PARAMEDIC ENTRANCE ACTUAL FINALS
QUESTIONS AND ANSWERS SET A+
✔✔list the treatment for a severe asthma attack - ✔✔*Assessment: assess airway
during initial assessment and then frequently throughout the call. Assist respiration with
ventilations and supplemental oxygen whenever pt has or develops inadequate
breathing
*Oxygen: main tx for resp difficulty. Non rebreather at 15 lpm
*Positioning: place in position of comfort (most likely sitting up, or tripod)
*Prescribed inhaler: if pt has one, assist if medical direction authorizes
With Medical Direction: SVN with Albuterol
Croup
*During the day, the child will usually have; mild fever, some hoarseness
*At night, condition worsens and develop; a loud "seal bark" cough, difficulty breathing,
signs of respiratory distress including nasal flaring, intercostal retractions, tugging at the
throat, restlessness, paleness with cyanosis
✔✔list the ways in which an allergen can enter the body - ✔✔inhaled, ingested, or enter
through the skin.
✔✔describe the classification, mechanism of action, and initial doses of activated
charcoal - ✔✔Activated Charcoal:
Classification: Gastric decontaminant
Mechinism of Action:
Activated charcoal (AC) is charcoal which has been treated with oxygen, which results
in the opening up of millions of pores between the charcoal's carbon atoms. These
pores directly absorb (bind) the molecules of a multitude of substances. In the EMS
setting, AC is utilized as a single dose gastrointestinal decontaminant following the oral
ingestion of a toxin (in the hospital, multiple doses are sometimes administered to
enhance elimination of a toxin). There are a number of substances that are not
chemically attracted to AC and are absorbed poorly if at all by AC. These include
electrolytes, iron, lithium, heavy metals, acids or bases, alcohols, cyanide, most
,common solvents, and most water insoluble compounds such as hydrocarbons
(petroleum distillates).
Protocol Indication(s):
1. Oral toxic ingestion within 1 hour of EMS contact
Contraindications:
1. Known hypersensitivity 2. Patient with altered mental status without a protected
airway (i.e. not intubated) 3. Due to the increased risk of aspiration without out benefit,
AC should not be administered following the ingestion of a substance known not to be
absorbed by AC 4. Corrosive ingestion (AC obscures endoscopy, which is performed in
such ingestions) unless there are life threatening co-ingestants which are adsorbed by
AC
Precautions:
1. Administration of AC increases the risk for aspiration
Significant adverse/side effects:
1. Nausea/vomiting 2. Intestinal obstruction (associated with the administration of
multiple doses)
Dosage per protocol(s):
Adults and teenagers—Dose is usually 25 to 100 grams. · Children 1 through 12 years
of age—Dose is usually 25 to 50 grams
✔✔describe the classification, mechanism of action, and initial doses of
aspirin(acetylsalicylic acid, ASA) - ✔✔Classification:
Non-steroidal Anti-inflammatory (NSAID)
Mech of Action:
Aspirin (ASA) has analgesic, antipyretic, anti-inflammatory and antithrombotic effects.
ASA is metabolized to salicylic acid, which is the active agent. Salicylic acid irreversibly
inhibits the cycloxygenase (COX) enzyme and results in the decreased production of
COX enzyme mediated end products such as thromboxane A2 (TXA2) and
prostaglandin E2 (PGE2). TXA2 stimulates the activation of new platelets and also
increases platelet aggregation (clumping). By decreasing levels of TXA2, ASA
decreases platelet activation and aggregation. Antiplatelet activity is present within 30-
60 minutes of oral ASA administration and lasts the lifetime of the platelet (7-10 days)
since the effects of ASA are irreversible. PGE2 production. PGE2 is thought to act as a
mediator of inflammation and to sensitize nerve endings to chemical mediators that are
released locally by the inflammatory response. By decreasing levels of PGE2, ASA
decreases pain and inflammation. ASA also reduces fever, which occurs when the set
point of the anterior hypothalamic thermoregulatory center is elevated. Elevation of the
hypothalamic thermoregulatory center can be caused by increased PGE2 synthesis,
stimulated by pyrogens released from white blood cells that are activated by infection,
hypersensitivity, malignancy, or inflammation. ASA decreases the body temperature in
febrile patients by impeding the synthesis and release of PGE2.
Protocol Indication(s):
1. Chest pain/discomfort believed to be of cardiac etiology 2. Acute coronary
syndrome/STEMI 3. Acute decompensated heart failure/pulmonary edema 4. Mild to
moderate pain in an adult patient
Contraindications:
, 1. Known hypersensitivity 2. Environmental hyperthermia 3. Peptic ulcer disease
(relative for cardiac indications) 4. Pedia
✔✔describe the classification, mechanism of action, and initial doses of glucose -
✔✔Dose(Dextrose)
Classification: Carbohydrate
Mech of Action:
Glucose is the primary carbohydrate used by cells for the production of adenosine
triphosphate (ATP), the main source of energy in the body. Glucose is taken into cells
by glucose-transporter proteins. These proteins are activated or stimulated by insulin,
which is released by pancreatic beta cells. While insulin stimulates the rapid uptake of
glucose by all tissues, it is not required for uptake by the brain and some other tissues.
