Kern County Paramedic Protocols: Questions With
Objective Solutions
Atropine for Organophosphate poisoning ADULT Accurate Answer:-
Poisoning/Ingestion/Overdose (119) - Atropine for Organophosphate
Poisoning, ADULT: If symptomatic organophosphate poisoning, administer
Atropine 2 mg IV every 5 minutes as needed.
Atropine for Organophosphate poisoning PEDS Accurate Answer:-
Poisoning/Ingestion/Overdose (119) - Pediatrics (Under 14): If symptomatic
organophosphate poisoning, administer Atropine 0.05-0.1mg/kg IV/IM every
5 minutes as needed
Atropine Doses - Bradycardias, ADULT: Accurate Answer:- Adult: 0.5mg
- 1mg for Bradycardias
Atropine Doses - Bradycardias, PEDS: Accurate Answer:- Peds: If
increased vagal tone or primary AV block, give Atropine 0.02 mg/kg minimum
dose 0.1 mg BEFORE epinephrine administration. May repeat as needed to
max of 1 mg.
Under 1 year with heart rate <60 BPM with signs of shock despite
oxygenation/ventilation? Perform CPR for 2 minutes, is patient still
bradycardic?
Do you give atropine for asystole? Accurate Answer:- No
Doses for Buprenorphine (Suboxone)? Accurate Answer:- 16mg SL
Clinical Opiate Withdrawal Scale (COWS) score required for Buprenorphine
administration Accurate Answer:- 6 or higher.
Buprenorphine contraindications Accurate Answer:- - patient is under
16 years of age
- any methadone use with in the last 10 days
- altered mental status
- Sepsis
- Current intoxication or recent use of benzodiazepine
,- COWS score of less than 7
What does the Red Tier indicate? Accurate Answer:- High Risk for
Serious Injury
What is one criterion for all patients to be classified as Red Tier? Accurate
Answer:- Unable to follow commands (motor GCS < 6)
What respiratory rate indicates a Red Tier classification for all patients?
Accurate Answer:- RR < 10 or > 29 breaths/min
What condition related to breathing indicates a Red Tier classification for all
patients? Accurate Answer:- Respiratory distress or need for
respiratory support
What is the room-air pulse oximetry threshold for Red Tier classification?
Accurate Answer:- Room-air pulse oximetry < 90%
What is the systolic blood pressure (SBP) threshold for children aged 0-9
years in Red Tier? Accurate Answer:- SBP < 70mm Hg + (2 x age years)
What is the SBP threshold for individuals aged 10-64 years in Red Tier?
Accurate Answer:- SBP < 90 mmHg or HR > SBP
What is the SBP threshold for individuals aged 65 years and older in Red Tier?
Accurate Answer:- SBP < 110 mmHg or HR > SBP
Red Tier Trauma:
Injury Patterns (2) Accurate Answer:- Penetrating injuries to head,
neck, torso, and proximal extremities
• Skull deformity, suspected skull fracture
• Suspected spinal injury with new motor or sensory loss
• Chest wall instability, deformity, or suspected flail chest
• Suspected pelvic fracture
• Suspected fracture of two or more proximal long bones
• Crushed, de-gloved, mangled, or pulseless extremity
• Amputation proximal to wrist or ankle
• Active bleeding requiring a tourniquet or wound packing with continuous
pressure
,Red Tier trauma triage criteria for injuries in addition to burns shall be...
Accurate Answer:- ...transported to a Level I or II Trauma Center in
accordance with Trauma Policies and Procedures.
Aspirin dose and contractions? Accurate Answer:- 325mg and
contraindications of aspirin which are GI bleed or allergy.
Ketamine dose and route ADULT: Accurate Answer:- IV - 15mg in
100mL N.S. infused over 5 minutes, may repeat one time in 15 minutes or
IN - 25mg, (after drawing up medication add NS to increase volume to 1mL
total volume) may repeat one time in 15 minutes or
IM - 15mg - do not dilute. Repeat in 15 minutes prn X 1, maximum total dose
30mg.
Ketamine dose and route PEDIATRICS: Accurate Answer:- 0.5mg/kg IN,
(after drawing up medication add NS to increase volume to 1mL total volume)
not to exceed adult dose; may repeat one time in 15 minutes.
