Protocol Knowledge Exam (Intermediate/Paramedic)

Epinephrine (1:10,000) is the appropriate medication for a patient in pulseless electrical activity (PEA) or asystole. PEA and asystole are both non-shockable rhythms, meaning that defibrillation is not effective. Epinephrine is a vasopressor that helps to increase blood flow and perfusion to vital organs. The recommended dose is 1 mg given intravenously or intraosseously every 3-5 minutes. This medication helps to improve the chances of successful resuscitation and is a key component of the advanced cardiac life support algorithm for these rhythms. Atropine is not indicated for PEA or asystole, and adenosine is used for the treatment of supraventricular tachycardia, which is not the presenting rhythm in this case. Epinephrine (1:1,000) is used for anaphylaxis and severe asthma, not for cardiac arrest.

Capnography measures the concentration of carbon dioxide (CO2) in the exhaled breath. In patients with respiratory distress, an increase in CO2 levels can indicate worsening ventilation and impending respiratory failure. In this scenario, the patient is short of breath, speaking in short sentences, and has low oxygen saturation. These findings suggest respiratory distress. Capnography can provide real-time monitoring of CO2 levels, allowing for early detection of respiratory decompensation before changes in pulse oximetry readings. Therefore, the statement "Capnography will alert you to patient decompensation before pulseOx" is true.

Generally speaking croup is manifested by abnormal sounds of the upper airway (e.g., trachea) while asthma includes the lower airways (e.g., bronchioles). Difficulty or swelling of the upper airway create inspiratory noises typically labeled as stridor while lower airway narrowing create expiratory noises labeled wheezing. Croup will often times include a fever and nighttime waking while asthma will generally not have an associated fever unless accompanied by a lower respiratory tract infection (e.g., pneumonia).

When following the "Chest Pain" protocol, obtaining a 12-lead EKG within 10 minutes of patient contact is crucial. This is because a 12-lead EKG helps in diagnosing and evaluating the cause of chest pain. It provides valuable information about the heart's electrical activity and can help identify any abnormalities or signs of a heart attack. Obtaining the EKG within 10 minutes allows for early detection and prompt medical intervention, which can significantly improve the patient's outcome.

Once a STEMI (ST-elevation myocardial infarction) is identified, it is crucial to reduce scene time to less than 20 minutes. This is because STEMI is a severe form of heart attack that requires immediate medical intervention to restore blood flow to the heart. The longer the delay in treatment, the higher the risk of permanent heart damage or even death. Therefore, minimizing scene time is essential to ensure prompt transportation to a specialized cardiac center where appropriate interventions can be performed.

Normal carbon monoxide levels in a smoker can indeed be as high as 9%. Smoking involves inhaling tobacco smoke, which contains carbon monoxide among other harmful substances. Carbon monoxide is a toxic gas that is produced when tobacco is burned. When smokers inhale carbon monoxide, it binds to hemoglobin in the blood, reducing its ability to carry oxygen to the body's tissues. This can lead to various health problems, including cardiovascular diseases and respiratory issues. Therefore, it is true that normal carbon monoxide levels can be as high as 9% in a smoker.

Based on the information provided, the patient jumped from a second-story balcony and landed on her back. Although it is uncertain if she hit her head, her friend reports that she is acting confused and slower than normal. These symptoms could indicate a potential head or spinal injury. Immobilizing the patient would be the appropriate course of action to prevent further injury and ensure the safety of the patient.

The patient in this scenario has multiple risk factors that suggest immobilization is appropriate. He was involved in an ATV accident with a high speed of 30 mph, was ejected from the vehicle, and was unconscious for a significant amount of time. The smell of alcohol on his breath indicates potential intoxication, which can impair judgment and coordination. The short-term memory deficit and repetitive questioning also indicate a possible head injury. The deep laceration across his forehead further raises concerns for potential skull fracture or brain injury. Immobilizing the patient would help prevent further injury and allow for proper evaluation and treatment of any potential spinal or head injuries.

