Your Emergency Department has introduced a

protocol for performing landmark guided fascia

iliaca compartment blocks (FICB) for patients
with a fractured neck of femur.
Question:
Describe the anatomical landmarks for performing
the FICB: (3)
Your Answer:
Correct Answer:
Draw an imaginary line between the anterior
superior iliac spine (ASIS) and the pubic tubercle.
Divide this line into thirds. Mark the point 1 cm
caudal (inferior) from the junction of the lateral and
middle third. This is the injection entry point.
Question:
Which nerves are blocked by the FICB? (3)
Your Answer:
Correct Answer:
The following 3 nerves are blocked by the FICB:

Femoral nerve

Obturator nerve

Lateral femoral cutaneous nerve

Question:
List 2 contraindications to performing a FICB: (2)
Your Answer:

Correct Answer:
Any 2 of:
Patient refusal
Anticoagulation or bleeding disorder
Allergy to local anaesthetics
Previous femoral bypass surgery
Infection / inflammation over the injection site
Question:
List 2 potential complications of a FICB: (2)
Your Answer:

Correct Answer:
Any 2 of:
Intravascular injection
Local anaesthetic toxicity
Local anaesthetic allergy
Temporary or permanent nerve damage
Infection

Block failure

A 25-year-old factory worker presents with

severe injuries to his right hand that occurred
when his hand became trapped in some
machinery. He is in severe pain and you want
to perform regional anaesthesia to ease his
discomfort.
Question:
Describe the anatomical landmarks of a median
nerve block at the wrist and how you would
perform the block. (4)
Your Answer:
Correct Answer:
The median nerve is located between the tendons
of palmaris longus and flexor carpi radialis.
The needle should be inserted approximately 2.5
cm proximal to flexor retinaculum, which can be
located underneath the wrist crease. In order to
perform the block correctly, the deep fascia, which

lies 3-5 mm beneath the skin, should be

penetrated.
Operators describe a fascial click as the being felt
as the needle passes through the fascia. The
fascia is relatively thin and not always felt so many
textbooks advise simply penetrating to a depth of
3-5 mms to ensure the fascia has been traversed
and that the local anaesthetic can bathe the
median nerve.
Question:
Describe the anatomical landmarks of an ulnar
nerve block at the wrist and how you would
perform the block. (3)
Your Answer:
Correct Answer:
The ulnar nerve passes between the ulnar artery
and the tendon of flexor carpi ulnaris.
The needle should be inserted under the tendon of
flexor carpi ulnaris close to its distal attachment
just above the styloid process of the ulna.

It should then be advanced 5-10 mm to just past

the tendon and the local anaesthetic infiltrated.
Question:
Describe the anatomical landmarks of a radial
nerve block at the wrist and how you would
perform the block. (3)
Your Answer:
Correct Answer:
The radial nerve runs along the medial aspect of
brachioradialis and then passes under its tendon in
the distal forearm, piercing the fascia on the dorsal
aspect.
This block is best performed with the wrist held in
slight dorsiflexion.
Local anaesthetic should be infiltrated
subcutaneously around the radial side and dorsum
of the wrist approximately 3 cm proximal to the
radial styloid, aiming medially towards the radial
artery but with care taken not to penetrate the

vessel itself. The infiltration can then be extended

laterally.
Because of the less predictable nature of local
anatomy associated with this block it is essentially
a field block and requires more extensive
infiltration than the other nerve blocks around the
wrist.

You see a 20 year-old man with a dislocated

shoulder. You plan to give him entonox whilst
you attempt to reduce his shoulder.
Question:
Which colours identify a cylinder of entonox? (1)
Your Answer:
Correct Answer:
White and blue.
Entonox is stored in white or blue cylinders with
blue and white shoulders.

