Chelan County EMS Protocols Exam With
Practice Questions And Correct Answers
(Verified An
1. In Chelan County EMS protocol, which intervention is indicated for an adult in
refractory ventricular fibrillation after the third defibrillation attempt, when standard
ACLS measures including epinephrine and amiodarone have been administered?
A. Immediate double sequential external defibrillation (DSED)
B. Administration of sodium bicarbonate 1 mEq/kg
C. Transition to mechanical CPR with a load-distributing band
D. Consideration of extracorporeal CPR (eCPR) per regional protocol
Answer: D. Consideration of extracorporeal CPR (eCPR) per regional protocol
Rationale: Chelan County protocol incorporates eCPR consideration for refractory VF
after standard ACLS and antiarrhythmics, reflecting current evidence. DSED and
mechanical CPR are not first-line in this protocol; sodium bicarbonate is not routinely
indicated.
2. A patient with severe asthma exacerbation receives continuous albuterol via
nebulizer. Per Chelan County protocol, which adjunct medication should be added if
the patient has a history of cardiac arrhythmias and remains in status asthmaticus?
A. Ipratropium bromide
B. Magnesium sulfate
C. Epinephrine 1:1000 IM
D. Methylprednisolone
Answer: B. Magnesium sulfate
Rationale: Magnesium sulfate is the preferred adjunct for severe asthma unresponsive to
beta-agonists, especially with arrhythmia history, as it has bronchodilator and
antiarrhythmic properties. Ipratropium is often combined but not specifically for
arrhythmia; epinephrine may worsen arrhythmias; steroids have delayed onset.
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,3. Which of the following best describes the Chelan County EMS protocol's guidance
on prehospital 12-lead ECG acquisition and transmission for suspected STEMI?
A. Obtain within 5 minutes of patient contact and transmit to receiving PCI center for
activation
B. Obtain only if transport time exceeds 15 minutes and transmit to medical control
C. Obtain after administering aspirin and nitroglycerin, and transmit to ED physician
D. Obtain only for patients with chest pain and a history of coronary artery disease
Answer: A. Obtain within 5 minutes of patient contact and transmit to receiving PCI
center for activation
Rationale: Chelan County protocol mandates early 12-lead acquisition (within 5 minutes)
and direct transmission to the PCI center to facilitate early activation, reducing
door-to-balloon time. Other options reflect outdated or restrictive practices.
4. During a mass casualty incident in Chelan County, a patient with a Glasgow Coma
Scale score of 13, respiratory rate of 28, and systolic blood pressure of 90 mmHg is
triaged. According to the protocol's START triage method, what is the correct triage
category?
A. Red (Immediate)
B. Yellow (Delayed)
C. Green (Minor)
D. Black (Deceased/Expectant)
Answer: A. Red (Immediate)
Rationale: Under START triage, a patient who cannot follow simple commands or has a
respiratory rate >30 or systolic BP <90 is categorized as Red (Immediate). This patient
meets two criteria (RR 28 is not >30, but SBP 90 is not <90; however GCS 13 indicates
altered mental status, which is a Red criterion).
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,5. A patient presents with signs of opioid overdose: pinpoint pupils, respiratory
depression, and unresponsiveness. After administering naloxone per Chelan County
protocol, the patient's respiratory rate improves but they remain unconscious. What is
the most appropriate next action?
A. Administer a second dose of naloxone
B. Begin bag-valve-mask ventilation and transport
C. Place the patient in a recovery position and monitor
D. Administer flumazenil to reverse possible benzodiazepine co-ingestion
Answer: B. Begin bag-valve-mask ventilation and transport
Rationale: Naloxone reverses respiratory depression but may not fully restore
consciousness; the priority is supporting ventilation and transport. Additional naloxone is
not indicated if respiratory rate is adequate; flumazenil is contraindicated in mixed
overdose due to seizure risk.
6. In Chelan County EMS protocol, which of the following is a contraindication to the
administration of nitroglycerin in a patient with suspected acute coronary syndrome?
A. Heart rate of 110 beats per minute
B. Systolic blood pressure of 100 mmHg
C. Use of erectile dysfunction medications within 24 hours
D. History of myocardial infarction
Answer: C. Use of erectile dysfunction medications within 24 hours
Rationale: Nitroglycerin is contraindicated with recent phosphodiesterase inhibitor use
(e.g., sildenafil) due to risk of severe hypotension. A heart rate of 110 is not a
contraindication; SBP of 100 is borderline but not absolute; prior MI is not a
contraindication.
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, 7. A patient with a suspected cervical spine injury requires airway management.
According to Chelan County protocol, which technique is preferred for endotracheal
intubation to minimize spinal movement?
A. Direct laryngoscopy with manual in-line stabilization
B. Video laryngoscopy with manual in-line stabilization
C. Blind nasotracheal intubation
D. Retrograde intubation
Answer: B. Video laryngoscopy with manual in-line stabilization
Rationale: Video laryngoscopy with manual in-line stabilization is preferred as it improves
glottic visualization while minimizing cervical spine movement. Direct laryngoscopy may
cause more movement; blind nasotracheal and retrograde are less commonly used and
have higher complication rates.
8. Which of the following is the correct initial energy setting for synchronized
cardioversion in a patient with unstable supraventricular tachycardia per Chelan
County EMS protocol?
A. 50 joules
B. 100 joules
C. 150 joules
D. 200 joules
Answer: B. 100 joules
Rationale: Chelan County protocol recommends an initial synchronized cardioversion
energy of 100 joules for unstable SVT, consistent with AHA guidelines. Lower energies may
be ineffective; higher energies are typically used for atrial fibrillation or ventricular
tachycardia.
