CRITICAL CARE PARAMEDIC UPDATED
SCRIPT 2026 PRACTICE SOLUTIONS
GRADED A+
● CVA HTN Tx if over Sys: 210 or Dia: 120. Answer: Start with
Nicardipine, 5mg/hr and titrate up with adding 2.5mg/hr every 5
minsnprior to dropping back down, up to 15mg
● Bougie Cricothyrotomy. Answer: Step1-Equipment (6cuffed,
syringe,scalpel, bvm w/Etco2, dressing, bougie)
Step2-Landmarks (between cricoid ring and thyroid cartilage)-can't find,
then vertical incision
Step3-1.5-2cm incision into cricothyroid membrane, immediately
placing finger into incision to augment/keep location.
Step4-insert bougie, feel for tracheal clicks
Step5-insert 6 ETT, make have to put pressure/back&forth, and once
balloon in, your good to blow up cuff
● hypotension with ACS. Answer: Consider 1-2L NS, and then
inotropes: dopamine/dobutamine
● For AMS and hx Alcoholism/Malnutrition. Answer: Give Thiamine IV
100mg
,● Options for Combative Patient. Answer: 1)Versed 2-5mg IV
2)Ativan 1-2mg IV, q/3mins can repeat
3)Valium 5-10mg can repeat 15min
4)Haldol same as Valium but IM also
5)Ketamine .2mg/kg
● For adult anaphylaxis don't forget. Answer: corticosteroid:
Solumedrol, helps with late phase
200mg Anaphylaxis, 125mg Hace and Resp. Distress
● History of WPW, treat like. Answer: V-Tach Protocol, not Afib-RVR
so Ami 150mg in ten mins, may repeat
● Afib RVR Stable vs. Unstable. Answer: Dilt IV 5-10 mins =Stable
(can repeat in 5-10) .25mg/kg (repeat at .35)
Cardiovert 100J=Unstable
don't forget 12 leads
● Positioning for CVA pts. Answer: 20-30 degree head elevation
● Cincinnati Stroke Scale. Answer: Droop, Drift, Speech
, ● On CVAs don't forget?. Answer: 12-lead, over 185/110 & candidate,
over 185 2x give 10mg labetalol, titrate to effect but don't drop more
than 15%
● Blood Glucose should not be dropped?. Answer: 50-100 mg/dl per
hour
● In DKA patients, avoid?. Answer: intubation, if you have to, set RR
@30, help breath off acid
● Sepsis Patient Induction. Answer: Use Ketamine over Etomidate due
to adrenal suppression,
● Fun Facts of Sepsis. Answer: 1-raise HOB 30-45 degrees
2-CVPs goal=8-12mmHg
3-MAP goal= greater than 65
4-fluid challenges, 3l crystalloid over 45 mins
● Levels of hyperkalemia. Answer: 1-Tall peaked T waves (6mEq/l)
2-Prolonged PR interval (6.5mEq/l)
3-Loss of p-wave (6.5-7)
4-Widening of qrs (7-7.5)
5-Sine wave, v-fib/tach (8-10)
SCRIPT 2026 PRACTICE SOLUTIONS
GRADED A+
● CVA HTN Tx if over Sys: 210 or Dia: 120. Answer: Start with
Nicardipine, 5mg/hr and titrate up with adding 2.5mg/hr every 5
minsnprior to dropping back down, up to 15mg
● Bougie Cricothyrotomy. Answer: Step1-Equipment (6cuffed,
syringe,scalpel, bvm w/Etco2, dressing, bougie)
Step2-Landmarks (between cricoid ring and thyroid cartilage)-can't find,
then vertical incision
Step3-1.5-2cm incision into cricothyroid membrane, immediately
placing finger into incision to augment/keep location.
Step4-insert bougie, feel for tracheal clicks
Step5-insert 6 ETT, make have to put pressure/back&forth, and once
balloon in, your good to blow up cuff
● hypotension with ACS. Answer: Consider 1-2L NS, and then
inotropes: dopamine/dobutamine
● For AMS and hx Alcoholism/Malnutrition. Answer: Give Thiamine IV
100mg
,● Options for Combative Patient. Answer: 1)Versed 2-5mg IV
2)Ativan 1-2mg IV, q/3mins can repeat
3)Valium 5-10mg can repeat 15min
4)Haldol same as Valium but IM also
5)Ketamine .2mg/kg
● For adult anaphylaxis don't forget. Answer: corticosteroid:
Solumedrol, helps with late phase
200mg Anaphylaxis, 125mg Hace and Resp. Distress
● History of WPW, treat like. Answer: V-Tach Protocol, not Afib-RVR
so Ami 150mg in ten mins, may repeat
● Afib RVR Stable vs. Unstable. Answer: Dilt IV 5-10 mins =Stable
(can repeat in 5-10) .25mg/kg (repeat at .35)
Cardiovert 100J=Unstable
don't forget 12 leads
● Positioning for CVA pts. Answer: 20-30 degree head elevation
● Cincinnati Stroke Scale. Answer: Droop, Drift, Speech
, ● On CVAs don't forget?. Answer: 12-lead, over 185/110 & candidate,
over 185 2x give 10mg labetalol, titrate to effect but don't drop more
than 15%
● Blood Glucose should not be dropped?. Answer: 50-100 mg/dl per
hour
● In DKA patients, avoid?. Answer: intubation, if you have to, set RR
@30, help breath off acid
● Sepsis Patient Induction. Answer: Use Ketamine over Etomidate due
to adrenal suppression,
● Fun Facts of Sepsis. Answer: 1-raise HOB 30-45 degrees
2-CVPs goal=8-12mmHg
3-MAP goal= greater than 65
4-fluid challenges, 3l crystalloid over 45 mins
● Levels of hyperkalemia. Answer: 1-Tall peaked T waves (6mEq/l)
2-Prolonged PR interval (6.5mEq/l)
3-Loss of p-wave (6.5-7)
4-Widening of qrs (7-7.5)
5-Sine wave, v-fib/tach (8-10)