Question:
Which gases and at what percentage make up
entonox? (2)
Your Answer:
Correct Answer:
Oxygen 50%
Nitrous oxide (N20) 50%
Question:
How long does entonox take to act and how long
does it act for after inhalation has ceased? (2)
Your Answer:
Correct Answer:
Entonox takes 30 seconds to act and continues for
approximately 60 seconds after inhalation has
ceased.
Question:
What is the 'Poynting effect'? (1)
Your Answer:
Correct Answer:

The Poynting effect involves the dissolution of

gaseous oxygen when bubbled through liguid N20
with vaporization of the liquid to form a gaseous
O2/N20 mixture.
Question:
What is the critical temperature of a gas and what
is the pseudocritical temperature of entonox?
Your Answer:
Correct Answer:
The critical temperature of a gas is the maximum
temperature at which compression can cause
liquefaction. Mixing gases may change their critical
temperature. The Poynting effect produces a 50:50
mixture, which reduces the critical temperature of
N20 and therefore Entonox has a pseudocritical
temperature of -6C.
Question:
List 4 containdications to the use of entonox: (2)
Your Answer:
Correct Answer:
Any 4 of: ( mark each)

Reduced conscious level

Diving injury
Pneumothorax
Middle ear disease
Sinus disease
Bowel obstruction
Documented allergy to Entonox
Hypoxia
Violent / disabled psychiatric patients

A patient in the resuscitation area of your

Emergency Department requires rapid
sequence induction (RSI) and intubation. You
have failed 3 times to intubate the patient and
have declared a 'failed intubation'.
Question:
Outline 2 steps that should now occur. (2)
Your Answer:
Correct Answer:
Call for senior anaesthetic help
Use a face-mask (1 or 2 person technique),

oxygenate and ventilate

Use an airway adjunct if necessary (oropharyngeal
or nasopharyngeal airway)
Question:
Despite the above measures the patient's oxygen
saturations drop to 87% with an FiO2 of 1.0. What
should occur next? (2)
Your Answer:
Correct Answer:
Insert LMA
Reduce cricoid force during insertion
Oxygenate and ventilate
Question:
You are still unable to ventilate the patient. You
decide to perform a needle cricothyroidotomy.
Describe how you would perform this procedure
and describe the anatomical landmarks you would
use. (4)
Your Answer:
Correct Answer:
mark each point:

Assemble and prepare oxygen tubing by

cutting a hole towards one end of the tubing
Connect tubing to an oxygen source capable
of delivering > 50 psi
Surgically prepare the neck using antiseptic
swabs
Palpate the cricothyroid membrane anteriorly
between the thyroid cartilage and cricoid cartilage
Puncture the skin in the midline and insert 12
G or 14 G cannula through cricothyroid membrane
at 45 degree angle caudally
Confirm tracheal position by air aspiration (20
ml syringe)
Attach ventilation system to cannula
Commence cautious ventilation (1 second on
and 4 seconds off)
Confirm ventilation of lungs, and exhalation
through upper airway
Ventilation can now be maintained for 30-45
minutes
Question:

List 4 potential complications of needle

cricothyroidotomy: (2)
Your Answer:

Correct Answer:
Any 4 of: ( mark each)
Inadequate ventilation, hypoxia and death
Aspiration (blood)
Oesophageal laceration
Haematoma
Perforation of posterior tracheal wall
Subcutaneous or mediastinal emphysema
Thyroid perforation

A 50-year-old man is brought in by ambulance

following a road traffic accident where his
motorcycle was struck by a lorry. He has
suffered significant facial injuries and has
signs of airway obstruction. His C-spine is
triple immobilized.