Once in the cell, through the process of glycolysis, glucose is converted to pyruvate,
giving off a small amount of chemical energy (ATP). Pyruvate is then converted to
Acetyl CoA. Through the citric acid cycle (Krebs cycle), Acetyl CoA is processed in the
mitochondria to produce energy precursors. Then through oxidative phosphorylation of
ADP, ATP is produced. In states of low blood glucose or when glucose is unable to
enter the cell, ATP production is decreased, leading to enzymatic and organ
dysfunction. Glucose is rapidly absorbed after IV administration, with a clinical response
observable within minutes. Distribution is widespread, and it reaches the CNS very
quickly. The brain is one of the organs most sensitive to hypoglycemia, but it is unable
to store glucose, making it susceptible to hypoglycemia. Dextrose is administered to
treat known or suspected hypoglycemia from a variety of causes. Dextrose 5% and
water (D5W) is sometimes used as a diluent for IV admixtures and is sometimes used
as a primary IV fluid for "keep vein open" purposes. Dextrose is also combined with
sodium chloride (D5NS, D5½NS) or Lactated Ringers Solution (D5LR) to alter the
osmolality of the solution or to add nutrient value. In some cases (e.g. TPN, insulin
therapy for hyperkalemia or calcium-channel blocker toxicity) dextrose may be
administered to
✔✔describe the classification, mechanism of action, and initial doses of nitroglycerin -
✔✔Classification: Organic nitrate
Mech of Action:
Nitroglycerin is an organic nitrate that is metabolized by smooth muscle to its active
metabolite, nitric oxide (NO). NO relaxes vascular smooth muscle resulting in marked
venous and arterial dilation. The end result is a reduction in cardiac pre and afterload
and a reduction in myocardial oxygen demand. In the setting of cardiac ischemia, NTG
decreases myocardial oxygen demand and improves myocardial oxygen supply. The
reduction of preload decreases heart size and reducing afterload decreases left
ventricular (LV) wall tension (the pressure in the wall of the left ventricle during ejection).
The effect of decreasing heart size and LV wall tension is decreased oxygen demand.
The increase in myocardial oxygen supply occurs secondary to two effects. Decreasing
preload decreases the distending pressure of the heart increasing subendocardial blood
flow (increased pressure collapses the subendocardial vasculature) and by vasodilating
epicardial and collateral coronary arteries, blood flow to ischemic myocardium is
increased. In the setting of acute decompensated heart failure (cardiogenic pulmonary
QUESTIONS AND ANSWERS SET A+
✔✔list the treatment for a severe asthma attack - ✔✔*Assessment: assess airway
during initial assessment and then frequently throughout the call. Assist respiration with
ventilations and supplemental oxygen whenever pt has or develops inadequate
breathing
*Oxygen: main tx for resp difficulty. Non rebreather at 15 lpm
*Positioning: place in position of comfort (most likely sitting up, or tripod)
*Prescribed inhaler: if pt has one, assist if medical direction authorizes
With Medical Direction: SVN with Albuterol
Croup
*During the day, the child will usually have; mild fever, some hoarseness
*At night, condition worsens and develop; a loud "seal bark" cough, difficulty breathing,
signs of respiratory distress including nasal flaring, intercostal retractions, tugging at the
throat, restlessness, paleness with cyanosis
✔✔list the ways in which an allergen can enter the body - ✔✔inhaled, ingested, or enter
through the skin.
✔✔describe the classification, mechanism of action, and initial doses of activated
charcoal - ✔✔Activated Charcoal:
Classification: Gastric decontaminant
Mechinism of Action:
Activated charcoal (AC) is charcoal which has been treated with oxygen, which results
in the opening up of millions of pores between the charcoal's carbon atoms. These
pores directly absorb (bind) the molecules of a multitude of substances. In the EMS
setting, AC is utilized as a single dose gastrointestinal decontaminant following the oral
ingestion of a toxin (in the hospital, multiple doses are sometimes administered to
enhance elimination of a toxin). There are a number of substances that are not
chemically attracted to AC and are absorbed poorly if at all by AC. These include
electrolytes, iron, lithium, heavy metals, acids or bases, alcohols, cyanide, most
,common solvents, and most water insoluble compounds such as hydrocarbons
(petroleum distillates).
Protocol Indication(s):
1. Oral toxic ingestion within 1 hour of EMS contact
Contraindications:
1. Known hypersensitivity 2. Patient with altered mental status without a protected
airway (i.e. not intubated) 3. Due to the increased risk of aspiration without out benefit,
AC should not be administered following the ingestion of a substance known not to be
absorbed by AC 4. Corrosive ingestion (AC obscures endoscopy, which is performed in
such ingestions) unless there are life threatening co-ingestants which are adsorbed by
AC
Precautions:
1. Administration of AC increases the risk for aspiration
Significant adverse/side effects:
1. Nausea/vomiting 2. Intestinal obstruction (associated with the administration of
multiple doses)
Dosage per protocol(s):
Adults and teenagers—Dose is usually 25 to 100 grams. · Children 1 through 12 years
of age—Dose is usually 25 to 50 grams
✔✔describe the classification, mechanism of action, and initial doses of
aspirin(acetylsalicylic acid, ASA) - ✔✔Classification:
Non-steroidal Anti-inflammatory (NSAID)
Mech of Action:
Aspirin (ASA) has analgesic, antipyretic, anti-inflammatory and antithrombotic effects.
