Resuscitation SAQ’s
With regard to intravenous regional anaesthesia of the upper limb:
List the indications
List the contra-indications
List the potential toxic effects of LA agents and how to minimise them in this
context
List the indications:
• Closed forearm fractures needing reduction
List the contra-indications:
• Unco-operative patient
• <10years old (persistent medullary circulation in humerus may allow access of LA
into systemic circulation, unclear if this is of clinical significance, large series in
children under ten show no significant complications)
• compromised circulation to the limb
• compartment syndrome in affected limb
• presence of sickle cell disease or Raynaud's disease
• fracture humerus on same side
• soft tissue injury at tourniquet site
• cellulitis/infected extremity
• LA allergy
• Cardiac conduction abnormalities
• Hypertension, systolic >200mg Hg
List the potential toxic effects of LA agents and how to minimise them in this
context:
• Premonitory CNS symptoms: (all potentiated by CO2 , pH)
Perioral tingling
Dizziness
Tinnitus
Unresponsiveness
Agitation
Nystagmus
Muscle twitching
• Seizures
Usually self-limiting due to drug redistribution
• CNS depression
• Respiratory
Hypoventilation, respiratory arrest
• CVS
Hypotension
Arrhythmia (bradycardia, VF/VT)
Myocardial depression
Palpitations
Vasodilation
Bupivacaine most cardiotoxic
• Allergy
Allergy to amides are uncommon
Prilocaine is only agent that should be used. Lignocaine and bupivacaine have high
incidence of complications and death
To minimize complications:
Consent + warn patient of premonitory CNS symptoms
Two doctors
Appropriate area plus resuscitation equipment and drugs
IV access in each arm – secured properly and not over joint
Double cuff pneumatic tourniquet inflated to systolic BP plus 100mg Hg
Check the radial pulse has disappeared before injecting prilocaine
Cuff should be inflated for at least 20 minutes and no longer than one hour
If toxicity does occur:
Treat seizures with benzodiazepines
Treat arrhythmias and arrest aggressively as acidosis, CO2, O2 cause worsening of
toxicity
A 2 year old child with severe dehydration arrives in the
emergency department. He is floppy and unresponsive. Soon
after arrival he suffers a PEA (Pulseless Electrical Activity)
arrest.
Question
Describe your management
Answer
Answer and Interpretation
FACEM SAQ Exam 2010.2 – Question 7
The overall pass rate for this question was 55/92
(59.8%)
Pass Criteria
Structured step-wise approach following
paediatric ALS algorithm
CPR continued throughout
Emphasis on early circulatory access, IO if
any delay in IV
Appropriate weight related resuscitation
doses of fluids and adrenaline
Identify and treat reversible causes (4Hs and
4Ts)
Good candidates also included: family
support/discussion, cessation of resuscitation, post
resuscitation care
Features of unsuccessful answers
Poor structure and flow – no smooth
sequence of BLS to ALS
Adrenaline – wrong dose, delays to
administration or none given
Failure to give adequate fluids, incorrect fluid
volume
Use of drugs to intubate (RSI) in cardiac arrest
SAQ 080
A 17 year old girl with severe asthma has a respiratory arrest in your ED. Outline how
you would go about intubating and ventilating her, and discuss the issues relating to
IPPV in severe asthma.
A 55 year old man has just undergone endotracheal intubation
for severe asthma. Immediately post intubation, his systolic
blood pressure falls to 80 mmHg.
Question
a. Outline the causes of post intubation hypotension in this man.
b. Describe your ventilation strategy for this man.
Answer
Answer and Interpretation
FACEM SAQ Exam 2006.2 – Question 5
The overall pass rate for this question was 54/57
(94.7%).
Pass Criteria
The examiners felt that this was a core
emergency medicine question pitched at the right
level for this examination.
Overall most candidates performed well on
this question.
Part (a) required a discussion of possible
causes which needed to include drugs, effects of
PPV, barotrauma, hypoxia of various causes,
cardiac events, dehydration and allergy.
Part (b) required a structured approach to the
problem addressing all the above mentioned
conditions.
In particular detail was required on the
optimal ventilation settings for a patient with this
presentation.
Features of unsuccessful answers
Candidates failed to pass this question if they
missed a number of the key points above.