Question:
He has suffered significant mid-face trauma and
the anaesthetist decides to secure a definitive
airway. Outline 8 pieces of equipment which
should be available prior to attempting intubation.
(4)
Your Answer:

Correct Answer:
Any 8 of: ( mark each)
Suction
Oxygen
Oropharyngeal airway
Bag-valve mask
Laryngoscope
Gum elastic bougie (GEB)
Extra-glottic device e.g. LMA
Endotracheal tubes (3 sizes)
Surgical or needle cricothyroidotomy kit
Pulse oximetry
CO2 detection device
Drugs to facilitate intubation
Question:

List 4 ways in which correct endotracheal tube

(ETT) placement can be verified. (2)
Your Answer:

Correct Answer:
Any 4 of: ( mark each)
Direct visualization of ETT passing through the
vocal cords
Fogging in the ETT
Auscultation of bilateral equal breath sounds
Absence of borborygmi in the epigastrium
Capnography / CO2 detector
Chest radiography
Question:
Describe how you would perform a needle
cricothyroidotomy in this patient. (4)
Your Answer:

Correct Answer:
mark each to a maximum of 4 marks:

Assemble and prepare equipment

Position the patient supine, with the neck in a

neutral position

Clean the patients neck in a sterile fashion

using antiseptic swabs.
Anesthetise the area locally, if time allows
Assemble a 12 or 14 gauge over-the-needle
catheter to a 10 mL syringe
Locate the cricothyroid membrane anteriorly
between the thyroid and cricoid cartilage
Stabilize the trachea with the thumb and
forefinger of one hand
Using the other hand, puncture the skin in the
midline with the needle over the cricothyroid
membrane.
Direct the needle at a 45 angle caudally while
applying negative pressure to the syringe
Maintain needle aspiration as the needle is
inserted through the lower half of the cricothyroid
membrane (aspiration of air signifies entry into the
tracheal lumen)
Remove the syringe and needle while
advancing the catheter to the hub
Attach the oxygen catheter and secure the
airway

A septic patient in the resuscitation area of

your Emergency Department requires
intubation prior to their transfer to ITU. The
anaesthetist has asked for your assistance.
Question:
They have asked for you to draw up
suxamethonium and thiopentone to facilitate the
RSI. What doses would you prepare? (2)
Your Answer:
Correct Answer:
Suxamethonium: 0.5-2.0 mg/kg (100 mg in
average sized adult)
Thiopentone: 4-6 mg/kg
Question:
What is the mode of action of suxamethonium? (1)
Your Answer:
Correct Answer:
Suxamethonium is a depolarizing neuromuscular
blocker. (Nicotinic acetylcholine receptor agonist)

Question:
List 4 potential side effects of suxamethonium: (2)
Your Answer:

Correct Answer:
Any 4 of: ( mark each)
Hyperkalaemia
Malignant hyperthermia
Rhabdomylosis
Ocular hypertension
Bradycardia
Ventricular arrhythmias
Cardiac arrest
Constipation
Suxamethonium apnoea
Question:
Name 2 drugs that could be used for maintenance
of paralysis in this patient. (2)
Your Answer:

Correct Answer:
Any 2 of:

Atracurium

Rocuronium

Vecuronium
Pancuronium
Question:
What is the Sellick manoeuvre? (1)
Your Answer:
Correct Answer:
Cricoid pressure applied during endotracheal
intubation in a RSI to prevent regurgitation of
gastric contents.
Question:
What is the 'BURP' manoeuvre and why is it used?
Your Answer:
Correct Answer:
Backwards upwards rightwards pressure applied to
the anterior aspect of the larynx to facilitate an
improved view of the glottis during laryngoscpy
and endotracheal intubation.

A 25 year-old man has suffered a fracturedislocation of his ankle whilst playing football.
The ED registrar wants you to help him to
perform procedural sedation whilst the fracture
is reduced by the on-call Orthopaedic registrar.
He plans on using propofol and fentanyl for the
procedure. The patient weighs 70 kg.
Question:
Give an appropriate weight related dose for each
of these drugs that would be appropriate under
these circumstances: (2)
Your Answer:
Correct Answer:
There is no fixed or widely accepted dosage, and
the drugs should be titrated according to the
circumstances and response, but any answer in
the region of the following would be acceptable:

