NYC REMAC ALS PROTOCOLS ACTUAL
EXAM QUESTIONS WITH 100%
ACCURATE SOLUTIONS SCORED A+
500-A -Smoke Inhalation: - ANS-1. BLS Procedures
2. If necessary, perform Advanced Airway Management
3. Begin Cardiac & Pulse Ox monitoring
4. Begin SPCO Monitoring if available
5. Begin two IV infusions of Normal Saline (0.9% NS). Refer to protocol 528 for all
patients with burns.
6. Patients with following symptoms, after exposure to smoke in an enclosed space,
should be administered the medications in table 1, if available.
- Hypotension not attributed to other causes
-AMS
-Come
-Seizures
-Respiratory Arrest
-Cardiac Arrest
NOTE: Prior to administration of Hydroxocobalamin, obtain 3 blood samples using the
tubes provided in the cyanide toxicity kit, if available.
Whenever Hydroxocobalamin is administered, follow with a 20ml flush of Normal Saline
prior to any other medication administration
TABLE 1 -One Bottle Kit- (5.0gm/200mL/bottle)
Infant/Toddler (0-2 years): Hydroxocobalamin 1/4 bottle. Sodium Thiosulfate 250mg/kg
(3cc/kg prepared solution) administered over 10 minutes, IV
,Preschool (3-5 years): Hydroxocobalamin 1/4 bottle. Sodium Thiosulfate 250mg/kg
(3cc/kg prepared solution) administered over 10 minutes, IV
Grade School (6-14 years): Hydroxocobalamin 1/2 bottle. Sodium Thiosulfate 250mg/kg
(3cc/kg prepared solution) administered over 10 minutes, IV
Adult (>15 years): Hydroxocobalamin 1 bottle. Sodium Thiosulfate 12.5 g (150ml of
prepared solution) over 10 minutes IV
Hydroxocobalamin may be mixed with D5W, Normal Saline, or Lactated Ringers. The
vented macro drip tubing that accompanies the Cyanokit, should be used, wide open to
ensure correct administration time of approximately 15 minutes for the kit.
Sodium Thiosulfate solution should be prepared by adding 12.5g (50mL) to a 100cc bag
of D5W
NOTE: In the event that only one intravascular access line is established, administer
Hydroxocobalamin first before Sodium Thiosulfate.
502-Obstructed Airway - ANS-1. Begin BLS procedures
2. Direct Laryngoscopy. If possible remove blockage with Magill forceps
3. Advanced Airway Management
4. If able to confirm tube placement but unable to ventilate:
-Note ET tube depth
-Deflate cuff
-Advance ET tube to max depth
-Return to original depth
-Inflate cuff and attempt ventilation
-If still unable to ventilate, rapid transport
5. Transport Decision
, 503-A -V-Fib/Pulseless V-Tach - ANS-1. Continue CPR with minimal interruptions
NOTE: In witnessed arrests, perform CPR until defib attatched. In unwitnessed perform
2 mins CPR prior to defib use
2. Defib using max joule setting
NOTE: If patient has permanent pacemaker in place, position defib pads at least one
inch away from pacemaker
3. Continue CPR. If no change in rhythm, defib at max setting.
4. Continue CPR. If no change in rhythm, defib at max setting.
5. Advanced Airway Management
6. If after every 2 mins of CPR there is still no change, defib at max setting
7. IV/IO
8. Vasopression, if available, 40 units IV/IO
9. If no change, Amiodarone 300mg IV/IO
10. Epinephrine 1mg 1:10,000 every 3-5 mins IV/IO
MEDICAL CONTROL OPTIONS:
A. Amiodarone 150mg IV/IO
B. Sodium Bicarb 44-88 mEq IV/IO. Repeat 44 mEq every 10 minutes.
C. Magnesium Sulfate 2g diluted in 10ml NS over 2 minutes IV/IO
D. Calcium Chloride 1g IV/IO
E. Transport Decision
503-B -PEA/Asystole - ANS-1. CPR with minimal interruptions
2. If Tension Pneumothorax suspected, perform Needle Decompression
3. Advanced Airway Management
EXAM QUESTIONS WITH 100%
ACCURATE SOLUTIONS SCORED A+
500-A -Smoke Inhalation: - ANS-1. BLS Procedures
2. If necessary, perform Advanced Airway Management
3. Begin Cardiac & Pulse Ox monitoring
4. Begin SPCO Monitoring if available
5. Begin two IV infusions of Normal Saline (0.9% NS). Refer to protocol 528 for all
patients with burns.