ALTERNATIVE
Describe the issues and process of intubation and ventilation in severe asthma
ISSUES
- Relative hypovolemia due to dehydration, decreased venous return
- High airway pressures ++
- Long expiratory time
- Auto/intrinsic PEEP – permissive hypercapnia
- Risks of barotrauma, mucus plugging, alveolar collapse
Intubation
Fluid load
Check K (may be low due to salbutamol)
Aim for RSI with good pre-oxygenation (?biPAP, allow to sit up until last moment), cricoid
pressure
Prepare:
Area – Full resus facilities with monitoring
Equipment – Airway trolley including difficult airway, suction, early NGT (decompress
inflated stomach, ileus due to low K), large ETT to allow bronchoscopy
Drugs – consider ketamine 1mg/kg, otherwise fent and midaz, may need little if impending
arrest, spray cords with lignocaine – avoid laryngospasm, suxamethonium 1.5mg/kg
Staff – at least 2 airway-experienced doctors, designated nurses for airway, cricoid,
documentation
Ventilation
Low RR ~ 6
High I:E ratio – allow long expiratory time
Volume controlled ventilation 5-7ml/kg
Pressure limited
Low PEEP 2.5 – 5 if tolerated
Optimise bronchodilation with beta-agonist, anticholinergic, MgSO4 via T-piece and po/iv
steroid; treat underlying infection; treat pneumothorax with ICC
Monitor for complications eg pneumothorax, mucus plugging
SAQ 094
A 35 year old woman with known myasthenia gravis presents with a week of fever and
productive cough. Her vital signs are:
• Temp 38.5'C
• P 130
• BP 100/80
• GCS 15
• SaO2 85 % on room air
• FVC 750 mls
a) Outline your management. (65%)
b) Outline how you would go about inducing and maintaining general anaesthesia in this
patient (35%)
Issues
Myasthenia gravis:
- autoantibodies to post-synaptic Ach receptors at NMJ
- sensitive to depolarizing paralytics
- ocular mm. and respiratory mm.
Risk of respiratory failure (definition: FVC < 15ml/kg = 900ml for 60kg patient)
Probable community acquired pneumonia with hypoxia, hemodynamic compromise and
serious comorbidity
Management
TREATMENT
1. Resus
A monitor patency and protection (GCS)
B RR, use of accessory muscles
Hypoxia and low FVC – impending respiratory failure; will probably need emergent I&V;
supplemental O2 15L via non-rebreather mask; biPAP (IPAP 12, EPAP 7, FiO2 to keep sats
>93%)
C IV access x 2
Fluid resus: early goal directed therapy in sepsis (Rivers et al, NEJM, 2001)
Goals
MAP 65 – 90 vasoactive agent
CVP 8 – 12 IV fluid
ScvO2 > 70% BTF to get Hct > 30%
Dobutamine
I&V to decrease O2 consumpn
Shown to decrease in-hospital mortality
Therefore: early aggressive fluid resuscitation within the first 6h
D monitor GCS, pupils
Monitor BSL
2. Specific treatment
IV antibiotics:
Community acquired pneumonia –
Benzylpenicillin 2.4g load then 1.2g qid iv
Erythromycin 500mg tds iv
Also consider:
?aspiration/pseudomonas – ceftriaxone
?staph – flucloxacillin
NB. Avoid aminoglycosides
Tetracyclines
Beta blockers
Morphine
Pethidine
Antiarrhythmics IA, IB
- cause prolonged NMJ block
3. Treatment of complications
Coagulopathy, DIC – FFP, platelets, cryoppt
Renal dysfunction – IV fluid, monitor UO, +/- hemodialysis
Liver dysfunction
Cerebral compromise
SUPPORTIVE CARE
Myasthenia –
a. Cholinergic crisis
therapy induced
bronchorrhea
generalized weakness
withhold therapy
b. Myasthenic crisis
resp and pharyngeal paresis
often early in Rx or post thymectomy
Cholinesterase inhibitors:
- neostigmine 2.5mg
- pyridostigmine 60mg tabs 1-3tabs 2-4x/day
both life-threatening - 4% mortality
edrophonium test will distinguish
- myasthenic crisis → improves
- cholinergic crisis → worsens (resp deterioration, cardiac dysrhythmia)
Prednisone 100mg/d
Cytotoxics, plasmapheresis
Chest physio
Analgesics, antiemetics
Nebulisers
Bronchoscopy and toilet
DISPOSAL
ICU – monitor gas exchange, hemodynamics, renal function
Input from intensivist, respiratory physician
GENERAL ANAESTHETIC
Issues
Resistant to depolarizing agent – double dose
Sensitive to non-depolarizing agent – don’t use
Little resp reserve – desaturates quickly
Elective intubation:
Fasted – OT - anaesthetist
Gas induction
High dose suxamethonium
?awake fibreoptic intubation
Emergent intubation:
1. RSI
pre-oxygenate
sedate with thiopentone or fent/midaz
cricoid
quick check that can ventilate with bag and mask
high dose suxamethonium 200mg
2. Awake intubation
pre-oxygenate – sedate – laryngoscopy – cophenylcaine spray to cords – ETT
Maintenance of GA:
Sedate with propofol or midaz only
AVOID ongoing paralysis - spontaneous breathing with PEEP & PS
SAQ 108
A term baby is delivered in an ambulance at the entrance to your ED. The child has no
palpable cardiac output, no spontaneous respirations and is generally cyanosed at one
minute of age. There is meconium in the baby's mouth. Outline your management.