Propofol: 1 mg/kg i.e. 70 mg

Fentanyl 0.5 mcg/kg i.e. 35 mcg

Question:
What is the mechanism of action of propofol? (2)

Your Answer:
Correct Answer:
Propofol acts by potentiation of GABAA receptors
slowing channel-closing time and also by sodium
channel blockade.
Question:
What is the mechanism of action of fentanyl? (2)
Your Answer:
Correct Answer:
Fentanyl acts by selective mu opioid receptor
agonism. This activates a G protein subunit, which
decreases calcium permeability. This has the effect
of hyperpolarizing the membrane and inhibiting
neuronal activity.
Question:
List 4 common side effects of propofol: (2)
Your Answer:
Correct Answer:
Any 4 of: ( mark each)

Hypotension

Bradycardia
Tachycardia
Twitching
Flushing
Apnoea
Hiccoughs
Headache
Question:
What is the relative potency of fentanyl compared
with morphine? (1)
Your Answer:
Correct Answer:
Fentanyl is 100 times more potent than morphine.
Question:
What is the onset of action of IV fentanyl? (1)
Your Answer:
Correct Answer:
2-5 minutes.

A 50-year-old man is brought in by ambulance

following a road traffic accident where his
motorcycle was struck by a lorry. He has
suffered significant facial injuries and has
signs of airway obstruction. His C-spine is
triple immobilized.
Question:
List 3 objective clinical features of airway
obstruction. (4)
Your Answer:

Correct Answer:
Any 3 of:
Agitation or confusion
Cyanosis
Reduced conscious level
Choking
Noisy breathing
Snoring
Gurgling
Stridor or crowing
Question:

List 3 categories of patients that require a

definitively secured airway. (3)
Your Answer:

Correct Answer:
Any 3 of:
Apnoeic patients
Glasgow Coma Scale < 9
Sustained seizure activity
Unstable mid-face trauma
Airway injuries
Large flail segment or respiratory failure
High aspiration risk
Inability to otherwise maintain an airway or
oxygenation
Question:
Which three signs are suggestive of laryngeal
fracture? (3)
Your Answer:

Correct Answer:

Hoarseness

Subcutaneous emphysema

Palpable fracture

A 50-year-old man is brought in by ambulance

following a road traffic accident where his
motorcycle was struck by a lorry. He has
suffered significant facial injuries and has
signs of airway obstruction. His C-spine is
triple immobilized.
Question:
Which basic airway manoeuvres can be used to
open his airway? (1)
Your Answer:
Correct Answer:
mark each:

Chin-lift manoeuvre

Jaw-thrust manoeuvre
Question:
List 4 categories of patients that require a
definitively secured airway. (4)
Your Answer:

Correct Answer:
Any 4 of:
Apnoeic patients
Glasgow Coma Scale < 9
Sustained seizure activity
Unstable mid-face trauma
Airway injuries
Large flail segment or respiratory failure
High aspiration risk
Inability to otherwise maintain an airway or
oxygenation
Question:
Briefly outline the LEMON assessment for difficult
intubation. (5)
Your Answer:

Correct Answer:
The LEMON assessment stands for:

L Look externally (for characteristics known

to cause difficult intubation of ventilation)

E Evaluate the 3-3-2 rule (incisor distance

<3 fingerbreadths, hyoid/mental distance <3

fingerbreadths, thyroid-to-mouth distance <2

fingerbreadths)

M Mallampati (Mallampati score 3)

O Obstruction (presence of any condition

that could cause an obstructed airway)

N Neck mobility (limited neck mobility)

A 50-year-old man is brought in by ambulance

following a road traffic accident where his
motorcycle was struck by a lorry. He has
suffered significant facial injuries and has
signs of airway obstruction. His C-spine is
triple immobilized. The anaesthetist has
attempted to intubate him but is unable to do
so and decides to perform a surgical
cricothyroidotomy.
Question:
List 4 contraindications to performing a surgical
cricothyroidotomy. (2)
Your Answer:
Correct Answer:

