PA EMS ALS Protocol Quiz
You should check the rhythm every _______ minutes.
2
Possible medical command orders may include administration of a medication via IV infusion. [__B__]What is the dose of Magnesium Sulfate
2 G
What medication [__A__] and dosage [__B__] is used for Torsades according to the Wide Complex Tachycardia - Adult Protocol? Answer B?
2 G
A 76 y/o female patient presents with a chief complaint of difficulty breathing and a history of IDDM, HTN, CVA, CHF, previous MI, and dementia. She has course crackles in the bases with expiratory wheezing. Her vitals are P 96 weak and regular, BP of 168/92, R 22 and labored. Her skin is diaphoretic and pale. You have administered a single nitroglycerin table. What is the subsequent dose of nitroglycerin?
2 SL tablets or sprays
A 64 year old male is apneic and pulseless.The monitor reveals Torsades de pointes?You have administered a vasopressor. [2] What is the dose for this drug?
2 g
What is the initial dose of morphine sulfate for a patient not responding to NTG?
2-10 mg IV
What is the dosage of a Lidocaine infustion if Medical Command is contacted?
2-4 mg/min
You have given your initial dosage of Amiodarone IV Drip. What is the maximum dosage of Amiodarone you can give within a 24-hour period?
2.2 G
A 3 year old is experiencing respiratory distress and meets the inclusion criteria for Protocol 4022. What is dose of albuterol for this patient?
2.5 mg
What is the initial amount of fluid you give for a pediatric patient?
20 cc/kg
You have established a dopamine drip on a 67 y/o male who is bradycardic and hypotensive.At what point must you contact medical command to increase the dose? [2] What is the maximum dose you can administer prior to contact medical command?
20 mcg/kg/min
A 67 y/o male presents with severe respiratory distress and a systolic BP of 78/P. You have attempted fluid resuscitation; medical command has ordered a DOBUTamine drip at 5 mcg/kg/min. What are the two endpoints to stop increasing this drip? [C] [D]
20 mcg/kg/min and SBP >100
What is the maximum dose of morphine sulfate?
20 mg
During continuous CPR the crew should switch compressors every ________ compressions.
200
What is the total amount of fluid you can given to an adult patient?
2000 cc
What's the [A] dose and [B] route of Captopril for a possible medical command order? Answer A?
25 mg
Which of the following require pacing without delay? Sinus rhythm with a first degree block 2nd Degee AV Type I 2nd Degree AV block Type II Third degree AV block
2nd Degree AV block Type II and Third Degree AV Block
After how many doses of nitroglycerine should you begin to administer a narcotic analgesic?
3
Epinephrine 1:[___a___]; [___b___] ] mg IV/IO every [___c___] to [___d___] minutes. Answer C
3
A 62 y/o male is complaining of respiratory distress. His PMHx includes: CHF, CABG x2, HTN, and NIDDM. Your assessment reveals skin that is pale and diaphoretic, P 108, R 26 shallow and labored, BP 202/136, crackles in all lung fields. You have administered a single nitroglycerin table. What is the subsequent dose of nitroglycerin?
3 SL tablets or sprays
A 53 y/o male complains of chest pain.The monitor reveals a sinus bradycardia at 47. Vitals are P 47, R 18, BP 88/62, SaO2 of 94%.You have established IV access and are about to administer atropine sulfate. [2] What is the max dose of atropine you can give?
3 mg
You have administered an initial dose of Lidocaine, the patient remains in pulseless ventricular tachycardia. [3]What is the maximum dose of lidocaine?
3 mg/kg
A 53 y/o male complains of chest pain.The monitor reveals a sinus bradycardia at 47. Vitals are P 47, R 18, BP 88/62, SaO2 of 94%.You have established IV access and are about to administer atropine sulfate. [3] At what interval should you repeat the atropine?