INTRO
This is a time critical situation with immediate threat to life of newborn.
Significant factors to consider
1-Baby- est weight 3.5KG
-Asphyxia –Apgar between 1-3 at 1 minute nil CO or resp effort –CPR needed
-meconium aspiration-associated complications aspiration,pneumothoraces, pulmonary
hypertension
2-Mother-second patient issues- Medical- maternal conditions leading to asphyxia of infant ie, APH , Also likely needs to
complete third stage
-Psychological-unexpected life threat to her newborn infant- ideally separate staff member
assigned to support.
3 -Father-psychosocial
4-Staff ,ambulance, nursing and medical need for de-brief post resuscitation
I would call for help-paediatrics, midwife/obstetrics, and social worker.
Two teams
Team 1 baby
Neonatal resuscitiaire overhead heater, timing device to start, full non invasive monitoring
If the baby was still hypotonic with no respiratory effort I would
Intubate 3.5 ETT baby and extubate suctioning simultaneously with meconium aspirator
device.
AIRWAY
I would then immediately re-intubate and confirm ETT placement –Direct vision tube
through cords, ETT CO2 (unreliable whilst no CO), bilateral air entry, ventilation aiming for
chest wall rise and hopefully improvement in heart rate and colour.
BREATHING
If after 5 breaths with good chest rise there is no improvement of HR > 60BPM team
member to commence chest compressions.
CIRCULATION
Chest compressions hand encircling technique thumbs in midline on sternum just below
inter-nipple line aim for compression third depth of chest.
3 compressions to 1 ventilation once HR and palpable output > 60bpm and rising
compressions can cease.
If no response to above measure and lung inflation and adequate ventilation confirmed
would administer 10mcg/kg of adrenaline 0.35mls 1 in 10,000 via IO/Umbilical venous
catheter. Continue in cycles every 3-5minutes.
History of volume loss re APH would give 10mls /kg of N.saline
DISABILITY
Dextrostix- BSL <2.5mmol/L slow bolus of 2-5mls/KG of 10% dextrose
DRY baby use overhead heater maintain normothermia
Throughout the resuscitation continual re-evaluation and team communication.
DISPOSITION
If good response to resuscitation will need admission to intensive care neonatal nursery.
Potential need for inter-hospital transfer. Ideally allow mother to see, touch hold baby if
condition allows.
If no signs of cardiac output at 10 minutes outcome likely to be very poor, decision and
discussion to stop effort should be made in conjunction with parents and paediatrician and
team. If baby dies parents to have time to be with baby in private with staff member
assigned for support.
Need for debrief of all staff needed.
TEAM 2 -mother
Assessment ideally with midwife in team attention especially to psychological support.
Completion of third stage of labour management of any complications.
Disposition to post natal ward parents to be kept fully informed of babies condition.
SAQ 331
A 42-year-old male is brought to your emergency department by ambulance after
jumping off a nearby 3-storey building.
His observations on arrival are:
GCS 11/15 (E-3, M-5, V-3)
HR 142
BP 78/40
RR 32
SaO2 94% (on 15 l/min O2 via non-rebreathing mask)
T 36.9
(a) Outline your assessment of this patient. (50%)
(b) Outline your management of this patient. (50%)
42 year old jumped from 3 stories • Hypotensive, tachycardic – likely hypovolaemic shock ?source of blood loss
• GCS 11/15 ?major head injury
• Tachypnoeic, Sats 94% on O2
• Probable suicide attempt
Priorities
1) airway remains patent and protected and ventilation is adequate
2) Identify immediately treatable causes of hypotension/tachypnoea
• Haemo/pneumothorax
• Pelvic fractures esp. vertical shear with potential for major haemorrhage
• Long bone fractures with potential haemorrhage
3) If no other cause identified and limited or no response to initial fluid resuscitation then
should have exploratory laparotomy to exclude/treat intraabdominal source of bleeding.
