SANTA CLARA COUNTY EMS PARAMEDIC PROTOCOL
PATIENT CARE PROCEDURES FINAL REVIEW PACK
COMPLETE ANSWERS - 204 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Emergency Medical Services
Description This examination assesses mastery of the Santa Clara County EMS paramedic
protocols, covering advanced life support procedures, pharmacological
interventions, and complex clinical decision-making in prehospital emergencies. It
aligns with national EMS education standards and county-specific operational
guidelines.
Expected Grade A+
Total Questions 204
Duration 3 hours
Learning Outcomes 1. Demonstrate proficiency in critical thinking and application of paramedic
protocols for diverse emergencies
2. Integrate pathophysiology, pharmacology, and procedure-specific knowledge
into clinical scenarios
3. Analyze subtle clinical distinctions to select the most appropriate intervention
4. Synthesize multiple protocol components to manage complex, multi-system
presentations
Accreditation Accredited by the Commission on Accreditation of Allied Health Education
Programs (CAAHEP) and compliant with National EMS Scope of Practice Model.
Page 1
,1. A patient presents with acute onset of unilateral weakness, facial droop, and
slurred speech. The Cincinnati Prehospital Stroke Scale is positive. Onset time
is 2 hours ago. The patient takes apixaban. Which of the following actions is
most critical before transport to a stroke center?
A. Administer aspirin 324 mg orally
B. Determine last known well time beyond 4.5 hours
C. Assess blood glucose and obtain glucose level
D. Administer 1 liter normal saline bolus
Answer: C. Assess blood glucose and obtain glucose level
Hypoglycemia can mimic stroke symptoms, so assessing and correcting glucose is
essential before activating stroke protocols. Aspirin is contraindicated if the
patient is on apixaban and may be a candidate for thrombolytics (risk of
bleeding). Determining last known well time is important but not the most critical
immediate action. Fluid bolus is not indicated unless hypotensive.
2. In a patient with tension pneumothorax following penetrating trauma, you
prepare to perform needle decompression. According to Santa Clara County
protocol, which location is preferred for initial decompression using a
14-gauge, 8-cm catheter?
A. Second intercostal space, midclavicular line
B. Fourth intercostal space, anterior axillary line
C. Fifth intercostal space, midaxillary line
D. Third intercostal space, midclavicular line
Answer: A. Second intercostal space, midclavicular line
The traditional and protocol-recommended site for needle decompression is the
second intercostal space, midclavicular line on the affected side (ipsilateral). This
site reliably enters the pleural space in most adults. The fourth intercostal space,
anterior axillary line is an alternative but not first-line. The fifth intercostal space
is too low (risk of abdominal injury). The third intercostal space is not standard.
Page 2
,3. During the management of a patient with septic shock, after initial fluid
resuscitation of 30 mL/kg of crystalloid, the patient remains hypotensive with a
mean arterial pressure of 58 mm Hg. Which vasopressor should be initiated
first per Santa Clara County sepsis protocol?
A. Dopamine at 5-10 mcg/kg/min
B. Norepinephrine at 0.5-30 mcg/min
C. Epinephrine at 2-10 mcg/min
D. Phenylephrine at 50-200 mcg/min
Answer: B. Norepinephrine at 0.5-30 mcg/min
Norepinephrine is the first-line vasopressor for septic shock per both national
guidelines and Santa Clara County protocols. Dopamine is a second-line agent
due to increased risk of arrhythmias. Epinephrine is reserved as a second-line or
adjunct. Phenylephrine is a pure alpha-agonist used only in specific
circumstances (e.g., tachyarrhythmias with norepinephrine).
4. A patient is in respiratory distress with audible stridor and a history of
anaphylaxis. The paramedic administers epinephrine 0.3 mg IM. After 5
minutes, there is no improvement. What is the most appropriate next step
according to local protocol?
