SUFFOLK ALS PROTOCOLS EXAM
QUESTIONS AND COMPLETE
SOLUTIONS GRADED A+
Your Exam Plug
,ALS ADULT CARE - Answer: For patients that do not fit into a specific protocol.
In addition this protocol is not intended for unstable patients. Unstable patients include those with:
-Pulse less than (<) 50 or over 110
-SBP less than (<) 90mmHg or above 180mmHg
-DBP over 110mmHg
Respiratory rate less than (<) 10 or above 29
-Persistent chest pain or discomfort.
-Persistent respiratory distress; unresolved AMS
-Status Post Cardiac or Respiratory Arrest
-Multisystem Trauma or Penetrating Trauma
-Assist airway / breathing / circulation.
-Protect cervical spine if necessary.
-Perform patient assessment as per NYS BLS protocols.
Administer Oxygen as per NYS BLS protocols.
-If the patient's signs / symptoms indicate that only BLS care is indicated, refer to
appropriate NYS BLS protocol.
-If the findings or signs / symptoms indicate that the patient fits into a specific
ALS protocol, refer to that protocol immediately.
-IV NS to KVO, or Saline Lock
-Apply Cardiac Monitor
-Perform Blood Glucose determination.
ADULT ADVANCED AIRWAY - Answer: EMT CC & MEDIC
-BLS Airway Management - OPA / NPA / BVM Suction as appropriate.
-BLS foreign body obstruction techniques as appropriate.
-Pulse oximetry, waveform capnography, cardiac monitor as appropriate.
-Endotracheal intubation / Supraglottic airway if indicated.
-Use of Magill forceps to remove foreign body obstruction.
MEDIC
,-Needle cricothyrotomy for unrelieved airway obstruction.
-MFI or RSI if agency is authorized and Paramedic is credentialed.
-ATV if approved by the agency in accordance with Appendix 48.
MEDICAL CONTROL OPTIONS
-Repeat any of the above.
ADULT RAPID SEQUENCE INTUBATION - Answer: This protocol is intended for use by agencies authorized
by their Service Medical Director and approved by the REMAC. Providers must have received specialized
training in Rapid Sequence Intubation prior to implementing this protocol. INDICATIONS: RSI may be
utilized by a single paramedic on standing orders in any adult protocol requiring advanced airway
management when definitive airway control is necessary for patients in imminent respiratory
compromise and / or failure; and where no other means of securing an airway can be obtained without
the use of sedative agents.
Paramedic
-If patient is exhibiting signs of respiratory compromise and / or the airway is not secure, pre-oxygenate
the patient via BVM or NRB and Nasal Cannula. Begin apneic oxygenation with NC at 15 lpm or
maximally tolerated rate, and continue until endotracheal tube or extraglottic airway is confirmed.
-IVofNSKVO
-Consider Fentanyl, up to 2 mcg / kg SLOW IV / IO, for pre-induction analgesia and in cases of elevated
intracranial
pressure, as long as the SBP is above than 90.
-Administer Etomidate 0.3 mg / kg over 30-60 sec IV / IO push OR Ketamine up to 1-2 mg / kg IVP / IO.
-Administer Succinylcholine 1.5mg / kg IV / IO push. (If Succinylcholine is contraindicated, administer
Rocuronium
1 mg / kg IV / IO push.)
-When paralysis is achieved, intubate the patient then confirm ET tube placement with lung sounds and
waveform
EtCO2. *(Maximum of 2 ETI attempts, interchanged with BVM ventilations.)*
-If attempts at intubation fail, insert Supraglottic airway via protocol.
-If unable to adequately oxygenate the patient by use of the above means, perform needle
cricothyrotomy as per
protocol to oxygenate.