Amiodarone is the correct next step in this scenario because the patient is in cardiac arrest and not responding to initial treatments such as electrical shocks and epinephrine. Amiodarone is an antiarrhythmic medication that can be used to treat life-threatening ventricular arrhythmias, which may be the cause of the patient's cardiac arrest. It is given after initial interventions have failed to restore normal cardiac rhythm.

In a patient experiencing an acute coronary event (e.g., ST elevation myocardial infarction or "heart attack") the most likely source of their hypotension is poor cardiac output from an injured heart muscle. The other sources of shock have preserved heart function and instead a failure of the vasculature to maintain adequate pressure. This distinction is critical as the treatments are different and if delivered inappropriately can exacerbate the shock state (e.g., aggressive IV fluid therapy will help someone in septic shock but may kill a patient in cardiogenic shock)

Instructing the bystander to continue CPR until EMS can take over is the correct answer because the patient is not conscious, not breathing, and does not have a palpable pulse. This indicates that the patient is in cardiac arrest and immediate CPR is necessary to maintain blood flow and oxygenation to the vital organs. Instructing the bystander to continue CPR ensures that the patient receives the necessary chest compressions until advanced medical support arrives.

In a patient experiencing no obvious distress, supplemental oxygen should only be delivered once oxygen saturation falls below 94%. This is because oxygen saturation levels above 94% indicate that the patient is adequately oxygenated and does not require additional oxygen support. Providing unnecessary supplemental oxygen can have potential adverse effects and should be avoided unless medically necessary.

The patient is presenting with a low blood pressure, rapid heart rate, and low oxygen saturation. These symptoms suggest a potentially life-threatening arrhythmia, such as ventricular tachycardia or supraventricular tachycardia with hemodynamic compromise. Synchronized cardioversion is the appropriate treatment in this case as it can quickly restore a normal heart rhythm and improve the patient's hemodynamic status. Adenosine, amiodarone, and nitro are not the first-line treatments for this type of arrhythmia.

The current PCGs went into effect at 0700 on January 1, 2014. The next update is scheduled for January 1, 2016.

You must remain on scene, at a safe distance if necessary, until law enforcement arrives in this scenario. Leaving before they arrive could constitute abandonment and place the child in further danger.

Regardless of pathology a patient losing consciousness from dyspnea is experiencing life-threatening hypoxia. Epinephrine works on both upper and lower airways and should be administered regardless of diagnosis in this situation.

You must wait outside the hospital structure until appropriate precautions have been taken when delivering a patient exposed to chemical, biological, nuclear, or radiation elements. If that patient enters the garage or hospital without proper safeguards he or she may contaminate staff and render the facility inoperable for an extended period of time.

It is acceptable to use an "adult" AED on an infant if it is the only one available because the main goal is to deliver a shock to restore the heart's normal rhythm. While using an adult AED may not be ideal, it can still provide a life-saving shock to an infant in a cardiac arrest situation. However, it is important to note that using an AED specifically designed for infants is preferred as it delivers a lower energy shock more suitable for their smaller size.

"Triple Zero" refers to a state where a person is pulseless, non-breathing, and has asystole (absence of heart activity). Hypothermic patients can sometimes exhibit very slow or weak pulses, shallow breathing, and a slow heart rate, which may be mistaken for "Triple Zero". Therefore, it is not accurate to confirm "Triple Zero" on hypothermic patients.

Based on the given scenario, the patient is not conscious, not breathing, and has no palpable pulse. The wife mentioned that he hasn't been feeling well and suddenly collapsed. The vital signs indicate a pulseless state and low oxygen saturation. The physical exam reveals an unresponsive and obese male with still warm skin. Considering these findings, the rhythm shown on the cardiac monitor is most likely ventricular fibrillation, which is a life-threatening arrhythmia characterized by chaotic, disorganized electrical activity in the ventricles.

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CPAP (Continuous Positive Airway Pressure) is a commonly used treatment for patients with obstructive sleep apnea, but it can also be beneficial for COPD (Chronic Obstructive Pulmonary Disease) patients in severe respiratory distress. COPD patients often experience difficulty breathing, and CPAP can help by providing a constant flow of air pressure to keep the airways open and improve oxygenation. This treatment can alleviate symptoms such as shortness of breath and reduce the work of breathing, making it an acceptable option for COPD patients in severe respiratory distress.