6. Patients with following symptoms, after exposure to smoke in an enclosed space,
should be administered the medications in table 1, if available.
- Hypotension not attributed to other causes
-AMS
-Come
-Seizures
-Respiratory Arrest
-Cardiac Arrest
NOTE: Prior to administration of Hydroxocobalamin, obtain 3 blood samples using the
tubes provided in the cyanide toxicity kit, if available.
Whenever Hydroxocobalamin is administered, follow with a 20ml flush of Normal Saline
prior to any other medication administration
TABLE 1 -One Bottle Kit- (5.0gm/200mL/bottle)
Infant/Toddler (0-2 years): Hydroxocobalamin 1/4 bottle. Sodium Thiosulfate 250mg/kg
(3cc/kg prepared solution) administered over 10 minutes, IV
,Preschool (3-5 years): Hydroxocobalamin 1/4 bottle. Sodium Thiosulfate 250mg/kg
(3cc/kg prepared solution) administered over 10 minutes, IV
Grade School (6-14 years): Hydroxocobalamin 1/2 bottle. Sodium Thiosulfate 250mg/kg
(3cc/kg prepared solution) administered over 10 minutes, IV
Adult (>15 years): Hydroxocobalamin 1 bottle. Sodium Thiosulfate 12.5 g (150ml of
prepared solution) over 10 minutes IV
Hydroxocobalamin may be mixed with D5W, Normal Saline, or Lactated Ringers. The
vented macro drip tubing that accompanies the Cyanokit, should be used, wide open to
ensure correct administration time of approximately 15 minutes for the kit.
Sodium Thiosulfate solution should be prepared by adding 12.5g (50mL) to a 100cc bag
of D5W
NOTE: In the event that only one intravascular access line is established, administer
Hydroxocobalamin first before Sodium Thiosulfate.
502-Obstructed Airway - ANS-1. Begin BLS procedures
2. Direct Laryngoscopy. If possible remove blockage with Magill forceps
3. Advanced Airway Management
4. If able to confirm tube placement but unable to ventilate:
-Note ET tube depth
-Deflate cuff
-Advance ET tube to max depth
-Return to original depth
-Inflate cuff and attempt ventilation
-If still unable to ventilate, rapid transport
5. Transport Decision
, 503-A -V-Fib/Pulseless V-Tach - ANS-1. Continue CPR with minimal interruptions
NOTE: In witnessed arrests, perform CPR until defib attatched. In unwitnessed perform
2 mins CPR prior to defib use
2. Defib using max joule setting
NOTE: If patient has permanent pacemaker in place, position defib pads at least one
inch away from pacemaker
3. Continue CPR. If no change in rhythm, defib at max setting.
4. Continue CPR. If no change in rhythm, defib at max setting.
5. Advanced Airway Management
6. If after every 2 mins of CPR there is still no change, defib at max setting
7. IV/IO
8. Vasopression, if available, 40 units IV/IO
9. If no change, Amiodarone 300mg IV/IO
10. Epinephrine 1mg 1:10,000 every 3-5 mins IV/IO
MEDICAL CONTROL OPTIONS:
A. Amiodarone 150mg IV/IO
B. Sodium Bicarb 44-88 mEq IV/IO. Repeat 44 mEq every 10 minutes.
C. Magnesium Sulfate 2g diluted in 10ml NS over 2 minutes IV/IO
D. Calcium Chloride 1g IV/IO
E. Transport Decision
503-B -PEA/Asystole - ANS-1. CPR with minimal interruptions
2. If Tension Pneumothorax suspected, perform Needle Decompression
3. Advanced Airway Management
