SANTA CLARA COUNTY EMS PARAMEDIC PROTOCOL PATIENT
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1. A paramedic is managing an adult trauma patient in Santa Clara County who has
sustained significant blunt abdominal trauma and presents with cool, pale skin, delayed
capillary refill, and a heart rate of 124 beats per minute. According to local county trauma
protocols, what is the most appropriate initial fluid management strategy for this patient?
A. Rapid administration of 20 mL/kg normal saline boluses until normal blood pressure is
achieved
B. Permissive hypotension aiming for a radial pulse and withholding IV fluids if blood pressure
is adequate
C. Immediate initiation of a wide-open normal saline infusion combined with hypertonic saline
D. Restriction of all intravenous access until the patient arrives at a designated trauma center
ANSWER: B. Permissive hypotension aiming for a radial pulse and withholding IV fluids if
blood pressure is adequate
In modern EMS trauma protocols, including Santa Clara County guidelines, uncontrolled
hemorrhage requires cautious fluid administration to prevent clot disruption, diluting clotting
factors, and worsening bleeding. Permissive hypotension focuses on maintaining organ
perfusion without aggressively elevating blood pressure. Option A is outdated, option C risks
blowing fresh clots, and option D delays necessary vascular access.
2. A paramedic responds to a residence for a 62-year-old male complaining of acute,
crushing chest pain radiating to his jaw. The 12-lead ECG reveals ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded, and what additional
ECG precaution should be considered prior to nitro administration?
A. Left anterior descending artery; obtain a posterior ECG
B. Right coronary artery; obtain a right-sided ECG (V3R-V5R) to evaluate for right ventricular
infarction
C. Left circumflex artery; administer high-flow oxygen regardless of saturation
,D. Left main coronary artery; apply transcutaneous pacing pads immediately
ANSWER: B. Right coronary artery; obtain a right-sided ECG (V3R-V5R) to evaluate for
right ventricular infarction
Leads II, III, and aVF view the inferior wall of the left ventricle, which is typically supplied
by the right coronary artery (RCA). Inferior wall myocardial infarctions frequently involve the
right ventricle. Checking right-sided leads ensures the patient is not experiencing a preload-
dependent right ventricular infarct, where nitrates would cause catastrophic hypotension.
3. An advanced life support crew arrives at the scene of a motor vehicle collision where an
unbuckled driver is trapped with a steering wheel deformity. The patient is tachypneic,
complaining of severe left-sided chest pain, and breath sounds are significantly diminished
on the left with absent movement. Jugular venous distension is noted. What is the
immediate life-saving intervention required under standard EMS procedures?
A. Immediate application of a three-sided occlusive dressing
B. Performing a needle decompression at the second intercostal space mid-clavicular line or
fifth intercostal space mid-axillary line
C. Endotracheal intubation and initiation of positive pressure ventilation at 20 breaths per
minute
D. Immediate administration of intravenous morphine and transport without delay
ANSWER: B. Performing a needle decompression at the second intercostal space mid-
clavicular line or fifth intercostal space mid-axillary line
The clinical presentation describes a tension pneumothorax, characterized by respiratory
distress, diminished breath sounds, tracheal deviation or JVD, and hemodynamic compromise.
Needle decompression relieves the intrapleural pressure immediately. A three-sided dressing is
for open pneumothoraxes (sucking chest wounds), and positive pressure ventilation can
worsen a tension pneumothorax rapidly.
4. A paramedic is treating a pediatric patient weighing approximately 15 kg who is
experiencing acute anaphylaxis following a bee sting. The child is wheezing, tachycardic,
and developing urticaria. What is the correct dosage and route for epinephrine
administration according to standard prehospital guidelines?