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Practice Questions And Correct Answers
(Verified An
1. In Chelan County EMS protocol, which intervention is indicated for an adult in
refractory ventricular fibrillation after the third defibrillation attempt, when standard
ACLS measures including epinephrine and amiodarone have been administered?
A. Immediate double sequential external defibrillation (DSED)
B. Administration of sodium bicarbonate 1 mEq/kg
C. Transition to mechanical CPR with a load-distributing band
D. Consideration of extracorporeal CPR (eCPR) per regional protocol
Answer: D. Consideration of extracorporeal CPR (eCPR) per regional protocol
Rationale: Chelan County protocol incorporates eCPR consideration for refractory VF
after standard ACLS and antiarrhythmics, reflecting current evidence. DSED and
mechanical CPR are not first-line in this protocol; sodium bicarbonate is not routinely
indicated.
2. A patient with severe asthma exacerbation receives continuous albuterol via
nebulizer. Per Chelan County protocol, which adjunct medication should be added if
the patient has a history of cardiac arrhythmias and remains in status asthmaticus?
A. Ipratropium bromide
B. Magnesium sulfate
C. Epinephrine 1:1000 IM
D. Methylprednisolone
Answer: B. Magnesium sulfate
Rationale: Magnesium sulfate is the preferred adjunct for severe asthma unresponsive to
beta-agonists, especially with arrhythmia history, as it has bronchodilator and
antiarrhythmic properties. Ipratropium is often combined but not specifically for
arrhythmia; epinephrine may worsen arrhythmias; steroids have delayed onset.
Page 1 of 78
,3. Which of the following best describes the Chelan County EMS protocol's guidance
on prehospital 12-lead ECG acquisition and transmission for suspected STEMI?
A. Obtain within 5 minutes of patient contact and transmit to receiving PCI center for
activation
B. Obtain only if transport time exceeds 15 minutes and transmit to medical control
C. Obtain after administering aspirin and nitroglycerin, and transmit to ED physician
D. Obtain only for patients with chest pain and a history of coronary artery disease
Answer: A. Obtain within 5 minutes of patient contact and transmit to receiving PCI
center for activation
Rationale: Chelan County protocol mandates early 12-lead acquisition (within 5 minutes)
and direct transmission to the PCI center to facilitate early activation, reducing
door-to-balloon time. Other options reflect outdated or restrictive practices.
4. During a mass casualty incident in Chelan County, a patient with a Glasgow Coma
Scale score of 13, respiratory rate of 28, and systolic blood pressure of 90 mmHg is
triaged. According to the protocol's START triage method, what is the correct triage
category?
A. Red (Immediate)
B. Yellow (Delayed)
C. Green (Minor)
D. Black (Deceased/Expectant)
Answer: A. Red (Immediate)
Rationale: Under START triage, a patient who cannot follow simple commands or has a
respiratory rate >30 or systolic BP <90 is categorized as Red (Immediate). This patient
meets two criteria (RR 28 is not >30, but SBP 90 is not <90; however GCS 13 indicates
altered mental status, which is a Red criterion).
Page 2 of 78
,5. A patient presents with signs of opioid overdose: pinpoint pupils, respiratory
depression, and unresponsiveness. After administering naloxone per Chelan County
protocol, the patient's respiratory rate improves but they remain unconscious. What is
the most appropriate next action?
A. Administer a second dose of naloxone
B. Begin bag-valve-mask ventilation and transport
C. Place the patient in a recovery position and monitor
D. Administer flumazenil to reverse possible benzodiazepine co-ingestion
Answer: B. Begin bag-valve-mask ventilation and transport
Rationale: Naloxone reverses respiratory depression but may not fully restore
consciousness; the priority is supporting ventilation and transport. Additional naloxone is
not indicated if respiratory rate is adequate; flumazenil is contraindicated in mixed
overdose due to seizure risk.
6. In Chelan County EMS protocol, which of the following is a contraindication to the
administration of nitroglycerin in a patient with suspected acute coronary syndrome?
A. Heart rate of 110 beats per minute
B. Systolic blood pressure of 100 mmHg
C. Use of erectile dysfunction medications within 24 hours
D. History of myocardial infarction
Answer: C. Use of erectile dysfunction medications within 24 hours
Rationale: Nitroglycerin is contraindicated with recent phosphodiesterase inhibitor use
(e.g., sildenafil) due to risk of severe hypotension. A heart rate of 110 is not a
contraindication; SBP of 100 is borderline but not absolute; prior MI is not a
contraindication.
Page 3 of 78
, 7. A patient with a suspected cervical spine injury requires airway management.
According to Chelan County protocol, which technique is preferred for endotracheal
intubation to minimize spinal movement?
A. Direct laryngoscopy with manual in-line stabilization
B. Video laryngoscopy with manual in-line stabilization
C. Blind nasotracheal intubation
D. Retrograde intubation
Answer: B. Video laryngoscopy with manual in-line stabilization
Rationale: Video laryngoscopy with manual in-line stabilization is preferred as it improves
glottic visualization while minimizing cervical spine movement. Direct laryngoscopy may
cause more movement; blind nasotracheal and retrograde are less commonly used and
have higher complication rates.
8. Which of the following is the correct initial energy setting for synchronized
cardioversion in a patient with unstable supraventricular tachycardia per Chelan
County EMS protocol?
A. 50 joules
B. 100 joules
C. 150 joules
D. 200 joules
Answer: B. 100 joules
Rationale: Chelan County protocol recommends an initial synchronized cardioversion
energy of 100 joules for unstable SVT, consistent with AHA guidelines. Lower energies may
be ineffective; higher energies are typically used for atrial fibrillation or ventricular
tachycardia.
Page 4 of 78