4) Rapidly identify and treat neurosurgical cause of altered GCS
5) Identify / manage all other injuries along standard lines (many potential injuries)
6) Consider, identify and treat potential ingestions if confirmed suicide attempt
Assessment and management occur concurrently and this should occur in a resuscitation
area with a full trauma team response.
(a) Assessment:
History (collateral from witnesses / ambulance personnel):
1) This event
• How landed
• Injuries apparent, evidence of blood loss
• Vital signs, conscious state and progression over time
• Treatment so far eg. Fluids, analgesia, sedation and response to treatment
• Evidence of drug ingestion eg. Note, pill packets, collateral
2) Past history (need to consult chart/family/sources collateral)
• Past medical and surgical history
• Past psychiatric history and social situation
• Medications (?potential ingestions available)
• Allergies
Examination:
Airway:
• Assess for injury/patency and ability to protect, reevaluate continuously
• C-spine examination not useful in view of conscious state
Breathing:
• Evidence of chest trauma, rib fractures (crepitus), pneumothorax (decr AE or expansion,
s/c emphysema) , aspiration, contusion
• Monitor resp rate/sats/oxygenation
Circulation:
• peripheral perfusion, PR, BP and response to treatment.
• IDC & hourly urine measures
• ?sources blood loss
uising, urethral bleeding, abn prostate
– bruising, tenderness, guarding, distension, PR
• peripheral pulses
• ? potential compartment syndrome areas
Disability:
• ?intracranial lesion needing OT: GCS, pupillary abnormality, hemiparesis, etc
• head trauma, BOS#, facial fractures
• ?spinal injury – complete neurological assessment including PR for documentation of
spinal injury, level etc.
• log roll and examination of entire spine
Other specific examination:
• Orthopaedic:
above
• Cardiothoracic:
– bruits, pulse deficits or inequalities, BP differences
– muffled heart signs, Kussmaul’s, distended neck veins
• Soft tissue wounds or injury
• Evidence of any toxidromes due to ingestion
Investigations:
Bedside:
• BSL
• ECG ?evidence of myocardial contusion etc
• ABG to assess gas exchange, ventilation, acid-base status (?shock), initial Hb.
Laboratory:
• FBE – baseline Hb, platelets
• UEG/LFT – baseline renal function and electrolytes, evidence of hepatic or tissue damage
• Lipase - ? pancreatic injury X-match 4-6 units
• Coag profile if requiring significant blood transfusion
• Paracetamol/salicylate and other levels as indicated
Radiology:
• CXR & Pelvis – detection of injuries as above
• C-spine/T-spine/L-spine indicated by mechanism and conscious state
• X-rays any injured joint/bones in view mechanism
• USS FAST of abdomen in conjunction surgeons – useful if hypotension/ongoing fluid
requirements in the presence of other causes hypotension (major pelvic or long bone
fractures or chest injury or spinal) to clarify need for immediate laparotomy
• CT to detect injuries as above
CTA chest
viscous injury, pancreas)
source of bleeding.
• ?Pelvic angiography if haemodynamically unstable pelvic fractures
Other
• ?TOE in OT or ED to investigate aorta if instability or other injuries preclude CTA
• DPL/DPA by surgical team as indicated (see below)
(b) Management:
Specific treatment:
Airway:
• GCS of 11/15 + RR32/sats 94% on 15 l/min + shock = elective intubation with RSI
reasonable (not initially mandated). Ongoing assessment/monitoring essential if not
intubated.
• Entire spinal precautions with collar, log rolling etc
Breathing:
• Treat identified trauma along standard lines eg. ICC’s for haemo/pneumothorax
• High flow oxygen (15 l/min)
• Monitor adequacy ventilation/gas exchange with Sats and ABG
Circulation:
• Large bore peripheral access – 2 x 16g or larger
• Initial fluid resuscitation of 2 litres N. Saline bolus.
• Aim for MAP of 65-70 mm Hg or SBP> 100, PR < 100, UO >= 1ml/kg/hr, normal acid-base
status.
• no response to saline then packed cells, 2 units initially ?response.
