After positioning supine with legs elevated, the patient does not recover within 2 minutes. What is the next step?
- Administer oral glucose
- Check blood glucose and call 911 (Correct answer)
- Apply smelling salts and wait another 5 minutes
- Administer 0.9% normal saline IV bolus
Correct answer: Check blood glucose and call 911
Prolonged loss of consciousness beyond expected vasovagal recovery time requires emergency services and glucose assessment to rule out hypoglycemia.
Question 4: What is the appropriate first-line management for a patient presenting with acute compartment syndrome of the foot following trauma?
- Elevation and ice application
- Compression bandaging and NSAIDs
- Emergent fasciotomy (Correct answer)
- Casting and non-weight bearing
Correct answer: Emergent fasciotomy
Acute compartment syndrome requires emergent fasciotomy to release pressure and prevent irreversible neurovascular damage.
Question 5: A patient on warfarin develops uncontrolled bleeding after a minor nail procedure. INR is later found to be 6.2. What reversal agent is most appropriate?
- Protamine sulfate
- Tranexamic acid topically only
- Vitamin K and/or fresh frozen plasma (Correct answer)
- Aspirin discontinuation alone
Correct answer: Vitamin K and/or fresh frozen plasma
Supratherapeutic INR with active bleeding requires reversal with Vitamin K and fresh frozen plasma for rapid correction of coagulopathy.
Question 6: Which finding in a diabetic patient with a foot wound indicates impending critical limb ischemia requiring vascular surgery referral?
- ABI of 0.9
- Toe pressure above 55 mmHg
- Rest pain with ABI below 0.4 (Correct answer)
- Mild dependent rubor with palpable pulses
Correct answer: Rest pain with ABI below 0.4
Rest pain combined with ABI below 0.4 indicates severe arterial insufficiency and critical limb ischemia requiring urgent vascular intervention.
Question 7: A patient develops sudden-onset severe chest pain and shortness of breath 30 minutes after an ankle block. What is the most likely serious complication?
- Panic attack from procedure anxiety
- Local anesthetic systemic toxicity (LAST)
- Pulmonary embolism (Correct answer)
- Costochondritis exacerbation
Correct answer: Pulmonary embolism
Sudden chest pain and dyspnea post-procedure should raise immediate concern for pulmonary embolism, especially in a post-procedural, immobilized patient.
PC Emergency Procedures & Response 2
A patient with diabetes presents with a foot ulcer showing signs of necrotizing fasciitis.
What is the most critical initial action?