The gravid uterus can compress the Inferior Vena Cava (IVC) and inhibit adequate blood return from the legs. By positioning the pregnant patient in a left lateral recumbent position the uterus drifts toward the left pelvis and away from the IVC positioned on the right.

An end tidal CO2 (capnography) reading less than 10 mmHg is indicative of cardiac death, even with adequate CPR. Capnography measures the concentration of carbon dioxide in exhaled breath, and a reading below 10 mmHg suggests that there is very little or no CO2 being exhaled. In a cardiac arrest situation, this can indicate that there is no blood flow or minimal blood flow to the lungs, which is a sign of cardiac death.

By definition an "unstable" patient requires immediate correcting intervention (e.g., pacing). Delaying that care for any reason places the patient at further risk. Pain medication or anxiolytics can be delivered to a patient displaying signs or symptoms that do not present an imminent life threat.

CPAP (Continuous Positive Airway Pressure) is the most appropriate intervention for this patient. The patient's symptoms, such as shortness of breath, tachycardia, and low oxygen saturation, indicate respiratory distress. CPAP provides positive pressure to the airways, preventing collapse and improving oxygenation. The patient's history of a previous episode requiring ventilation also suggests a chronic respiratory condition. Administering CPAP would help alleviate the patient's distress and improve oxygenation more rapidly and thoroughly compared to other interventions such as defibrillation, Duoneb (a bronchodilator), or oxygen by nasal cannula.

A mother with multiple previous deliveries will most likely complete delivery much more quickly than a mother delivering for the first or second time. It is therefore important you obtain pregnancy and delivery history from a patient complaining of abdominal pain in pregnancy.

The only option above that will reverse this patient's iatrogenic (caused by healthcare provider) vital sign change is Narcan. She is suffering the side effect of an opiate, in this case bradypnea and subsequent hypoxia. Delivery of oxygen is appropriate but not the most necessary and if substituted for Narcan will be insufficient to reverse this patient's opiate overdose.

The patient is a 64-year-old male experiencing a fluttering sensation in his chest. His blood pressure is 142/80, heart rate is 174, respiratory rate is 18, and oxygen saturation is 99% on room air. Based on these symptoms and vital signs, it is likely that the patient is experiencing supraventricular tachycardia (SVT). Adenosine is the drug of choice for treating SVT, and the recommended initial dose is 6 mg followed by a 12 mg dose if needed. Therefore, the correct treatment in this case would be Adenosine (max 12 mg).

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Although one could argue the injury to the abdomen would constitute a "distracting" injury the guidelines clearly state a penetrating injury without neurologic deficit should not be immobilize. If this individual reported the inability to move his legs, indicating a thoracic or lumbar spinal cord injury immobilization would be appropriate.

In this scenario, the patient is presenting with a cardiac arrest and has not responded to multiple shocks. The given options for the next medication include Magnesium, Synchronized Cardioversion, Lidocaine, and Repeat Epinephrine. Among these options, Magnesium is the most appropriate choice. Magnesium is commonly used in the treatment of cardiac arrest caused by torsades de pointes, a specific type of ventricular arrhythmia. The patient's change in rhythm after multiple shocks suggests the presence of a ventricular arrhythmia, making Magnesium the best option for further treatment.

In this scenario, the patient is experiencing agonal respirations, has no pulse, and has a heart rate of 184 bpm. These signs indicate a cardiac arrest or a life-threatening arrhythmia. Defibrillation is the appropriate treatment in this situation. Defibrillation is the delivery of an electric shock to the heart to restore its normal rhythm. It is used for patients in cardiac arrest or with certain life-threatening arrhythmias. Adenosine is not indicated as it is used for certain types of supraventricular tachycardias. Nitro is used for chest pain related to angina or heart attack. Synchronized cardioversion is used for certain stable arrhythmias, which is not the case here.