OR 0.2mg/kg IM (do not dilute). Single max dose of 15mg IM. Repeat in 15
minutes prn x1, maximum 2 total doses.
KETAMINE Contraindications: Accurate Answer:- Age < 4 years, GCS 14
or less, Known or suspected alcohol or drug intoxication, Known or suspected
pregnancy
Ketamine IN administration Accurate Answer:- The syringe must have
a total of 1mL of fluid
Psych transport if pt has no other medical complaints? Accurate Answer:-
KMC
Burns with trauma destination? Accurate Answer:- KMC (Trauma
Center)
(Trauma Policies and Procedures: YELLOW TIER - "• Burns in conjunction
with trauma")
, How many minutes confirmed pulseless to not start cpr? Accurate
Answer:- 10 minutes
Needle decompression placement? Accurate Answer:- PEDS: 2nd
intercostal space, mid-clavicular line for pediatric patients or
ADULT: 4th intercostal space, mid-axillary line for adult patients. The
approved thoracic decompression device for adult is a 10-gauge IV needle
with catheter at least 3.25 inches in length. Standard length 2-inch needle
should be used for pediatric patients.
Heart rate when you start to see symptoms of tachycardia? Accurate
Answer:- 150 or greater
What type of stroke scale do we use? Accurate Answer:- Cincinnati
Prehospital Stroke Scale (CPSS).
Cincinnati Prehospital Stroke Scale (CPSS) components Accurate
Answer:- - Arm Drift,
- Facial Droop,
- Slurred (abnormal) Speech.
What is the push dose of epinephrine for adults? Accurate Answer:- 0.5
mL every 1-5 minutes
What is the push dose of epinephrine for pediatrics? Accurate Answer:-
Same as adult: 0.5 mL every 1-5 minutes
What is the cardiac arrest dose of epinephrine for adults? Accurate
Answer:- Epinephrine drip 2-8 mcg/min, starting at 8 mcg/min and titrating
down to effect
What is the cardiac arrest dose of epinephrine for pediatrics? Accurate
Answer:- Epinephrine drip 0.1 - 1 mcg/kg/min, not to exceed adult dose,
starting at the higher end and titrating down to effect
Objective Solutions
Atropine for Organophosphate poisoning ADULT Accurate Answer:-
Poisoning/Ingestion/Overdose (119) - Atropine for Organophosphate
Poisoning, ADULT: If symptomatic organophosphate poisoning, administer
Atropine 2 mg IV every 5 minutes as needed.
Atropine for Organophosphate poisoning PEDS Accurate Answer:-
Poisoning/Ingestion/Overdose (119) - Pediatrics (Under 14): If symptomatic
organophosphate poisoning, administer Atropine 0.05-0.1mg/kg IV/IM every
5 minutes as needed
Atropine Doses - Bradycardias, ADULT: Accurate Answer:- Adult: 0.5mg
- 1mg for Bradycardias
Atropine Doses - Bradycardias, PEDS: Accurate Answer:- Peds: If
increased vagal tone or primary AV block, give Atropine 0.02 mg/kg minimum
dose 0.1 mg BEFORE epinephrine administration. May repeat as needed to
max of 1 mg.
Under 1 year with heart rate <60 BPM with signs of shock despite
oxygenation/ventilation? Perform CPR for 2 minutes, is patient still
bradycardic?
Do you give atropine for asystole? Accurate Answer:- No
Doses for Buprenorphine (Suboxone)? Accurate Answer:- 16mg SL
Clinical Opiate Withdrawal Scale (COWS) score required for Buprenorphine
administration Accurate Answer:- 6 or higher.
Buprenorphine contraindications Accurate Answer:- - patient is under
16 years of age
- any methadone use with in the last 10 days
- altered mental status
- Sepsis
- Current intoxication or recent use of benzodiazepine
,- COWS score of less than 7
What does the Red Tier indicate? Accurate Answer:- High Risk for
Serious Injury
What is one criterion for all patients to be classified as Red Tier? Accurate
Answer:- Unable to follow commands (motor GCS < 6)
What respiratory rate indicates a Red Tier classification for all patients?
Accurate Answer:- RR < 10 or > 29 breaths/min
What condition related to breathing indicates a Red Tier classification for all
patients? Accurate Answer:- Respiratory distress or need for
respiratory support
What is the room-air pulse oximetry threshold for Red Tier classification?