A. 0.3 mg of 1:1,000 solution administered intravenously over one minute
B. 0.15 mg of 1:1,000 solution administered via an auto-injector or intramuscularly
C. 0.01 mg/kg of 1:1,000 solution administered intramuscularly, resulting in a 0.15 mg dose
,D. 1.0 mg of 1:10,000 solution administered via rapid IV push
ANSWER: C. 0.01 mg/kg of 1:1,000 solution administered intramuscularly, resulting in a
0.15 mg dose
For pediatric anaphylaxis, the standard weight-based intramuscular dose of epinephrine
(1:1,000) is 0.01 mg/kg, which calculates to 0.15 mg for a 15 kg child. Intramuscular
administration in the anterolateral thigh provides rapid and reliable absorption. Option A and
D use incorrect concentrations or routes that risk severe toxicity.
5. During a multi-agency mass casualty incident in Santa Clara County, a paramedic is
assigned as the Triage Officer using the START (Simple Triage and Rapid Treatment)
method. An adult patient is non-ambulatory, has a respiratory rate of 34 breaths per
minute, a delayed capillary refill of 4 seconds, and is unable to follow simple commands.
What triage category should be assigned?
A. Green (Minor)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant / Deceased)
ANSWER: C. Red (Immediate)
Under START triage, any patient who fails any of the assessment criteria—respirations
greater than 30, capillary refill greater than 2 seconds (or absent radial pulse), or inability to
follow simple commands—is classified as Red (Immediate). This patient has a respiratory rate
over 30, slow capillary refill, and mental status deficits.
6. A paramedic is assessing an elderly patient complaining of generalized weakness,
confusion, and palpitations. The monitor displays a narrow-complex, irregularly irregular
rhythm at a rate of 140 beats per minute with no discernible P waves. The patient's blood
pressure is 112/74 mmHg. Which management approach is most appropriate?
A. Immediate synchronized cardioversion at 100 joules
B. Immediate administration of atropine 0.5 mg IV push
C. Rate control consideration and transport, consulting base hospital for synchronized
cardioversion or rate-controlling agents if indicated
D. Immediate transcutaneous pacing at a rate of 80 beats per minute
, ANSWER: C. Rate control consideration and transport, consulting base hospital for
synchronized cardioversion or rate-controlling agents if indicated
The rhythm is atrial fibrillation with a rapid ventricular response (RVR). Since the patient is
stable (blood pressure is maintained), immediate cardioversion is not indicated as an
emergency first step. Base hospital consultation is required for rhythm or rate management
strategies. Atropine would increase the heart rate, and pacing is for bradycardia.
7. A paramedic responds to a call for an adult male found unresponsive in a parked vehicle
with empty prescription bottles scattered around. The patient is unresponsive to painful
stimuli, has pinpoint pupils, and exhibits a respiratory rate of 6 breaths per minute with
shallow excursion. What is the priority intervention?
A. Immediate administration of high-dose oral activated charcoal
B. Endotracheal intubation followed by administration of 50 percent dextrose
C. Assisted ventilation via bag-valve-mask with supplemental oxygen and cautious titration of
naloxone
D. Immediate placement of pacing pads in anticipation of asystole
ANSWER: C. Assisted ventilation via bag-valve-mask with supplemental oxygen and
cautious titration of naloxone
The clinical presentation is classic for opioid overdose leading to respiratory depression. The
primary killer in overdose is hypoxia caused by hypoventilation. Therefore, airway
management and assisted ventilation take immediate precedence over reversal agents,
followed by careful titration of naloxone to restore adequate breathing without precipitating
acute withdrawal or severe combativeness.
8. A paramedic is treating a 45-year-old female experiencing a severe asthma exacerbation.
She is speaking in single words, sitting upright in a tripod position, and expiratory wheezes
are barely audible due to minimal air movement ("silent chest"). Following nebulized
albuterol and ipratropium bromide, her condition deteriorates. Which intervention is
indicated next?