Based on the given scenario, the patient is a 72-year-old female who is experiencing shortness of breath, tachycardia, tachypnea, and low oxygen saturation. She has a history of a similar episode and has been on medications for heart-related conditions such as Metoprolol, Furosemide, Digoxin, Lisinopril, and Aspirin. The physical exam findings of coarse crackles in the lungs and pale lips suggest fluid overload and poor oxygenation, which are consistent with congestive heart failure. Therefore, the most appropriate patient care guideline to use in this case would be Congestive Heart Failure.

Unless a patient is deemed incapable of making decisions he or she chooses the final destination, even if the provider disagrees.

The correct answer is Sinus Tachycardia. Sinus tachycardia is a normal rhythm but with an elevated heart rate. In this scenario, the patient is experiencing shortness of breath and is in distress, which can cause an increase in heart rate. The vital signs also show tachycardia, which supports the diagnosis of sinus tachycardia. The presence of crackles in the lungs suggests fluid overload, which can be a cause of sinus tachycardia. The cardiac monitor does not show any abnormal rhythm patterns like SVT, A-fib, or third-degree heart block.

Versed is a medication commonly used to treat seizures in children. It can be administered through various routes depending on the situation. IV (intravenous) administration involves injecting the medication directly into the patient's vein, allowing for rapid absorption and onset of action. IO (intraosseous) administration involves injecting the medication into the bone marrow, which is an alternative route when IV access is not readily available. IN (intranasal) administration involves spraying the medication into the patient's nostril, where it is absorbed through the nasal mucosa. These routes are effective and commonly used for delivering Versed to a seizing child.

In this scenario, the patient is not conscious, not breathing, and has no palpable pulse. These signs indicate a cardiac arrest. The patient's wife mentioned that he had not been feeling well and suddenly collapsed, suggesting a possible cardiac event. The vital signs also show that the patient's blood pressure is extremely low and his respiratory rate is agonal. The physical exam reveals an unresponsive, obese male with warm skin. Given the severity of the situation and the inability to establish an IV, the options for delivering Epinephrine are Intraosseous (IO), same as IV dose, and ET tube, double the IV dose. These routes of administration are chosen because they provide direct access to the bloodstream and can rapidly deliver the medication.

Eclampsia or seizures in pregnancy is associated with great risk to both mother and unborn child. Although benzodiazepines might help Magnesium is the recommended and first-line therapy. Although the mechanism is not entirely clear it is believed that Magnesium creates vasodilation and helps to lower blood pressure. It is also though it limits cerebral edema seen in pregnant patients with high blood pressure. Both processes might help prevent or abort a seizure in this patient population.

Based on the given information, the patient is a 34-year-old restrained driver involved in a car accident. Although his car was struck by a semi-trailer at a considerable speed, he did not lose consciousness and was able to walk after the incident. He complains of bilateral wrist pain, but there is no deformity and the pain is rated at a low intensity. Vital signs and physical examination are normal, except for mild tenderness in the wrists. Considering these factors, it is determined that immobilization is not necessary in this case.

Amiodarone is the correct answer because the patient's presentation suggests a possible cardiac arrhythmia. The high heart rate of 180 bpm indicates tachycardia, which can cause symptoms of chest pressure. Amiodarone is an antiarrhythmic medication that can be used to treat various types of arrhythmias, including supraventricular tachycardia. It is a common choice in stable patients with tachycardia and can help restore normal heart rhythm.

The correct answer is Terminal rhythm - asystole, Unwitnessed arrest, Secured and confirmed airway. These criteria must be met to consider termination of resuscitation. Terminal rhythm - asystole indicates that there is no electrical activity in the heart, making resuscitation unlikely to be successful. Unwitnessed arrest means that there were no witnesses to the cardiac arrest, which decreases the chances of successful resuscitation. Secured and confirmed airway ensures that the airway is open and breathing can be supported. These criteria together suggest that further resuscitation efforts may not be beneficial and termination of resuscitation can be considered.

