,SANTA CLARA COUNTY EMS PARAMEDIC
PROTOCOL PATIENT CARE PROCEDURES FINAL
REVIEW PACK – COMPLETE ANSWERS 2026
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
*C) Assess blood glucose and obtain glucose level *
Rationale: 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 . Determining last known well time is important but not the
most critical immediate action .
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
*A) Second intercostal space, midclavicular line *
,Rationale: The protocol-recommended site for needle decompression is the
second intercostal space, midclavicular line on the affected side. This site
reliably enters the pleural space in most adults. The fourth intercostal space,
anterior axillary line is an alternative but not first-line .
3. A paramedic is preparing to administer adenosine for a patient with
supraventricular tachycardia. The patient has a history of asthma and
is currently wheezing. What modification to the protocol is most
appropriate?
A) Use a lower initial dose of 3 mg IV
B) Avoid adenosine and consider synchronized cardioversion
C) Administer adenosine via continuous infusion over 1 hour
D) Premedicate with 125 mg methylprednisolone IV
*B) Avoid adenosine and consider synchronized cardioversion *
Rationale: Adenosine can exacerbate bronchospasm in asthmatic patients
due to its effects on mast cells and airway smooth muscle. In a patient with
active wheezing and known asthma, synchronized cardioversion is a safer
alternative .
4. During transport of a patient with suspected acute myocardial
infarction, the paramedic notes the patient has a significant
bradycardia of 45 bpm with hypotension (80/50 mm Hg) and
symptoms of hypoperfusion. The patient is on a nitroglycerin drip.
What is the first intervention according to Santa Clara County
protocol?
A) Administer atropine 0.5 mg IV
B) Stop the nitroglycerin infusion
, C) Start transcutaneous pacing
D) Administer epinephrine 1 mg IV
*B) Stop the nitroglycerin infusion *
Rationale: Nitroglycerin can cause hypotension and reflex bradycardia,
especially in right ventricular infarction. Stopping the infusion may quickly
reverse the hypotension. Atropine is indicated for symptomatic bradycardia,
but first addressing a reversible cause is appropriate .
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
*C) Begin positive pressure ventilation with bag-valve-mask *
Rationale: 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. 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
PROTOCOL PATIENT CARE PROCEDURES FINAL
REVIEW PACK – COMPLETE ANSWERS 2026
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
*C) Assess blood glucose and obtain glucose level *
Rationale: 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 . Determining last known well time is important but not the
most critical immediate action .
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
*A) Second intercostal space, midclavicular line *
,Rationale: The protocol-recommended site for needle decompression is the
second intercostal space, midclavicular line on the affected side. This site
reliably enters the pleural space in most adults. The fourth intercostal space,
anterior axillary line is an alternative but not first-line .
3. A paramedic is preparing to administer adenosine for a patient with
supraventricular tachycardia. The patient has a history of asthma and
is currently wheezing. What modification to the protocol is most
appropriate?
A) Use a lower initial dose of 3 mg IV
B) Avoid adenosine and consider synchronized cardioversion
C) Administer adenosine via continuous infusion over 1 hour
D) Premedicate with 125 mg methylprednisolone IV
*B) Avoid adenosine and consider synchronized cardioversion *
Rationale: Adenosine can exacerbate bronchospasm in asthmatic patients
due to its effects on mast cells and airway smooth muscle. In a patient with
active wheezing and known asthma, synchronized cardioversion is a safer
alternative .
4. During transport of a patient with suspected acute myocardial
infarction, the paramedic notes the patient has a significant
bradycardia of 45 bpm with hypotension (80/50 mm Hg) and
symptoms of hypoperfusion. The patient is on a nitroglycerin drip.
What is the first intervention according to Santa Clara County
protocol?
A) Administer atropine 0.5 mg IV
B) Stop the nitroglycerin infusion
, C) Start transcutaneous pacing
D) Administer epinephrine 1 mg IV
*B) Stop the nitroglycerin infusion *
Rationale: Nitroglycerin can cause hypotension and reflex bradycardia,
especially in right ventricular infarction. Stopping the infusion may quickly
reverse the hypotension. Atropine is indicated for symptomatic bradycardia,
but first addressing a reversible cause is appropriate .
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
*C) Begin positive pressure ventilation with bag-valve-mask *
Rationale: 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. 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