A. Administration of intramuscular epinephrine 1:1,000 and preparation for advanced airway
management
B. Immediate administration of oral cough suppressants and reassurance
C. Restriction of all further respiratory medications to prevent toxicity
D. Application of a non-rebreather mask at 6 liters per minute
CARE PROCEDURES FINAL EXAM REVIEW– QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST| DOWNLOAD
INSTANT PDF
1. A paramedic is managing an adult trauma patient in Santa Clara County who has
sustained significant blunt abdominal trauma and presents with cool, pale skin, delayed
capillary refill, and a heart rate of 124 beats per minute. According to local county trauma
protocols, what is the most appropriate initial fluid management strategy for this patient?
A. Rapid administration of 20 mL/kg normal saline boluses until normal blood pressure is
achieved
B. Permissive hypotension aiming for a radial pulse and withholding IV fluids if blood pressure
is adequate
C. Immediate initiation of a wide-open normal saline infusion combined with hypertonic saline
D. Restriction of all intravenous access until the patient arrives at a designated trauma center
ANSWER: B. Permissive hypotension aiming for a radial pulse and withholding IV fluids if
blood pressure is adequate
In modern EMS trauma protocols, including Santa Clara County guidelines, uncontrolled
hemorrhage requires cautious fluid administration to prevent clot disruption, diluting clotting
factors, and worsening bleeding. Permissive hypotension focuses on maintaining organ
perfusion without aggressively elevating blood pressure. Option A is outdated, option C risks
blowing fresh clots, and option D delays necessary vascular access.
2. A paramedic responds to a residence for a 62-year-old male complaining of acute,
crushing chest pain radiating to his jaw. The 12-lead ECG reveals ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded, and what additional
ECG precaution should be considered prior to nitro administration?
A. Left anterior descending artery; obtain a posterior ECG
B. Right coronary artery; obtain a right-sided ECG (V3R-V5R) to evaluate for right ventricular
infarction
C. Left circumflex artery; administer high-flow oxygen regardless of saturation
,D. Left main coronary artery; apply transcutaneous pacing pads immediately
ANSWER: B. Right coronary artery; obtain a right-sided ECG (V3R-V5R) to evaluate for
right ventricular infarction
Leads II, III, and aVF view the inferior wall of the left ventricle, which is typically supplied
by the right coronary artery (RCA). Inferior wall myocardial infarctions frequently involve the
right ventricle. Checking right-sided leads ensures the patient is not experiencing a preload-
dependent right ventricular infarct, where nitrates would cause catastrophic hypotension.
3. An advanced life support crew arrives at the scene of a motor vehicle collision where an
unbuckled driver is trapped with a steering wheel deformity. The patient is tachypneic,
complaining of severe left-sided chest pain, and breath sounds are significantly diminished
on the left with absent movement. Jugular venous distension is noted. What is the
immediate life-saving intervention required under standard EMS procedures?
A. Immediate application of a three-sided occlusive dressing
B. Performing a needle decompression at the second intercostal space mid-clavicular line or
fifth intercostal space mid-axillary line
C. Endotracheal intubation and initiation of positive pressure ventilation at 20 breaths per
minute
D. Immediate administration of intravenous morphine and transport without delay
ANSWER: B. Performing a needle decompression at the second intercostal space mid-
clavicular line or fifth intercostal space mid-axillary line
The clinical presentation describes a tension pneumothorax, characterized by respiratory
distress, diminished breath sounds, tracheal deviation or JVD, and hemodynamic compromise.
Needle decompression relieves the intrapleural pressure immediately. A three-sided dressing is
for open pneumothoraxes (sucking chest wounds), and positive pressure ventilation can
worsen a tension pneumothorax rapidly.
4. A paramedic is treating a pediatric patient weighing approximately 15 kg who is
experiencing acute anaphylaxis following a bee sting. The child is wheezing, tachycardic,
and developing urticaria. What is the correct dosage and route for epinephrine
administration according to standard prehospital guidelines?