• Urgent surgical assessment required from outset and failure to respond to fluid
resuscitation in absence of obvious cause (haemopneumothorax, peripheral fractures,
pelvic fractures) indicates laparotomy.
• Unstable pelvic fractures = pelvic binder or sheet tie
• Major pelvic fractures + shock = DPL/DPA/or FAST to clarify need for laparotomy and use
of ex-fix and/or angiography as per orthopods
• External haemorrhage control.
• Warm fluids to 37C
Disability:
• Neurosurgical lesion suspected = neurosurgical r/v, CT if able. Supportive management
along standard lines for head injury.
• Spinal cord injury = immobilisation, orthopaedic review re reduction of dislocations or
decompressive surgery, methylprednisolone depending on local practices
Other management of identified injuries or ingestions along standard lines
Supportive care:
• Analgesia – morphine in aliquots of 2.5 mg IV
• Antiemetic as indicated
• NGT as indicated
• Maintain normothermia
• Counsel relatives/friends
Disposition:
• OT as indicated
• Likely to require HDU or ICU level monitoring in view of conscious state, hypotension,
likely injuries. Certainly necessary if intubated.
• Will need psychiatric input and assessment to clarify situation and ensure safety once
recovering.
1. A 12 month old infant is brought to your ED after being found submerged and
unresponsive in a local home swimming pool. CPR is in progress, and there has been no
return of spontaneous circulation.
2.
(a) Describe the technique you use to establish an intraosseous line.
(70%)
(b) What are the complications of an intraosseous line
(30%)
Describe the factors you use to decide the time to discontinue resuscitation of out of
hospital cardiac arrest.
3. SAQ 1 2006/1
4. a. Outline the evidence for therapeutic hypothermia in post cardiac arrest patients. (30%)
5. b. Describe a protocol for therapeutic hypothermia in your ED. (70%)
6. SAQ 7 2006/1
7. A 55 year old man presents to triage complaining of throat tightness, itch, generalised
erythema and
8. lip swelling whilst eating at a local Thai restaurant.
9. a. Outline your history and examination of this patient. (50%)
10. b. Describe your management of this patient. (50%)
11.
12.
13. SAQ 4 2007/1
14. Compare and contrast the cardiac arrest algorithm for asystole between adults and
children older than one year. (100%)
FACEM SAQ Exam 2007.1 – Question 4
The overall pass rate for this question was 22/55
(40.0%).
Pass Criteria
The examiners felt that this was an excellent
core knowledge question on a topic recently
overviewed in widely discussed concensus
statements (ILCOR/AHA/ARC).
It was thought to have been overall answered
very poorly by most candidates.
Good responses identified the differences in
pathophysiology (and hence, priorities) in children,
highlighted the potential reversible causes and
exhibited knowledge of the recently published
algorithms in this area.
Features of unsuccessful answers
Common errors in answering this question were
incorrect drug doses, incorrect CPR ratios/rates, failure to
mention intraosseous vascular access techniques and
disregard of the differing pathophysiology.
15. SAQ 3 2007/2
16. A 72 year old man presents to the emergency department with a two day history of
abdominal pain. A CT scan undertaken to investigate recent weight loss and jaundice
shows a pancreatic mass lesion.
17. On examination, he is confused and jaundiced with maximal tenderness in the right upper
quadrant.
18. His observations are:
19. Temp 39.8oC
20.
21.
22.
23.
24.
PR 120 per min
BP 100/65 mmHg
RR 22 per min
O2 Sat 98% on oxygen 6 LPM
Describe your management. (100%)
25.
26. SAQ 5 2007/2
27. Discuss the pharmacological options available (including dosages and modes of delivery)
to treat anaphylaxis in the emergency department. (100%)
28.
29. SAQ 6 2007/2
30. A 58 year old patient who is undergoing Continuous Ambulatory Peritoneal Dialysis for
end stage renal disease presents with a 6 hour history of severe abdominal pain and
vomiting.
31. His observations are:
32. Temp 38.8oC
33. PR 110 per min
34. BP 150/90 mmHg
35. RR 22 per min
36. O2 Sat 98% on oxygen 6 LPM
37. Describe your assessment. (100%)
Discuss the strategies available in the event of a failed orotracheal intubation.
~ You
are preparing to semi-urgently intubate a patient
a.) outline how you assess the likelihood of this being a difficult intubation b.) describe your
approach to managing a potentially difficult intubation.