Any 4 of: ( mark each)

Patients < 12 years of age
Laryngeal fracture
Pre-existing or acute laryngeal pathology
Tracheal transection with retraction of trachea
into mediastinum
Anatomical landmarks obscured by effects of
trauma
Question:
List 4 potential complications of surgical
cricothyroidotomy. (2)
Your Answer:

Correct Answer:
Any 4 of: ( mark each)
Aspiration (blood)
Creation of a false passage into the tissues
Subglottic stenosis or oedema
Laryngeal stenosis
Haemorrhage or hematoma formation
Laceration of the oesophagus
Laceration of the trachea
Mediastinal emphysema

Vocal cord paralysis or hoarseness

Question:
Describe how you would perform a surgical
cricothyroidotomy in this patient. (6)
Your Answer:

Correct Answer:
mark each to a maximum of 6 marks:
Assemble and prepare equipment
Position the patient supine, with the neck in a
neutral position
Clean the patients neck in a sterile fashion
using antiseptic swabs
Anesthetise the area locally, if time allows
Locate the cricothyroid membrane anteriorly
between the thyroid and cricoid cartilage.
Stabilize the trachea with the left hand until the
trachea is intubated
Make a transverse incision through the
cricothyroid membrane.
Insert the scalpel handle into the incision and
rotate 90. (A hemostat may also be used to open
the airway.)

Insert a proper-size, cuffed endotracheal tube

(usually a 5 or 6) into the cricothyroid membrane
incision, directing the tube distally into the trachea

Inflate the cuff and apply ventilation

Observe and check for chest rise and

auscultate chest for adequate ventilation

Secure the airway to prevent dislodging

A 60 year-old woman has presented with a

right-sided distal radius fracture. You have
been asked to help your Consultant perform a
Biers block.
Question:
Which local anaesthetic, and at what maximum
dose, should be used for a Biers block? (2)
Your Answer:
Correct Answer:
According to the 2014 CEM best practice guidelint
on intravenous regional anaesthesia (IRVA or
Biers block):

0.5% or 1% prilocaine should be used (without

preservative)

Maximum dose of prilocaine is 3 mg/kg

Bupivacaine should NOT be used

0.5% lidocaine at 3mg/kg with a maximum dose of

200mg (40ml) may be used as an alternative but
prilocaine remains the first line drug of choice.
Question:
Name one complication that is specific to this local
anaesthetic, and the treatment that should be
instituted if it occurs: (2)
Your Answer:
Correct Answer:
Methaemoglobinaemia specific to prilocaine and
usually only occurs at doses > 16 mg/kg
The treatment is IV methylene blue 1-2 mg/kg
Question:
List 4 contraindications to the use of a Biers block:
(2)
Your Answer:

Correct Answer:
Any 4 of: ( mark each)
Morbid obesity (cuff unreliable of obese arms)
Peripheral vascular disease
Raynauds phenomenon
Severe hypertension (>200 mmHg systolic)
Scleroderma
Epilepsy
Sickle cell disease or trait
Methaemoglobinaemia
Monckbergs calcinosis
Uncooperative or confused patient
Procedures needed in both arms
Allergy to local anaesthetic
Infection in the affected limb
Lymphoedema
Question:
Describe how you would perform a Biers block: (4)
Your Answer:

Correct Answer:
Any 8 of: ( mark each)

Ensure patient is on a cardiac monitor

Ensure that two doctors are present

throughout the procedure (One of which should
have adequate airway management training)
Elevate the injured arm for three minutes to
exsanguinate the limb
Apply and inflate the double-cuff tourniquet
and inflate to 100 mmHg above the systolic BP or to
300 mmHg (whichever is greater)
Check for the absence of radial pulse
Inject the 0.5% plain prilocaine
Warn the patient about the cold/hot sensation
and mottled appearance of the arm
Check for anaesthesia, may have touch but
not pain, after five minutes
If anaesthesia inadequate, flush cannulae with
10-15 ml normal saline
Remove the cannula
Lower arm on to a pillow and check tourniquet
not leaking
Perform the reduction of the fracture and
obtain check x-ray
Watch for signs of toxicity
The cuff must be inflated for a minimum of 20
minutes and a maximum of 45 minutes