3-5 minutes
Medical command has ordered you to start a Dopamine drip at 5 mcg/kg/min. Your patient weighs 176 pounds. Available you have 400 mg of dopamine, a 500 cc bag, and a mini drip set. How many drops per minute will you give? Drip Rate [__D__]
30 gtts/min
What is the maximum dose of fentanyl?
300 mcg
A 68 year old male is in ventricular fibrillation. What is the initial dose of amiodarone?
300 mg
A 56y/o male complains chest pain and shortness of breath that began 20 minutes ago and is rated a 10/10. He has a PMHX of a previous MI, HTN, and high cholesterol. He takes NTG as needed daily he takes 81mg aspirin, metoprolol 100mg twice per day, and Crestor 20mg once daily. What is the dose of ASA for this patient?
324 mg
A 12 Y/O female is complaining of shortness of breath and meets the inclusion criteria for Protocol 4022. What does do you administer of Albuterol/Ipratropium to this patient:
Albuterol 3 mg Ipratropium 500 mcg
If you are unsuccessful on your third intubation attempt, what method should be used to secure the airway?
Alternative Airway
This sedative has a dose of 5-10mg, what is the drug?
Diazepam/Valuim
A 63 y/o female complains of chest pain. The monitor reveals a sinus bradycardia at 42. Vitals are P 42, R 15, BP 86/60, SaO2 of 94%. You have established IV access and administered the maximum dose of atropine. Pacing has failed to capture. What two medications may be ordered by the medical command physician? [2] Medication 2 and initial dose
Dopamine; 5 mcg/kg/min
A 68 year old male is experiencing an irregular, narrow complex tachycardia. [__b__] How should diltiazem be administered?
Drip
A 63 y/o female complains of chest pain. The monitor reveals a sinus bradycardia at 42. Vitals are P 42, R 15, BP 86/60, SaO2 of 94%. You have established IV access and administered the maximum dose of atropine. Pacing has failed to capture. What two medications may be ordered by the medical command physician? [1]Medication 1 and initial dose
Epinephrine; 10-20 mcg bolus
Your patient has recently started a new medication called Norvasc (Calcium Channel Blocker) and you note that the bottle is empty. What medication might be a medical command order initially [__A__]? What is the dosage of this medication [__B__]? Answer A?
Calcium Chloride
A 76 y/o male has overdosed on Verapamil.What medication and dose should the medical command physician order for this calcium channel blocker overdose? [1] Medication and Dose
Calcium Chloride and 10 mL
Which types of shock are not treat under this protocol 7005? [Shock/Spesis]
Cardiogenic Shock, Hypovolemic/Traumatic Shock, Neurogenic Shock
A 58 year y/o male presents in a narrow complex tachycardia with a rate of 180 bpm. He has an extensive medial history including a previous TIA, and HTN. Based on this information you should avoid what treatments?
Carotid Massage
A 56 y/o male complains of chest pain and shortness of breath that began 20 minutes ago and is rated a 10/10. You acquire a prehospital 12-lead, and upon note ST elevation in leads II, III, and avF, V3, and V4. The patient needs to be transported to a facility with what capabilities?
PPCI/Cath Lab
A 34 year old female is pulseless and apneic. By-standers state that the patient was prescribed a Elavil yesterday. You find an empty prescription bottle for this tricyclic antidepressant. What medication is medical command most likely to order for this overdose?
Sodium Bicarbonate
A 56 year old male is apneic and pulseless at the dialysis clinic. You suspect him to be hyperkalemic. Which 2 medications should be considered for this case?
Sodium Bicarbonate & Calcium Choloride
Nitroglycerin is contraindicated if the patient has taken these medications within 24 hours [A][B]. and this medication within the past 48 hours [C]. Answer A/B?
Suldenafil and Vardenafil
A 68 y/o male is complaining of chest pain and respiratory distress. He takes simvastatin, and Cardizem. His vital signs are BP 110/70, R 22, P 220. ECG reveals a wide complex tachycardia. You should next:
Synchronous cardiovert at 100 J
What systolic blood pressure represents the endpoint for administration of NTG?