ASA is metabolized to salicylic acid, which is the active agent. Salicylic acid irreversibly
inhibits the cycloxygenase (COX) enzyme and results in the decreased production of
COX enzyme mediated end products such as thromboxane A2 (TXA2) and
prostaglandin E2 (PGE2). TXA2 stimulates the activation of new platelets and also
increases platelet aggregation (clumping). By decreasing levels of TXA2, ASA
decreases platelet activation and aggregation. Antiplatelet activity is present within 30-
60 minutes of oral ASA administration and lasts the lifetime of the platelet (7-10 days)
since the effects of ASA are irreversible. PGE2 production. PGE2 is thought to act as a
mediator of inflammation and to sensitize nerve endings to chemical mediators that are
released locally by the inflammatory response. By decreasing levels of PGE2, ASA
decreases pain and inflammation. ASA also reduces fever, which occurs when the set
point of the anterior hypothalamic thermoregulatory center is elevated. Elevation of the
hypothalamic thermoregulatory center can be caused by increased PGE2 synthesis,
stimulated by pyrogens released from white blood cells that are activated by infection,
hypersensitivity, malignancy, or inflammation. ASA decreases the body temperature in
febrile patients by impeding the synthesis and release of PGE2.
Protocol Indication(s):
1. Chest pain/discomfort believed to be of cardiac etiology 2. Acute coronary
syndrome/STEMI 3. Acute decompensated heart failure/pulmonary edema 4. Mild to
moderate pain in an adult patient
Contraindications:
, 1. Known hypersensitivity 2. Environmental hyperthermia 3. Peptic ulcer disease
(relative for cardiac indications) 4. Pedia
✔✔describe the classification, mechanism of action, and initial doses of glucose -
✔✔Dose(Dextrose)
Classification: Carbohydrate
Mech of Action:
Glucose is the primary carbohydrate used by cells for the production of adenosine
triphosphate (ATP), the main source of energy in the body. Glucose is taken into cells
by glucose-transporter proteins. These proteins are activated or stimulated by insulin,
which is released by pancreatic beta cells. While insulin stimulates the rapid uptake of
glucose by all tissues, it is not required for uptake by the brain and some other tissues.
Once in the cell, through the process of glycolysis, glucose is converted to pyruvate,
giving off a small amount of chemical energy (ATP). Pyruvate is then converted to
Acetyl CoA. Through the citric acid cycle (Krebs cycle), Acetyl CoA is processed in the
mitochondria to produce energy precursors. Then through oxidative phosphorylation of
ADP, ATP is produced. In states of low blood glucose or when glucose is unable to
enter the cell, ATP production is decreased, leading to enzymatic and organ
dysfunction. Glucose is rapidly absorbed after IV administration, with a clinical response
observable within minutes. Distribution is widespread, and it reaches the CNS very
quickly. The brain is one of the organs most sensitive to hypoglycemia, but it is unable
to store glucose, making it susceptible to hypoglycemia. Dextrose is administered to
treat known or suspected hypoglycemia from a variety of causes. Dextrose 5% and
water (D5W) is sometimes used as a diluent for IV admixtures and is sometimes used
as a primary IV fluid for "keep vein open" purposes. Dextrose is also combined with
sodium chloride (D5NS, D5½NS) or Lactated Ringers Solution (D5LR) to alter the
osmolality of the solution or to add nutrient value. In some cases (e.g. TPN, insulin
therapy for hyperkalemia or calcium-channel blocker toxicity) dextrose may be
administered to
✔✔describe the classification, mechanism of action, and initial doses of nitroglycerin -
✔✔Classification: Organic nitrate
Mech of Action:
Nitroglycerin is an organic nitrate that is metabolized by smooth muscle to its active
metabolite, nitric oxide (NO). NO relaxes vascular smooth muscle resulting in marked
venous and arterial dilation. The end result is a reduction in cardiac pre and afterload
and a reduction in myocardial oxygen demand. In the setting of cardiac ischemia, NTG
decreases myocardial oxygen demand and improves myocardial oxygen supply. The
reduction of preload decreases heart size and reducing afterload decreases left
ventricular (LV) wall tension (the pressure in the wall of the left ventricle during ejection).
The effect of decreasing heart size and LV wall tension is decreased oxygen demand.
The increase in myocardial oxygen supply occurs secondary to two effects. Decreasing
preload decreases the distending pressure of the heart increasing subendocardial blood
flow (increased pressure collapses the subendocardial vasculature) and by vasodilating
epicardial and collateral coronary arteries, blood flow to ischemic myocardium is
increased. In the setting of acute decompensated heart failure (cardiogenic pulmonary