If satisfied with the post reduction position of

fracture, deflate the cuff observing the patient and
monitor

Observe the patient and limb closely for signs

of delayed toxicity until fully recovered

Check limb circulation prior to discharge

Arrange patient follow up and analgesia as

appropriate

A patient in the resuscitation area of your

Emergency Department requires rapid
sequence induction (RSI) and intubation.
Question:
Which drugs and at what doses are classically
used to facilitate RSI? (2)
Your Answer:
Correct Answer:
Suxamethonium: 0.5-2.0 mg/kg (100 mg in
average sized adult)
Thiopentone: 4-6 mg/kg

Question:
Describe the modified Mallampati classification
used to predict the ease of intubation. (4)
Your Answer:
Correct Answer:
Class 1: Full visibility of tonsils, uvula and soft
palate
Class 2: Visibility of hard and soft palate, upper
portion of tonsils and uvula
Class 3: Soft and hard palate and base of the
uvula are visible
Class 4: Only hard palate visible
Question:
What is the '3-3-2 rule' by which difficult intubation
can be predicted? (3)
Your Answer:
Correct Answer:
To allow for alignment of the pharyngeal, laryngeal
and oral axes, and therefore simple intubation, the
following relationships should be observed:

The distance between the patient's incisor

teeth should be at least 3 finger breadths

The distance between the hyoid bone and the

chin should be at least 3 finger breadths

The distance between the thyroid notch and

the floor of the mouth should be at least 2 finger
breadths

Question:
Outline 2 external patient factors that would predict
a difficult intubation. (1)
Your Answer:

Correct Answer:
Any 2 of: ( mark each)
C-spine injury
Arthritis of the cervical spine
Maxillofacial or mandibular trauma
Limited mouth opening
Receding chin
Overbite
Short, muscular neck

A septic patient in the resuscitation area of

your Emergency Department requires

intubation prior to their transfer to ITU. The

anaesthetist has asked for your assistance.
Question:
Describe the process of a rapid sequence
induction with the doses of the drugs classically
used. (4)
Your Answer:

Correct Answer:
mark for each point:
Prepare airway trolley and equipment
Apply full monitoring
Explain procedure to patient if possible
Adjust head and neck position prior to starting
Optimal pre-oxygenation (3 mins with 100%
oxygen)
Give induction agent Thiopentone 4-6 mg/kg
Give muscle relaxant Suxamethonium 0.5-2
mg/kg
Assistant applies cricoid pressure (30 N force)
Direct laryngoscopy undertaken
Pass endotracheal tube (ETT) through vocal
cords

Tie / secure ETT

Question:
Outline 2 ways that endotracheal intubation can be
confirmed. (2)
Your Answer:

Correct Answer:
Any 2 of:
Direct visualization of the tip of the tube
passing through the glottis
Listening to bilateral equal breath sounds
Waveform capnography
Oesophageal detector
Question:
The anaesthetist is unable to intubate on their
initial attempt. Outline 3 manoeuvres that could be
undertaken to aid intubation. (3)
Your Answer:

Correct Answer:
Any 3 of:

Re-position patient (neck flexed 35 degrees

onto chest and 15 degrees face extension)

Reduce cricoid force

Attempt BURP manouevre
Use gum elastic bougie (seek clicks)
Try alternative laryngoscopy blade e.g. Miller
or McCoy
Question:
How many attempts at intubation are permitted
before a 'failed intubation' should be announced?
(1)
Your Answer:
Correct Answer:
3 attempts

