Kern County EMS Protocols Complete
Examination Preparation Tool 100
Questions and Verified Answers.
Jurisdiction: Kern County, California
Governing Body: Kern County Emergency Medical Services (KCEMS)
Base Hospital: Kern Medical (Level II Trauma Center)
Provider Levels: EMR, EMT, AEMT, Paramedic
Alignment: California Title 22 Regulations
DOMAIN I: CARDIAC ARREST & DYSRHYTHMIAS (Questions 1–20)
Weight: 20% of examination
Q1. During a cardiac arrest, you are performing CPR on an adult patient. What is the correct
compression depth and rate per Kern County protocol?
A. 1.5 inches depth, 80-100 compressions/min
B. 2 inches depth, 100-120 compressions/min ✓
C. 2.5 inches depth, 120-140 compressions/min
D. 1 inch depth, 60-80 compressions/min
Correct Answer: B
Rationale: Kern County protocol follows AHA guidelines: compression depth ≥2 inches (5 cm)
for adults, rate 100-120 compressions/min, full chest recoil, minimize interruptions (<10
seconds).
Q2. A patient is in ventricular fibrillation (VF) cardiac arrest. You deliver the first shock (200J
biphasic). What is the NEXT action according to Kern County protocol?
A. Check pulse immediately
B. Resume CPR for 2 minutes ✓
,C. Administer epinephrine
D. Administer amiodarone
Correct Answer: B
Rationale: After defibrillation, immediately resume CPR for 2 minutes before checking rhythm
or pulse. Minimizes no-flow time and improves coronary perfusion pressure.
Q3. List the reversible causes of cardiac arrest (H's and T's) as described in Kern County
protocols.
Complete Answer:
H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia
T's: Tension pneumothorax, Tamponade (cardiac), Toxins (overdose), Thrombosis (pulmonary –
PE), Thrombosis (coronary – MI)
Q4. According to Kern County protocol, what is the correct adult dose and concentration of
epinephrine for cardiac arrest?
A. 0.1 mg IV of 1:1,000
B. 0.3 mg IM of 1:1,000
C. 1 mg IV/IO of 1:10,000 ✓
D. 2 mg IV of 1:10,000
Correct Answer: C
Rationale: Epinephrine 1 mg IV/IO of 1:10,000 (0.1 mg/mL) every 3-5 minutes. The 1:1,000
concentration is for anaphylaxis (0.3 mg IM), NOT cardiac arrest.
Q5. A patient achieves ROSC after 8 minutes of CPR. What is the target SpO2 range per Kern
County post-cardiac arrest care protocol?
A. 88-92%
B. 94-99% ✓
C. 100%
D. >99%
Correct Answer: B
,Rationale: Maintain SpO2 94-99%. Avoid hyperoxia (100% FiO2 prolonged) which causes free
radical injury and worsens neurological outcomes.
Q6. In a patient with ROSC who remains comatose, what is the target temperature
management goal per Kern County protocol?
A. 32-34°C
B. 36°C (normothermia) ✓
C. 37-38°C
D. No temperature management
Correct Answer: B
Rationale: Current protocol targets normothermia at 36°C. Prevent fever (>38°C) for at least 72
hours.
Q7. A 68-year-old male is in PEA with HR 40 bpm. What is the FIRST medication per Kern
County protocol?
A. Atropine 0.5 mg IV
B. Epinephrine 1 mg IV/IO ✓
C. Amiodarone 300 mg IV
D. Calcium chloride 1 g IV
Correct Answer: B
Rationale: Epinephrine 1 mg IV/IO every 3-5 minutes is first-line for PEA/asystole. Atropine is
NO LONGER recommended for PEA/asystole in current ACLS.
Q8. A patient in VF has received 2 shocks and 1 dose of epinephrine. VF persists. What is the
NEXT antiarrhythmic?
A. Lidocaine 1 mg/kg IV
B. Amiodarone 300 mg IV push ✓
C. Magnesium sulfate 2 g IV
D. Procainamide 100 mg IV
Correct Answer: B
, Rationale: Amiodarone 300 mg IV/IO push for refractory VF/pVT after 2nd or 3rd shock. May
repeat with 150 mg. Magnesium is for torsades de pointes.
Q9. A patient has symptomatic bradycardia (HR 38, BP 72/40, AMS). Atropine 3 mg total given
with no response. What is NEXT?
A. Continue atropine to 5 mg
B. Transcutaneous pacing (TCP) ✓
C. Amiodarone 150 mg IV
D. Defibrillation at 100J
Correct Answer: B
Rationale: Atropine max 3 mg. If no response, initiate TCP immediately. Consider dopamine (2-
10 mcg/kg/min) or epinephrine infusion.
Q10. A stable patient has narrow-complex regular tachycardia at 180 bpm. What is the FIRST
intervention?
A. Synchronized cardioversion at 50J
B. Vagal maneuvers ✓
C. Adenosine 12 mg rapid IV push
D. Amiodarone 150 mg IV
Correct Answer: B
Rationale: For stable narrow-complex regular tachycardia, first attempt vagal maneuvers. If
unsuccessful, adenosine 6 mg rapid IV push, then 12 mg if needed.
Q11. A patient with unstable narrow-complex tachycardia (BP 78/50, AMS) requires
synchronized cardioversion. What is the INITIAL energy setting?
A. 25-50J
B. 50-100J ✓
C. 120-200J
D. 360J
Correct Answer: B
Examination Preparation Tool 100
Questions and Verified Answers.