Accurate Answer:- Room-air pulse oximetry < 90%
What is the systolic blood pressure (SBP) threshold for children aged 0-9
years in Red Tier? Accurate Answer:- SBP < 70mm Hg + (2 x age years)
What is the SBP threshold for individuals aged 10-64 years in Red Tier?
Accurate Answer:- SBP < 90 mmHg or HR > SBP
What is the SBP threshold for individuals aged 65 years and older in Red Tier?
Accurate Answer:- SBP < 110 mmHg or HR > SBP
Red Tier Trauma:
Injury Patterns (2) Accurate Answer:- Penetrating injuries to head,
neck, torso, and proximal extremities
• Skull deformity, suspected skull fracture
• Suspected spinal injury with new motor or sensory loss
• Chest wall instability, deformity, or suspected flail chest
• Suspected pelvic fracture
• Suspected fracture of two or more proximal long bones
• Crushed, de-gloved, mangled, or pulseless extremity
• Amputation proximal to wrist or ankle
• Active bleeding requiring a tourniquet or wound packing with continuous
pressure
,Red Tier trauma triage criteria for injuries in addition to burns shall be...
Accurate Answer:- ...transported to a Level I or II Trauma Center in
accordance with Trauma Policies and Procedures.
Aspirin dose and contractions? Accurate Answer:- 325mg and
contraindications of aspirin which are GI bleed or allergy.
Ketamine dose and route ADULT: Accurate Answer:- IV - 15mg in
100mL N.S. infused over 5 minutes, may repeat one time in 15 minutes or
IN - 25mg, (after drawing up medication add NS to increase volume to 1mL
total volume) may repeat one time in 15 minutes or
IM - 15mg - do not dilute. Repeat in 15 minutes prn X 1, maximum total dose
30mg.
Ketamine dose and route PEDIATRICS: Accurate Answer:- 0.5mg/kg IN,
(after drawing up medication add NS to increase volume to 1mL total volume)
not to exceed adult dose; may repeat one time in 15 minutes.
OR 0.2mg/kg IM (do not dilute). Single max dose of 15mg IM. Repeat in 15
minutes prn x1, maximum 2 total doses.
KETAMINE Contraindications: Accurate Answer:- Age < 4 years, GCS 14
or less, Known or suspected alcohol or drug intoxication, Known or suspected
pregnancy
Ketamine IN administration Accurate Answer:- The syringe must have
a total of 1mL of fluid
Psych transport if pt has no other medical complaints? Accurate Answer:-
KMC
Burns with trauma destination? Accurate Answer:- KMC (Trauma
Center)
(Trauma Policies and Procedures: YELLOW TIER - "• Burns in conjunction
with trauma")
, How many minutes confirmed pulseless to not start cpr? Accurate
Answer:- 10 minutes
Needle decompression placement? Accurate Answer:- PEDS: 2nd
intercostal space, mid-clavicular line for pediatric patients or
ADULT: 4th intercostal space, mid-axillary line for adult patients. The
approved thoracic decompression device for adult is a 10-gauge IV needle
with catheter at least 3.25 inches in length. Standard length 2-inch needle
should be used for pediatric patients.
Heart rate when you start to see symptoms of tachycardia? Accurate
Answer:- 150 or greater
What type of stroke scale do we use? Accurate Answer:- Cincinnati
Prehospital Stroke Scale (CPSS).
Cincinnati Prehospital Stroke Scale (CPSS) components Accurate
Answer:- - Arm Drift,
- Facial Droop,
- Slurred (abnormal) Speech.
What is the push dose of epinephrine for adults? Accurate Answer:- 0.5
mL every 1-5 minutes
What is the push dose of epinephrine for pediatrics? Accurate Answer:-
Same as adult: 0.5 mL every 1-5 minutes
What is the cardiac arrest dose of epinephrine for adults? Accurate
Answer:- Epinephrine drip 2-8 mcg/min, starting at 8 mcg/min and titrating
down to effect
What is the cardiac arrest dose of epinephrine for pediatrics? Accurate
Answer:- Epinephrine drip 0.1 - 1 mcg/kg/min, not to exceed adult dose,
starting at the higher end and titrating down to effect