Systolic Pressure < 100 mmHg
Nitroglycerin is contraindicated if the patient has taken these medications within 24 hours [A][B]. and this medication within the past 48 hours [C]. Answer C?
Tadalafil
A 56y/o male complains chest pain and shortness of breath that began 20 minutes ago and is rated a 10/10. You acquire a prehospital 12-lead, and upon note ST elevation in leads II, III, aVF, V3, and V5. Which wall or walls is the patient experiencing an MI?
Inferior
A 64 y/o female patient complains of chest pain. She has a PMHX of COPD, A-fib, and pulmonary hypertension. Meds include: albuterol, sildenafil, and Lanoxin. Her vital signs are P 88, R 20 and BP 146/88. Which of the medication is contraindicated in this patient?
Nitroglycerine
A 70 y/o male with a history of heart transplant is experiencing a symptomatic bradycardia. Which of the following medications will be ineffective and should be avoided? a. Diazepam b. Atropine c. Epinephrine d. Dopamine
b. Atropine
Which of the following patients is excluded from Protocol 4022? a. 12 y/o male with respiratory distress, wheezing and rhonchi and excess mucous b. 67 y/o female with respiratory distress, asthma and wheezing c. 75 y/o male respiratory distress, on home oxygen, a barrel chest and wheezing d. 58 y/o male with respiratory distress, crackles and pedal edema
d. 58 y/o male with respiratory distress, crackles and pedal edema
A 4 year old female is not responding to the treatments initiated under Protocol 4022. You contact medical command to administer EPINEPHrine 1:1000. What is the dose for this patient?
0.01 mg/kg IM
A 72 y/o female has overdosed on propranolol.What medication and dose should the medical command physician order for this beta blocker overdose? [2] Dose
0.05 mg/kg
Your patient above did not respond to your initial treatment. What other medication might be considered by Medical Command [__A__]? What is the dosage of this medication [__B__]? Answer B?
0.05 mg/kg
Dosage and Maximum Dosage for Midazolam
0.05 mg/kg; 0.1 mg/kg
Dosage and Maximum Dosage for Diazepam
0.1 mg/kg; 0.3 mg/kg
Dosage and Maximum Dosage for Lorazepam
0.1 mg/kg; 4 mg
A 68 year old male is experiencing an irregular, narrow complex tachycardia. [__a__] What is the initial dose of diltiazem?
0.25 mg/kg
A 64 year old female is not responding to the treatments initiated under Protocol 4022. You contact medical command to administer EPINEPHrine 1:1000. What is the dose for this patient?
0.3 mg IM
A 68 year old male is experiencing an irregular, narrow complex tachycardia. [__d__] What is the repeat dose?
0.35 mg/kg
Medical command has ordered you to start a Dopamine drip at 5 mcg/kg/min. Your patient weighs 176 pounds. Available you have 400 mg of dopamine, a 500 cc bag, and a mini drip set. How many drops per minute will you give? Volume [__C__]
0.5 cc/min
A 53 y/o male complains of chest pain.The monitor reveals a sinus bradycardia at 47. Vitals are P 47, R 18, BP 88/62, SaO2 of 94%.You have established IV access and are about to administer atropine sulfate. [1] What is the initial dose of atropine?
0.5 mg
What is the [A] dose and [B] route for the medical command order for enalapril? Answer A?
0.625-1.25 mg
You have administered an initial dose of Lidocaine, the patient remains in pulseless ventricular tachycardia. [1] What is the repeat dose of lidocaine?
0.75 mg/kg
Epinephrine 1:[___a___]; [___b___] ] mg IV/IO every [___c___] to [___d___] minutes. Answer B
1
A 88 y/o male is complaining of respiratory distress. His PMHx includes: CHF, MI, HTN. Assessment reveals skin that is pale and cool, P 118, R 24 shallow and labored, BP 108/62, crackles in all lung fields. You have administered a single nitroglycerin table. What is the subsequent dose of nitroglycerin?