Jurisdiction: Kern County, California
Governing Body: Kern County Emergency Medical Services (KCEMS)
Base Hospital: Kern Medical (Level II Trauma Center)
Provider Levels: EMR, EMT, AEMT, Paramedic
Alignment: California Title 22 Regulations
DOMAIN I: CARDIAC ARREST & DYSRHYTHMIAS (Questions 1–20)
Weight: 20% of examination
Q1. During a cardiac arrest, you are performing CPR on an adult patient. What is the correct
compression depth and rate per Kern County protocol?
A. 1.5 inches depth, 80-100 compressions/min
B. 2 inches depth, 100-120 compressions/min ✓
C. 2.5 inches depth, 120-140 compressions/min
D. 1 inch depth, 60-80 compressions/min
Correct Answer: B
Rationale: Kern County protocol follows AHA guidelines: compression depth ≥2 inches (5 cm)
for adults, rate 100-120 compressions/min, full chest recoil, minimize interruptions (<10
seconds).
Q2. A patient is in ventricular fibrillation (VF) cardiac arrest. You deliver the first shock (200J
biphasic). What is the NEXT action according to Kern County protocol?
A. Check pulse immediately
B. Resume CPR for 2 minutes ✓
,C. Administer epinephrine
D. Administer amiodarone
Correct Answer: B
Rationale: After defibrillation, immediately resume CPR for 2 minutes before checking rhythm
or pulse. Minimizes no-flow time and improves coronary perfusion pressure.
Q3. List the reversible causes of cardiac arrest (H's and T's) as described in Kern County
protocols.
Complete Answer:
H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia
T's: Tension pneumothorax, Tamponade (cardiac), Toxins (overdose), Thrombosis (pulmonary –
PE), Thrombosis (coronary – MI)
Q4. According to Kern County protocol, what is the correct adult dose and concentration of
epinephrine for cardiac arrest?
A. 0.1 mg IV of 1:1,000
B. 0.3 mg IM of 1:1,000
C. 1 mg IV/IO of 1:10,000 ✓
D. 2 mg IV of 1:10,000
Correct Answer: C
Rationale: Epinephrine 1 mg IV/IO of 1:10,000 (0.1 mg/mL) every 3-5 minutes. The 1:1,000
concentration is for anaphylaxis (0.3 mg IM), NOT cardiac arrest.
Q5. A patient achieves ROSC after 8 minutes of CPR. What is the target SpO2 range per Kern
County post-cardiac arrest care protocol?
A. 88-92%
B. 94-99% ✓
C. 100%
D. >99%
Correct Answer: B
,Rationale: Maintain SpO2 94-99%. Avoid hyperoxia (100% FiO2 prolonged) which causes free
radical injury and worsens neurological outcomes.
Q6. In a patient with ROSC who remains comatose, what is the target temperature
management goal per Kern County protocol?
A. 32-34°C
B. 36°C (normothermia) ✓
C. 37-38°C
D. No temperature management
Correct Answer: B
Rationale: Current protocol targets normothermia at 36°C. Prevent fever (>38°C) for at least 72
hours.
Q7. A 68-year-old male is in PEA with HR 40 bpm. What is the FIRST medication per Kern
County protocol?
A. Atropine 0.5 mg IV
B. Epinephrine 1 mg IV/IO ✓
C. Amiodarone 300 mg IV
D. Calcium chloride 1 g IV
Correct Answer: B
Rationale: Epinephrine 1 mg IV/IO every 3-5 minutes is first-line for PEA/asystole. Atropine is
NO LONGER recommended for PEA/asystole in current ACLS.
Q8. A patient in VF has received 2 shocks and 1 dose of epinephrine. VF persists. What is the
NEXT antiarrhythmic?
A. Lidocaine 1 mg/kg IV
B. Amiodarone 300 mg IV push ✓
C. Magnesium sulfate 2 g IV
D. Procainamide 100 mg IV
Correct Answer: B
, Rationale: Amiodarone 300 mg IV/IO push for refractory VF/pVT after 2nd or 3rd shock. May
repeat with 150 mg. Magnesium is for torsades de pointes.
Q9. A patient has symptomatic bradycardia (HR 38, BP 72/40, AMS). Atropine 3 mg total given
with no response. What is NEXT?
A. Continue atropine to 5 mg
B. Transcutaneous pacing (TCP) ✓
C. Amiodarone 150 mg IV
D. Defibrillation at 100J
Correct Answer: B
Rationale: Atropine max 3 mg. If no response, initiate TCP immediately. Consider dopamine (2-
10 mcg/kg/min) or epinephrine infusion.
Q10. A stable patient has narrow-complex regular tachycardia at 180 bpm. What is the FIRST
intervention?
A. Synchronized cardioversion at 50J
B. Vagal maneuvers ✓
C. Adenosine 12 mg rapid IV push
D. Amiodarone 150 mg IV
Correct Answer: B
Rationale: For stable narrow-complex regular tachycardia, first attempt vagal maneuvers. If
unsuccessful, adenosine 6 mg rapid IV push, then 12 mg if needed.
Q11. A patient with unstable narrow-complex tachycardia (BP 78/50, AMS) requires
synchronized cardioversion. What is the INITIAL energy setting?
A. 25-50J
B. 50-100J ✓
C. 120-200J
D. 360J
Correct Answer: B