A. Repeat epinephrine 0.3 mg IM
B. Administer epinephrine 0.1 mg IV slowly
C. Start albuterol nebulized treatment
D. Administer diphenhydramine 50 mg IV
Answer: A. Repeat epinephrine 0.3 mg IM
In anaphylaxis, if no improvement after first IM epinephrine, the protocol allows
repeat IM doses every 5-15 minutes as needed. IV epinephrine is reserved for
severe, refractory anaphylaxis with impending arrest and should be given as a
continuous infusion or dilute bolus with caution. Albuterol treats bronchospasm
but not laryngeal edema. Diphenhydramine is adjunctive, not first-line for acute
airway compromise.
Page 3
, 5. A patient with a suspected opioid overdose has received 0.4 mg of naloxone
IV. Ten minutes later, the patient is still apneic with a respiratory rate of 4.
Heart rate is 120 bpm, blood pressure 170/90 mm Hg. What is the most
appropriate next action?
A. Repeat same dose of naloxone 0.4 mg IV
B. Administer 2 mg naloxone IV push
C. Begin positive pressure ventilation with bag-valve-mask
D. Administer flumazenil 0.2 mg IV
Answer: C. Begin positive pressure ventilation with bag-valve-mask
The patient is in severe respiratory depression and is not responding to initial
naloxone. The immediate priority is to provide assisted ventilation (BVM) to
ensure oxygenation and ventilation. Higher doses of naloxone may cause
withdrawal but can be considered after ventilation. Flumazenil is contraindicated
in suspected opioid overdose and may precipitate seizures. Per protocol,
ventilation is the cornerstone before repeated pharmacological reversal.
6. Which of the following is the most appropriate indication for withholding
spinal motion restriction (SMR) in a patient with potential spinal injury
according to Santa Clara County protocol?
A. Patient has a distracting injury, such as a femur fracture
B. Patient has an isolated penetrating trauma without neurological deficit
C. Patient has altered mental status due to intoxication
D. Patient has paresthesias in the extremities
Answer: B. Patient has an isolated penetrating trauma without neurological
deficit
Local protocol states that SMR may be withheld in patients with isolated
penetrating trauma (e.g., gunshot wound) to the spine without neurological
deficit, as SMR does not improve outcome and may delay transport. Distracting
injury, altered mental status, and neurological deficits are all indications for
SMR because they increase suspicion of unstable spinal injury.
Page 4
PATIENT CARE PROCEDURES FINAL REVIEW PACK
COMPLETE ANSWERS - 204 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Emergency Medical Services
Description This examination assesses mastery of the Santa Clara County EMS paramedic
protocols, covering advanced life support procedures, pharmacological
interventions, and complex clinical decision-making in prehospital emergencies. It
aligns with national EMS education standards and county-specific operational
guidelines.
Expected Grade A+
Total Questions 204
Duration 3 hours
Learning Outcomes 1. Demonstrate proficiency in critical thinking and application of paramedic
protocols for diverse emergencies
2. Integrate pathophysiology, pharmacology, and procedure-specific knowledge
into clinical scenarios
3. Analyze subtle clinical distinctions to select the most appropriate intervention
4. Synthesize multiple protocol components to manage complex, multi-system
presentations
Accreditation Accredited by the Commission on Accreditation of Allied Health Education
Programs (CAAHEP) and compliant with National EMS Scope of Practice Model.
Page 1
,1. A patient presents with acute onset of unilateral weakness, facial droop, and
slurred speech. The Cincinnati Prehospital Stroke Scale is positive. Onset time
is 2 hours ago. The patient takes apixaban. Which of the following actions is
most critical before transport to a stroke center?
A. Administer aspirin 324 mg orally
B. Determine last known well time beyond 4.5 hours
C. Assess blood glucose and obtain glucose level
D. Administer 1 liter normal saline bolus
Answer: C. Assess blood glucose and obtain glucose level
Hypoglycemia can mimic stroke symptoms, so assessing and correcting glucose is
essential before activating stroke protocols. Aspirin is contraindicated if the
patient is on apixaban and may be a candidate for thrombolytics (risk of
bleeding). Determining last known well time is important but not the most critical
immediate action. Fluid bolus is not indicated unless hypotensive.
2. In a patient with tension pneumothorax following penetrating trauma, you
prepare to perform needle decompression. According to Santa Clara County
protocol, which location is preferred for initial decompression using a
14-gauge, 8-cm catheter?