A. 0.3 mg of 1:1,000 solution administered intravenously over one minute
B. 0.15 mg of 1:1,000 solution administered via an auto-injector or intramuscularly
C. 0.01 mg/kg of 1:1,000 solution administered intramuscularly, resulting in a 0.15 mg dose
,D. 1.0 mg of 1:10,000 solution administered via rapid IV push
ANSWER: C. 0.01 mg/kg of 1:1,000 solution administered intramuscularly, resulting in a
0.15 mg dose
For pediatric anaphylaxis, the standard weight-based intramuscular dose of epinephrine
(1:1,000) is 0.01 mg/kg, which calculates to 0.15 mg for a 15 kg child. Intramuscular
administration in the anterolateral thigh provides rapid and reliable absorption. Option A and
D use incorrect concentrations or routes that risk severe toxicity.
5. During a multi-agency mass casualty incident in Santa Clara County, a paramedic is
assigned as the Triage Officer using the START (Simple Triage and Rapid Treatment)
method. An adult patient is non-ambulatory, has a respiratory rate of 34 breaths per
minute, a delayed capillary refill of 4 seconds, and is unable to follow simple commands.
What triage category should be assigned?
A. Green (Minor)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant / Deceased)
ANSWER: C. Red (Immediate)
Under START triage, any patient who fails any of the assessment criteria—respirations
greater than 30, capillary refill greater than 2 seconds (or absent radial pulse), or inability to
follow simple commands—is classified as Red (Immediate). This patient has a respiratory rate
over 30, slow capillary refill, and mental status deficits.
6. A paramedic is assessing an elderly patient complaining of generalized weakness,
confusion, and palpitations. The monitor displays a narrow-complex, irregularly irregular
rhythm at a rate of 140 beats per minute with no discernible P waves. The patient's blood
pressure is 112/74 mmHg. Which management approach is most appropriate?
A. Immediate synchronized cardioversion at 100 joules
B. Immediate administration of atropine 0.5 mg IV push
C. Rate control consideration and transport, consulting base hospital for synchronized
cardioversion or rate-controlling agents if indicated
D. Immediate transcutaneous pacing at a rate of 80 beats per minute
, ANSWER: C. Rate control consideration and transport, consulting base hospital for
synchronized cardioversion or rate-controlling agents if indicated
The rhythm is atrial fibrillation with a rapid ventricular response (RVR). Since the patient is
stable (blood pressure is maintained), immediate cardioversion is not indicated as an
emergency first step. Base hospital consultation is required for rhythm or rate management
strategies. Atropine would increase the heart rate, and pacing is for bradycardia.
7. A paramedic responds to a call for an adult male found unresponsive in a parked vehicle
with empty prescription bottles scattered around. The patient is unresponsive to painful
stimuli, has pinpoint pupils, and exhibits a respiratory rate of 6 breaths per minute with
shallow excursion. What is the priority intervention?
A. Immediate administration of high-dose oral activated charcoal
B. Endotracheal intubation followed by administration of 50 percent dextrose
C. Assisted ventilation via bag-valve-mask with supplemental oxygen and cautious titration of
naloxone
D. Immediate placement of pacing pads in anticipation of asystole
ANSWER: C. Assisted ventilation via bag-valve-mask with supplemental oxygen and
cautious titration of naloxone
The clinical presentation is classic for opioid overdose leading to respiratory depression. The
primary killer in overdose is hypoxia caused by hypoventilation. Therefore, airway
management and assisted ventilation take immediate precedence over reversal agents,
followed by careful titration of naloxone to restore adequate breathing without precipitating
acute withdrawal or severe combativeness.
8. A paramedic is treating a 45-year-old female experiencing a severe asthma exacerbation.
She is speaking in single words, sitting upright in a tripod position, and expiratory wheezes
are barely audible due to minimal air movement ("silent chest"). Following nebulized
albuterol and ipratropium bromide, her condition deteriorates. Which intervention is
indicated next?
A. Administration of intramuscular epinephrine 1:1,000 and preparation for advanced airway
management
B. Immediate administration of oral cough suppressants and reassurance
C. Restriction of all further respiratory medications to prevent toxicity
D. Application of a non-rebreather mask at 6 liters per minute