In the case of a prolapsed cord, it is important to relieve pressure on the cord to ensure proper blood flow to the baby. Placing a gloved hand inside the vagina helps to lift the pressure off the cord and prevent further compression. Positioning the mother with knees to chest also helps to relieve pressure on the cord and can aid in repositioning the baby. Pulling vigorously is not recommended as it can further compress the cord and potentially cause harm to the baby.

Epinephrine is indicated in a newborn when the heart rate is less than 60 bpm with effective respiratory assistance. This suggests that the newborn is not able to maintain an adequate heart rate on their own and requires the use of epinephrine to support cardiac function. Additionally, a flaccid infant with a non-palpable pulse also indicates the need for epinephrine as it suggests severe cardiovascular compromise. The other options, HR < 100 bpm with effective respirations and pulse 100, RR 40, do not meet the criteria for epinephrine administration.

Nitroglycerine is a potent vasodilator and although it can provide pain relief to an person with angina or even an heart attack it can have undesirable side effects. Since Nitro primarily works on the venous system it may lead to venous pooling and in turn decreased blood volume (preload) to the right heart. The subsequent decreased cardiac output from the right heart is delivered to the left heart. The ejection of that decreased volume from the left heart into the aorta results in decreased blood volume to the coronary arteries. With less blood from the coronaries delivered to the injured heart nitro-induced hypotension might lead to expansion of the ischemic area and a larger infarct size. We must also remember that the right heart is volume dependent so lower systemic blood pressures make a weakened right heart even less effective. Persistent or prolonged hypotension can then lead to organ dysfunction. EKG leads II, III, and aVF indicate an "inferior MI" and typically include right heart involvement. If you are uncertain of the STEMI pattern simply treat the patient based on signs and symptoms understanding that hypotension is a contraindication to Nitro delivery. A "headache" is not a contraindication and can be addressed after you have treated the life threat.

Sodium Bicarbonate just prior to release and Duoneb are the correct answers because they are both medications that can be administered to a crushed patient during the extrication process. Sodium Bicarbonate is used to treat acidosis, which can occur as a result of prolonged extrication. Duoneb, on the other hand, is a combination of ipratropium bromide and albuterol sulfate, which can help improve breathing and alleviate bronchospasms in patients with crushed injuries. The other options, such as Sodium Bicarbonate after release, Epinephrine, and Ice packs to injured extremity, are not specifically indicated for use during the extrication process.

These etiologies are potential explanations for abnormal psychological behavior because they can all affect the brain and its functioning. Hypoglycemia, which is low blood sugar, can lead to confusion, irritability, and changes in behavior. A stroke, or cerebrovascular accident, can cause damage to the brain and result in various psychological symptoms depending on the area affected. Seizures can also cause abnormal behavior and can be a result of underlying neurological conditions. Hypoxia, which is a lack of oxygen to the brain, can lead to cognitive impairment and changes in behavior. Poisoning, depending on the substance, can also affect brain function and lead to abnormal psychological behavior.

This individual is showing signs of Central Cord Syndrome, a fairly common incomplete spinal cord injury characterized by disproportionate motor dysfunction in the arms compared to the legs. It is most often seen in hyperextension injuries. Forces generated at the point of injury generally exceed any force produced by field providers, even when placing immobilization equipment. You can be reassured that foregoing immobilization in this individual will carry very low risk of worsening his spinal cord injury. By keeping the c-collar in place when the patient clearly explains worsening symptoms is unsafe and should be avoided even though spinal immobilization guidelines include him.

The patient is experiencing an allergic reaction, as indicated by the itching hives and the scratchy sensation in her throat. The hoarse voice and wheezing during lung exam suggest that the reaction is progressing and potentially causing airway compromise. The increased heart rate and normal blood pressure also indicate an anaphylactic reaction. Epinephrine (1:1000) 0.3 mg IM should be administered to help relieve the symptoms and improve breathing. Benadryl 25-50 mg IV/IM should also be given to further reduce allergic symptoms. Duoneb may be administered to help with bronchodilation and improve breathing. Epinephrine (1:10,000) 0.5 mg IV/IO is not indicated in this case as the patient's blood pressure is normal.

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