NYC REMAC PROTOCOLS 2020 KEY
POINTS AND CONSIDERATIONS Exam
Questions With Detailed Answers
Introduction - ANS-Each level provider should start from the top of any given protocol,
and complete the treatments in the order listed. EMTs and Paramedics should complete
their treatments for the lower provider levels before proceeding to the section for their
level of care.
Introduction: Pediatric Protocols start at what age - ANS-Pediatric protocols should be
considered for patients who have not yet reached their 15th birthday.
General Cardiac Arrest Care (Non-traumatic) (Adult) - ANS-Special Considerations
When applying pads: if a pt has a medication patch, it should be removed (use PPE)
prior to pad placement, the chest should be dry, if needed shave chest hair
attach external chest pads
if pt has a pacemaker position pads at least 1 inch away from the pacemaker device.
VFIB/ Pulseless V-Tach (adult) - ANS-Do not interrupt compressions for placement of
an advanced airway
maximum joule setting may vary depending on defibrillator
Calcium Chloride and Sodium Bicarb should be given in separate IV lines or separated
by at least a 2cc flush.
PEA/ Asystole (adult) - ANS-Do not interrupt compressions for advanced airway
consider possibility of conditions masquerading PEA/Asystole which require immediate
intervention
If the glucometer reading is above 60mg/dL, dextrose should be withheld.
Calcium Chloride and Sodium Bicarb must be separate lines or 20cc flush.
, Non traumatic Cardiac Arrest and Severe Bradycardia (pediatric) - ANS-The IV dose of
Epinephrine is 0.01mg/kg (0.1mL/kg 1:10,000 solution)
refer all weight based fluids.meds to e Length Based Dosing Device
15:2 ration of compressions to ventilations at a rate of 120 events (105 compressions :
15 ventilations) per minute.
If defib is unable to deliver recommended dose, use the lowest available setting.
Respiratory Distress/Failure/APE (adult) - ANS-All pts must have ventilators assistance
unless a valid NYS Prehospital DNR and/or MOLST for is presented.
Assisted ventilations should be done with pocket mask, 02 10-15LPM or BVM and
reservoir flow set 10-15LPM
*Drug advisories* Nitroglycerin- shall not be administered to pts who have used erectile
dysfunction meds in the past 72 hours, unless otherwise directed by telemetry. Or BP
<100mmHg
Respiratory Distress/Failure/Arrest (pediatric) - ANS-respiratory. Distress characterized
by: increased resp. Effort WITHOUT central cyanosis. Ie: anxiety, nasal flaring, or
intercostal retractions
resp. Failure characterized by: ineffective resp. Effort WITH central cyanosis. Ie:
agitation, lethargy, severe dyspnea, labored breathing, bobbing, grunting, or
intercostal/parasternal retractions
bradycardia is ominous sign that indicated hypoxia cardiac arrest may be imminent
high flow 02 always should be used
DO NOT press mask against eyes
DO NOtT hyperextend neck.
Tension pneumothorax may develop
AMS (adult and pediatric) - ANS-Consider trauma, medical, behavior underlying issue
utilize law enforcement for suicidal/violent threats of imposed danger to pt or crew
do not admin. Any oral solutions if pt is unconscious or pt with head injuries
Diabetic pts w. A BGL reading between 6-80 mg/dL may still be hypoglycemic
Each certification level provider may administer a MAX of TWO Narcan doses as
described in their protocol section
POINTS AND CONSIDERATIONS Exam
Questions With Detailed Answers
Introduction - ANS-Each level provider should start from the top of any given protocol,
and complete the treatments in the order listed. EMTs and Paramedics should complete
their treatments for the lower provider levels before proceeding to the section for their
level of care.
Introduction: Pediatric Protocols start at what age - ANS-Pediatric protocols should be
considered for patients who have not yet reached their 15th birthday.
General Cardiac Arrest Care (Non-traumatic) (Adult) - ANS-Special Considerations
When applying pads: if a pt has a medication patch, it should be removed (use PPE)
prior to pad placement, the chest should be dry, if needed shave chest hair
attach external chest pads
if pt has a pacemaker position pads at least 1 inch away from the pacemaker device.
VFIB/ Pulseless V-Tach (adult) - ANS-Do not interrupt compressions for placement of
an advanced airway
maximum joule setting may vary depending on defibrillator
Calcium Chloride and Sodium Bicarb should be given in separate IV lines or separated
by at least a 2cc flush.
PEA/ Asystole (adult) - ANS-Do not interrupt compressions for advanced airway
consider possibility of conditions masquerading PEA/Asystole which require immediate
intervention
If the glucometer reading is above 60mg/dL, dextrose should be withheld.
Calcium Chloride and Sodium Bicarb must be separate lines or 20cc flush.
, Non traumatic Cardiac Arrest and Severe Bradycardia (pediatric) - ANS-The IV dose of
Epinephrine is 0.01mg/kg (0.1mL/kg 1:10,000 solution)
refer all weight based fluids.meds to e Length Based Dosing Device
15:2 ration of compressions to ventilations at a rate of 120 events (105 compressions :
15 ventilations) per minute.
If defib is unable to deliver recommended dose, use the lowest available setting.
Respiratory Distress/Failure/APE (adult) - ANS-All pts must have ventilators assistance
unless a valid NYS Prehospital DNR and/or MOLST for is presented.
Assisted ventilations should be done with pocket mask, 02 10-15LPM or BVM and
reservoir flow set 10-15LPM
*Drug advisories* Nitroglycerin- shall not be administered to pts who have used erectile
dysfunction meds in the past 72 hours, unless otherwise directed by telemetry. Or BP
<100mmHg
Respiratory Distress/Failure/Arrest (pediatric) - ANS-respiratory. Distress characterized
by: increased resp. Effort WITHOUT central cyanosis. Ie: anxiety, nasal flaring, or
intercostal retractions
resp. Failure characterized by: ineffective resp. Effort WITH central cyanosis. Ie:
agitation, lethargy, severe dyspnea, labored breathing, bobbing, grunting, or
intercostal/parasternal retractions
bradycardia is ominous sign that indicated hypoxia cardiac arrest may be imminent
high flow 02 always should be used
DO NOT press mask against eyes
DO NOtT hyperextend neck.
Tension pneumothorax may develop
AMS (adult and pediatric) - ANS-Consider trauma, medical, behavior underlying issue
utilize law enforcement for suicidal/violent threats of imposed danger to pt or crew
do not admin. Any oral solutions if pt is unconscious or pt with head injuries
Diabetic pts w. A BGL reading between 6-80 mg/dL may still be hypoglycemic
Each certification level provider may administer a MAX of TWO Narcan doses as
described in their protocol section