7. An 86 year-old woman is brought in by ambulance from her nursing home. She was found
unconscious in her room, 12 hours after being seen to be her usual self.
Preliminary findings:
GCS
3 (tolerating oro-pharyngeal airway)
BP
200/110 mmHg
HR
50
bpm
Temp
31
deg C
Outline your approach to this case (100%).
Issues

Immediate control of critically unwell patient – assume team leadership, and establish order
and direction early

Preliminary assessment:
o
Immediate life threats
o
Cause of coma – stroke, incl ICH
o


Complications of coma – hypothermia, hypoglycaemia, other
Preliminary management
o
Airway support
o
Rewarming
o
Metabolic correction (eg hypoglycaemia)
Ongoing:
o
CT Brain – with our without ETT
o
End of Life Consideration - depends on more info from NOK, NH, GP etc
o
Palliative care is paramount. Additional Rx beyond this is subject to multiple factors,
including time.
o

Appropriate disposition
Liaison with family / NOK is crucial
SAQ 2
Discuss the use of non-invasive ventilation in the emergency department. (100%)
The overall pass rate for this question was 39/67 (58.2%).
Pass criteria
Primary rationale for CPAP is correction of hypoxaemia versus correction of hypercarbia for
BiPAP
Understanding of the physiologic advantages of these therapies – both decrease work of
breathing
and improve V/Q matching
Specific concerns re risk of aspiration
Specific concerns re patient tolerability / acceptability
Technical / nursing load and demands created by both therapies
SAQ 4
Compare and contrast the cardiac arrest algorithm for asystole between adults and children
older than one year. (100%)
The overall pass rate for this question was 22/55 (40.0%).
The examiners felt that this was an excellent core knowledge question on a topic recently
overviewed in widely discussed concensus statements (ILCOR/AHA/ARC). It was thought to
have been overall answered very poorly by most candidates. Good responses identified the
differences in pathophysiology (and hence, priorities) in children, highlighted the potential
reversible causes and exhibited knowledge of the recently published algorithms in this area.
Common errors in answering this question were incorrect drug doses, incorrect CPR
ratios/rates, failure to mention intraosseous vascular access techniques and disregard of the
differing pathophysiology.
SAQ 6
A 62 year old man with known chronic renal failure presents with respiratory failure,
secondary to
pulmonary oedema. Oxygen saturation is 89% on 100% oxygen utilizing bi-level positive
airway
pressure (BiPAP). His observations are:
Glasgow Coma Score 14
Temperature 37.0oC
Respiratory Rate 32 /min
Systolic blood pressure 90 mmHg
Electrocardiograph Rate of 105 /min with a regular broad complex rhythm.
An urgent Potassium level of 8.7 mmol/L (Reference Range: 3.5-4.9 mmol/L) has been
recorded.
Discuss rapid sequence induction in this man. (100%)
The overall pass rate for this question was 23/56 (41.1%).
Examiners noted that this was a challenging question that required far more than a simple
description of an RSI template. In particular as a discuss question it required consideration of
whether RSI was appropriate at all, alternative approaches, the clinical context of a patient
with life
threatening hyperkalaemia and the pros and cons of elements of RSI such as drugs, posture,
haemodynamics etc.
SAQ 2
Discuss the role of adrenaline and vasopressin in cardiac arrest.
The overall pass rate for this question was 33 / 64 (51.6%).
It was expected that a good answer would explain the current place of both drugs in
resuscitation
guidelines but with an appreciation of the limited evidence for the efficacy of either. As a
discuss
question a solid list of pros and cons was expected with this being a good opportunity to
discuss
some of the quality of evidence issues. Failing answers lacked pros and cons, had limited
detail and
made incorrect assertions regarding the role of the drugs.
2008.2 SAQ 4
Compare and contrast propofol and ketamine for procedural sedation in the
emergency department. (100%)
SAQ 4
Describe a detailed protocol for the use of propofol in the emergency department.
The overall pass rate for this question was 22 / 44 (50%).
The expectation was that candidates would provide substantial detail in this answer on a topic
in
which they could reasonably be expected to have a high level of knowledge. Although
technical
issues such as pharmacology, dosing, indications were clearly required this in itself was not
sufficient to pass. Since the question asked for a detailed protocol examiners expected that
more
managerial issues such as consent, credentialing of staff and audit would be addressed.
2. What features would you want in a patient trolley (bed) for a resuscitation area? Justify your answer.