A. Second intercostal space, midclavicular line
B. Fourth intercostal space, anterior axillary line
C. Fifth intercostal space, midaxillary line
D. Third intercostal space, midclavicular line
Answer: A. Second intercostal space, midclavicular line
The traditional and protocol-recommended site for needle decompression is the
second intercostal space, midclavicular line on the affected side (ipsilateral). This
site reliably enters the pleural space in most adults. The fourth intercostal space,
anterior axillary line is an alternative but not first-line. The fifth intercostal space
is too low (risk of abdominal injury). The third intercostal space is not standard.
Page 2
,3. During the management of a patient with septic shock, after initial fluid
resuscitation of 30 mL/kg of crystalloid, the patient remains hypotensive with a
mean arterial pressure of 58 mm Hg. Which vasopressor should be initiated
first per Santa Clara County sepsis protocol?
A. Dopamine at 5-10 mcg/kg/min
B. Norepinephrine at 0.5-30 mcg/min
C. Epinephrine at 2-10 mcg/min
D. Phenylephrine at 50-200 mcg/min
Answer: B. Norepinephrine at 0.5-30 mcg/min
Norepinephrine is the first-line vasopressor for septic shock per both national
guidelines and Santa Clara County protocols. Dopamine is a second-line agent
due to increased risk of arrhythmias. Epinephrine is reserved as a second-line or
adjunct. Phenylephrine is a pure alpha-agonist used only in specific
circumstances (e.g., tachyarrhythmias with norepinephrine).
4. A patient is in respiratory distress with audible stridor and a history of
anaphylaxis. The paramedic administers epinephrine 0.3 mg IM. After 5
minutes, there is no improvement. What is the most appropriate next step
according to local protocol?
A. Repeat epinephrine 0.3 mg IM
B. Administer epinephrine 0.1 mg IV slowly
C. Start albuterol nebulized treatment
D. Administer diphenhydramine 50 mg IV
Answer: A. Repeat epinephrine 0.3 mg IM
In anaphylaxis, if no improvement after first IM epinephrine, the protocol allows
repeat IM doses every 5-15 minutes as needed. IV epinephrine is reserved for
severe, refractory anaphylaxis with impending arrest and should be given as a
continuous infusion or dilute bolus with caution. Albuterol treats bronchospasm
but not laryngeal edema. Diphenhydramine is adjunctive, not first-line for acute
airway compromise.
Page 3
, 5. A patient with a suspected opioid overdose has received 0.4 mg of naloxone
IV. Ten minutes later, the patient is still apneic with a respiratory rate of 4.
Heart rate is 120 bpm, blood pressure 170/90 mm Hg. What is the most
appropriate next action?
A. Repeat same dose of naloxone 0.4 mg IV
B. Administer 2 mg naloxone IV push
C. Begin positive pressure ventilation with bag-valve-mask
D. Administer flumazenil 0.2 mg IV
Answer: C. Begin positive pressure ventilation with bag-valve-mask
The patient is in severe respiratory depression and is not responding to initial
naloxone. The immediate priority is to provide assisted ventilation (BVM) to
ensure oxygenation and ventilation. Higher doses of naloxone may cause
withdrawal but can be considered after ventilation. Flumazenil is contraindicated
in suspected opioid overdose and may precipitate seizures. Per protocol,
ventilation is the cornerstone before repeated pharmacological reversal.
6. Which of the following is the most appropriate indication for withholding
spinal motion restriction (SMR) in a patient with potential spinal injury
according to Santa Clara County protocol?
A. Patient has a distracting injury, such as a femur fracture
B. Patient has an isolated penetrating trauma without neurological deficit
C. Patient has altered mental status due to intoxication
D. Patient has paresthesias in the extremities
Answer: B. Patient has an isolated penetrating trauma without neurological
deficit
Local protocol states that SMR may be withheld in patients with isolated
penetrating trauma (e.g., gunshot wound) to the spine without neurological
deficit, as SMR does not improve outcome and may delay transport. Distracting
injury, altered mental status, and neurological deficits are all indications for
SMR because they increase suspicion of unstable spinal injury.
Page 4