1 SL tablet or spray
What is the dosage of an Amiodarone Infusion?
1 mg/min
A 56 y/o male patient presents with CHF and respiratory distress. You have placed the patient on CPAP. His vital signs are P 120, R 30, BP 190/108. Medical Command has authorized the use of nitroglycerin paste. What is the correct dosing range for this patient
1-2 inches
What are the two endpoints to the administration of nitroglycerine?
SBP <100 and BP Drop by 25% of initial SBP
What s the [A] dose and [B] route of Captopril for a possible medical command order Answer B?
SL
What is the repeat dose of morphine sulfate ?
Same as the initial dose
You are administering a dose of adenosine to a 24 year old female patient experiencing a regular narrow complex tachycardia with a rate of 192. [__c__] At what dose are you required to contact medical command for additional dosing.
12 mg
A 68 year old male is experiencing an irregular, narrow complex tachycardia. [__c__] At what time interval may you repeat this medication?
15 Minutes
Medical command has ordered verapamil to a patient in symptomatic atrial fibrillation. [__c__] How long must you wait to administer this second dose?
15 minutes
What is the initial dose of Amiodarone for this protocol? [Wide Complex Tachycardia Adult]
150 mg
You have administered amiodarone to a 65 year old male in ventricular fibrillation. [2] What will be the second dose of amiodarone?
150mg
At 17:05 you administered NTG a 67 y/o female with respiratory distress. At what time can you administer that repeat dose?
17:08
A 75 year old female is in pulseless ventricular tachycardia.You have elected to administer Lidocaine. [1] What is the initial dose?
1.5 mg/kg
What is the initial dose of Lidocaine in protocol 5023A? [Wide Complex Tachycardia Adult]
1.5 mg/kg
What is the repeat dose of fentanyl?
1/2 of the initial dose
Ventilate the cardiac arrest patient [___a___] to [___b___] breaths per minute. Answer B
10
Your patient has recently started a new medication called Norvasc (Calcium Channel Blocker) and you note that the bottle is empty. What medication might be a medical command order initially [__A__]? What is the dosage of this medication [__B__]? Answer B?
10 mL of 10% solution
A 67 y/o male presents with severe respiratory distress and a systolic BP of 78/P. You have attempted fluid resuscitation; medical command has ordered a DOBUTamine drip at 5 mcg/kg/min. [A] At what interval may you increased the dosage?
10 minutes
Over how many minutes does Amiodarone need to be infused?
10 minutes
You have administered amiodarone to a 65 year old male in ventricular fibrillation. [1] How long must you wait to administer a second dose?
10 minutes
Epinephrine 1:[___a___]; [___b___] ] mg IV/IO every [___c___] to [___d___] minutes. Answer A
10,000
What is the dose of push dose Epinephrine?
10-20 mcg IV push
You are about to initiate pacing to a 48 y/o male who is complaining of chest pain and respiratory distress. His vital signs are P 45, R 18. What is the minimum acceptable systolic blood pressure to administer sedation?
100
What energy setting do you begin Cardioversion at in this protocol? [Wide Complex Tachycardia Adult]
100 J
Medical command has ordered you to start a Dopamine drip at 5 mcg/kg/min. Your patient weighs 176 pounds. Available you have 400 mg of dopamine, a 500 cc bag, and a mini drip set. How many drops per minute will you give? Desired Dose [__A__]
400 mcg/min
You have administered amiodarone to a 65 year old male in ventricular fibrillation. [3] What is the maximum dose of amiodarone?
450mg
Epinephrine 1:[___a___]; [___b___] ] mg IV/IO every [___c___] to [___d___] minutes. Answer D
5
At what frequency may you repeat morphine sulfate?
5 Minutes
At which time interval may you repeat medications for sedation for external pacing?
