PC Emergency Procedures & Response 3 — Questions and Answers
Question 1: When managing local anesthetic systemic toxicity (LAST), what is the recommended antidote for refractory cardiovascular collapse?
- Sodium bicarbonate IV push
- 20% lipid emulsion (Intralipid) IV (Correct answer)
- Epinephrine high-dose bolus alone
- Magnesium sulfate infusion
Correct answer: 20% lipid emulsion (Intralipid) IV
20% lipid emulsion therapy (Intralipid) is the specific antidote for LAST by sequestering local anesthetic from cardiac tissue.
Question 2: A patient presents with a puncture wound to the foot and inability to bear weight, with signs of plantar space infection. What imaging is most appropriate initially?
- CT scan with contrast
- Plain radiographs to assess for foreign body and osteomyelitis signs (Correct answer)
- MRI of the foot
- Ultrasound only
Correct answer: Plain radiographs to assess for foreign body and osteomyelitis signs
Plain radiographs should be obtained first to quickly identify radiopaque foreign bodies and bony changes before advanced imaging.
Question 3: What is the correct adult dose of epinephrine (1:1000) for anaphylaxis via intramuscular injection?
- 0.1 mg in the deltoid
- 0.3–0.5 mg in the anterolateral thigh (Correct answer)
- 1.0 mg IV push
- 0.01 mg/kg subcutaneously only
Correct answer: 0.3–0.5 mg in the anterolateral thigh
The standard adult IM dose for anaphylaxis is 0.3–0.5 mg of 1:1000 epinephrine administered in the anterolateral thigh for fastest absorption.
Question 4: A 70-year-old patient with a history of atrial fibrillation on apixaban sustains a large laceration during a podiatric procedure. What is the best initial hemostatic strategy?
- Administer protamine sulfate immediately
- Apply direct pressure, hemostatic agents, and consider andexanet alfa if available (Correct answer)
- Administer fresh frozen plasma immediately
- Suture the wound immediately without additional steps
Correct answer: Apply direct pressure, hemostatic agents, and consider andexanet alfa if available
Direct pressure and hemostatic agents are first-line; andexanet alfa is the reversal agent for factor Xa inhibitors like apixaban if bleeding is severe.
Question 5: Which of the following is the most reliable early clinical sign of acute osteomyelitis in a diabetic foot ulcer that would indicate an emergency?
- Presence of callus around the wound
- Probe-to-bone test positive (Correct answer)
- ABI above 1.2
- Mild erythema without warmth
Correct answer: Probe-to-bone test positive
A positive probe-to-bone test has high predictive value for osteomyelitis in diabetic foot ulcers and necessitates urgent evaluation and management.
Question 6: What is the appropriate position to place a patient experiencing a hypoglycemic episode who is conscious and able to swallow?
- Supine with legs elevated
- Seated upright, administer 15–20 g fast-acting carbohydrates orally (Correct answer)
- Lateral recovery position
- Trendelenburg position with IV dextrose only
Correct answer: Seated upright, administer 15–20 g fast-acting carbohydrates orally
Conscious hypoglycemic patients should be seated and given 15–20 g of fast-acting carbohydrates by mouth as the first-line treatment.
Question 7: During wound irrigation of a deep plantar abscess, a patient suddenly develops hypotension and fever. What condition must be immediately considered?
- Medication side effect from local anesthetic
- Septic shock from bacteremia (Correct answer)
- Vasovagal reaction
- Lidocaine toxicity
Correct answer: Septic shock from bacteremia
Hypotension with fever during manipulation of a deep infection suggests bacteremia progressing to septic shock, requiring immediate resuscitation and escalation.
PC Emergency Procedures & Response 3
When managing local anesthetic systemic toxicity (LAST), what is the recommended antidote for refractory cardiovascular collapse?