A 60 year-old woman has presented with a

right-sided distal radius fracture. Two of your
colleagues have performed a Biers block.
There has been a reported cuff leak during the
injection of the local anaesthetic and they have
also inadvertently given double the
recommended strength of local anaesthetic.
The patient is restless and complaining of

circumoral paraesthesia. You have been asked

to review the patient due to their concerns
about potential local anaesthetic toxicity.
Question:
Which local anaesthetic, and at what dose, should
be used for a Biers block? (2)
Your Answer:
Correct Answer:
According to the 2014 CEM best practice guidelint
on intravenous regional anaesthesia (IVRA or
Biers block):

0.5% or 1% prilocaine should be used (without

preservative)

Maximum dose of prilocaine is 3 mg/kg

Bupivacaine should NOT be used

0.5% lidocaine at 3mg/kg with a maximum dose of
200mg (40ml) may be used as an alternative but
prilocaine remains the first-line drug of choice.
Question:

List 6 signs consistent with severe local

anaesthetic toxicity: (3)
Your Answer:

Correct Answer:
Any 6 of: ( mark each)
Sudden alteration in mental status
Severe agitation
Loss of consciousness
Muscle twitching
Convulsions
Hypotension and circulatory collapse
Bradycardias and conduction blocks
Ventricular tachyarrhythmias
Asystolic cardiac arrest
Question:
Outline 3 points in your immediate management of
the patient: (3)
Your Answer:

Correct Answer:
Any 3 of:

Call for senior help / anaesthetist

Stop injecting the local anaesthetic, if not

already done
Maintain the airway with adjuncts, or if
necessary endotracheal intubation
Give 100% oxygen
Give 1-2 litres of IV crystalloid
Give IV diazepam 5-10 mg or IV lorazepam 4
mg for seizures
Give IV ephedrine 3-6 mg increments for
severe hypotension
Question:
The patients condition continues to deteriorate
and despite the above measures they become
profoundly hypotensive with the systolic blood
pressure recorded 60 mmHg. Which specific drug
and at what dose is indicated under these
circumstances? (2)
Your Answer:
Correct Answer:
20% lipid emulsion (intralipid) 1.5 ml/kg as an IV
bolus over 1 minute

A 42 year-old man presents with a femoral

shaft fracture that occurred during a
motorcycle accident. You have been asked to
perform a femoral nerve block.
Question:
Describe the anatomical landmarks for a femoral
nerve block: (3)
Your Answer:
Correct Answer:
Identify the inguinal ligament by drawing an
imaginary line between the anterior superior iliac
spine (ASIS) and the pubic symphysis. The
femoral nerve passes through the centre of this
line and is most superficial at the level of the
inguinal crease. The femoral pulse should be
palpated at the level of the inguinal ligament and
the femoral nerve lies approximately 1-1.5 cm
lateral to this point, the needle entry point should
be here.
Question:

What is the root value of the femoral nerve? (1)

Your Answer:
Correct Answer:
The femoral nerve arises from the dorsal branches
of L2-L4
Question:
Which local anaesthetic would you choose for the
femoral nerve block? What is the maximum dose
of this particular local anaesthetic that can be
administered? (2)
Your Answer:
Correct Answer:
Any long acting local anaesthetic can be chosen
e.g. 0.25-0.375% bupivacaine. The maximum dose
of bupivacaine is 2 mg/kg.
Question:
List 2 contraindications to performing a femoral
nerve block: (2)
Your Answer:
Correct Answer:

Any 2 of:
Patient refusal
Anticoagulation or bleeding disorder
Allergy to local anaesthetics
Previous femoral bypass surgery
Infection / inflammation over the injection site
Question:
List 2 potential complications of a femoral nerve
block: (2)
Your Answer:

Correct Answer:
Any 2 of:
Intravascular injection
Local anaesthetic toxicity
Local anaesthetic allergy
Temporary or permanent nerve damage
Infection
Block failure