5 Minutes
A 67 y/o male presents with severe respiratory distress and a systolic BP of 78/P. You have attempted fluid resuscitation; medical command has ordered a DOBUTamine drip at 5 mcg/kg/min. [B] What does should you increase this drip by?
5 mcg/kg/min
You are treating a patient who is severely hypotensive. You have attempted fluid resuscitation with your patient; however, the blood pressure is still 78/P. You are contacting medical command for possible orders to give Dopamine due to possible shock. What is the starting dose of Dopamine?
5 mcg/kg/min
Medical command has ordered verapamil to a patient in symptomatic atrial fibrillation. [__a__] What is the inititial dose of Verapamil
5 mg
At what frequency may you repeat fentanyl?
5 minutes
Medical command has ordered verapamil to a patient in symptomatic atrial fibrillation. [__b__] What is the subsequent dose of verapamil?
5- 10 mg
You have administered an initial dose of Lidocaine, the patient remains in pulseless ventricular tachycardia. [2] How long must you wait before administering the drug?
5-10 Minutes
What is the initial dose of energy for synchronous cardioversion in an unstable SVT?
50-100 J
What is the initial dose of Fentanyl for a patient not responding to NTG?
50-100 mcg
What is the initial amount of fluid you give an adult patient?
500 mL
You are administering a dose of adenosine to a 24 year old female patient experiencing a regular narrow complex tachycardia with a rate of 192. [__a__] What is the initial dose of this drug?
6 mg
What is the formula for calculating pediatric baseline SBP?
70 + (2 x age in years)
If a patient's SBP is between ________________ mmHG, DOBUTamine should be considered.
70-90
Ventilate the cardiac arrest patient [___a___] to [___b___] breaths per minute. Answer A
8
You are about to initiate pacing on an 86 y/o female.What are the initial pacemaker settings? [1] Current:
80
You are about to initiate pacing on an 86 y/o female.What are the initial pacemaker settings? [2] Heart Rate:
80
Medical command has ordered you to start a Dopamine drip at 5 mcg/kg/min. Your patient weighs 176 pounds. Available you have 400 mg of dopamine, a 500 cc bag, and a mini drip set. How many drops per minute will you give? Concentration [__B__]
800 mcg/cc
When managing cardiogenic shock you should consider DOPAmine of the patients SBP is less than __________ mmHg.
90
You have established a dopamine drip on a 67 y/o male who is bradycardic and hypotensive.At what point must you contact medical command to increase the dose? [1] What is your target blood pressure?
90
For an adult patient, when giving fluid challenges your aim as a provider is to titrate the SBP to what?
> 100 mmHg
CPAP may be applied if the SBP is __________ mmHg.
>90
Inclusion criteria for Protocol 4022 include what? [ASTHMA / COPD / BRONCHOSPASM Adult}
A patient with signs and symptoms of acute respiratory distress from bronchospasm or restrictive airway disease: 1. Symptoms/signs may include: a. Wheezing - will have expiratory wheezing unless they are unable to move adequate air to generate wheezes b. May have signs of respiratory infection (e.g. fever, nasal congestion, cough, sore throat) c. May have acute onset after inhaling irritant 2. This includes: a. Asthma exacerbation b. COPD exacerbation c. Wheezing from suspected pulmonary infection (e.g. pneumonia, acute bronchitis)
You have intubated an apneic patient and auscultate breath sounds. Breath sound are absent over the epigastrium and present bilaterally over the lungs. What is the next mandatory confirmation?
Continuous waveform ETCO2
A 62 y/o old male complains of chest pain and difficulty breathing. You have administered three sprays of nitroglycerin. The patient's continues to rate the pain as 10/10. The current BP is 180/92. How often may you repeat nitroglycerin?
Every 5 minutes
True or False: A 67 y/o male with a past medical history of emphysema is complaining of respiratory distress. His SpO2 is 90%. Oxygen is contraindicated in this patient.
False
True or False: Cardioversion should be delayed for sedation in the unstable patient.
False
True or False: Fentanyl may only be administered via IV.
False
True or False: Nitroglycerine is contraindicated in patients with suspected inferior or right ventricular infarction.
False
True or False: The max single dose of Ativan is 4 mg/dose?
False
True or False: To give a narcotic analgesic the patients SBP <100
False
True/False: The max dose for a pediatric fluid challenge is 40 mL/kg?
False
A 72 y/o female has overdosed on propranolol.What medication and dose should the medical command physician order for this beta blocker overdose? [1] Medication
Glucagon
What is the [A] dose and [B] route for the medical command order for enalapril? Answer B?
IV
A 75 year old female is in pulseless ventricular tachycardia.You have elected to administer Lidocaine. [2] What are the possible routes of administration?
IV/IO
This Sedative has a dose of 0.1 mg/kg, maximum dose of 2mg/dose, what am I?
Lorazepam/Ativan
A 64 year old male is apneic and pulseless.The monitor reveals Torsades de pointes?You have administered a vasopressor. [1] What is the "anti-arrhythmic" drug of choice for this rhythm?
Magnesium Sulfate
Possible medical command orders may include administration of a medication via IV infusion. [__A__]What is this medication?
Magnesium Sulfate
What medication [__A__] and dosage [__B__] is used for Torsades according to the Wide Complex Tachycardia - Adult Protocol? Answer A?
Magnesium Sulfate
A 67 year old female with respiratory distress is receiving a nebulized bronchodilator and has been placed on CPAP. Prior to contacting medical command you may also administer:
Methylprednisolone 125mg IV
A 7 year old male with respiratory distress is receiving a nebulized bronchodilator. Prior to contacting medical command you may also administer:
Methylprednisolone 2mg/kg IV
Sedation options for a patient being paced include which medications?
Midazolam, Diazepam, Lorazepam
This sedative has a dose of 1-5 mg, what drug am I?
Midazolam/Versed
What are 2 examples of irregular Wide-Complex Tachycardias?
Polymorphic Ventricular Tachycardia and Atrial Fibrillation
You are administering a dose of adenosine to a 24 year old female patient experiencing a regular narrow complex tachycardia with a rate of 192. [__b__] How should this medication be administered?
Rapid IV push
Required performance parameters for QA of protocol 4022, name them. [Asthma/COPD/Bronchospasm Adult]
Review for documentation of lung sounds, pulse oximetry, repeat assessment/ pulse oximetry readings, and response to treatment
True or False: 12-Lead EKGs should be transmitted to receiving/command facilities.
True
True or False: Sildenafil can be used to treat both erectile dysfunction and pulmonary hypertension.
True
True or False: Vagal Maneuvers can be cosidered in patients in a Regular Wide-Complex Tachycardia?
True
True or False: When treating a patient with suspected CHF you need to evaluate their SBP. The Pennsylvania State Protocol breaks down your treatments based on three SBP ranges: What are the ranges?
True: SBP > 100 mmHg; SBP 90-100 mmHg; SBP <90 mmHg
A 67 y/o female complains of chest pain and difficulty breathing. You auscultate rales bilaterally in the bases of the lungs. She has a narrow complex tachycardia at 186 bpm. Her vitals are BP 90/P, R 26, P 186; her skin is pale, cool and diaphoretic. Based on these findings you will follow which, stable or unstable, of the protocol?
Unstable
A 27 y/o female with a history or asthma is in severe respiratory distress. Which of the following is most important in her management? a. Aggressive use of bronchochodilators b. Endotracheal intubation c. CPAP d. Methylprednisolone
a. Aggressive use of bronchodilators
Which of the following should be avoided during the initial 10 minutes of the cardiac arrest? a. Endotracheal Intubation b. Administration of Epinephrine c. Debrillation d. Chest Compression
a. Endotracheal Intubation