, -Confirm ET tube or Supraglottic airway placement and attach a continuous EtCO2 monitor (ventilate to
maintain
EtCO2 between 35-45 mmHg), and secure the E
ADULT MEDICATION FACILITATED INTUBATION - Answer: This protocol is intended for use by agencies
authorized by their Service Medical Director and approved by the REMAC. Providers must have received
specialized training and are authorized in Medication Facilitated Intubation (MFI) prior to implementing
this protocol. INDICATIONS: Medication Facilitated Intubations may be utilized on standing orders in any
protocol requiring advanced airway management when definitive airway control is necessary for
patients in imminent respiratory comprise and / or failure; and where no other means of securing an
airway can be obtained without the use of sedative agents.
CONTRAINDICATIONS / PRECAUTIONS: The use of sedation agents is contraindicated in patients that
cannot be ventilated with a bag-valve-mask (BVM) due to anatomy, facial / airway trauma or other
reasons.
-Properly position the patient. Apply Pulse Oximetry and ECG monitor with high flow oxygen via NRB.
-Assemble and test all basic and advanced airway equipment including suction.
• If patient is exhibiting signs of respiratory compromise and / or the airway is not secure, pre-oxygenate
the patient via
BVM while applying laryngeal manipulation.•
-IVofNSKVO•
-Administer Etomidate 0.3 mg/kg over 30-60 sec IV push.
• When deep sedation is achieved, intubate the patient and then confirm ET tube placement with lung
sounds and
waveform EtCO2. (Maximum of 2 ETI attempts < 15 seconds, interchanged with BVM ventilations.)
• If attempts at intubation fail, insert Supraglottic via protocol. Must be unconscious or heavily sedated.
• If unable to adequately ventilate the patient by use of the above means, perform a needle
cricothyrotomy as per
protocol to oxygenate.
• Confirm ET tube or Combitube placement and attach a continuous EtCO2 monitor (ventilate to
maintain EtCO2 between 35-45 mmHg) and secure the ET tube via protocol.
-If addi
VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA - Answer: - Follow NYS BLS
protocols for cardiac arrest care.
QUESTIONS AND COMPLETE
SOLUTIONS GRADED A+
Your Exam Plug
,ALS ADULT CARE - Answer: For patients that do not fit into a specific protocol.
In addition this protocol is not intended for unstable patients. Unstable patients include those with:
-Pulse less than (<) 50 or over 110
-SBP less than (<) 90mmHg or above 180mmHg
-DBP over 110mmHg
Respiratory rate less than (<) 10 or above 29
-Persistent chest pain or discomfort.
-Persistent respiratory distress; unresolved AMS
-Status Post Cardiac or Respiratory Arrest
-Multisystem Trauma or Penetrating Trauma
-Assist airway / breathing / circulation.
-Protect cervical spine if necessary.
-Perform patient assessment as per NYS BLS protocols.
Administer Oxygen as per NYS BLS protocols.
-If the patient's signs / symptoms indicate that only BLS care is indicated, refer to
appropriate NYS BLS protocol.
-If the findings or signs / symptoms indicate that the patient fits into a specific
ALS protocol, refer to that protocol immediately.
-IV NS to KVO, or Saline Lock
-Apply Cardiac Monitor
-Perform Blood Glucose determination.
ADULT ADVANCED AIRWAY - Answer: EMT CC & MEDIC
-BLS Airway Management - OPA / NPA / BVM Suction as appropriate.
-BLS foreign body obstruction techniques as appropriate.
-Pulse oximetry, waveform capnography, cardiac monitor as appropriate.
-Endotracheal intubation / Supraglottic airway if indicated.
-Use of Magill forceps to remove foreign body obstruction.
MEDIC
,-Needle cricothyrotomy for unrelieved airway obstruction.
-MFI or RSI if agency is authorized and Paramedic is credentialed.
-ATV if approved by the agency in accordance with Appendix 48.
MEDICAL CONTROL OPTIONS
-Repeat any of the above.
ADULT RAPID SEQUENCE INTUBATION - Answer: This protocol is intended for use by agencies authorized
by their Service Medical Director and approved by the REMAC. Providers must have received specialized
training in Rapid Sequence Intubation prior to implementing this protocol. INDICATIONS: RSI may be
utilized by a single paramedic on standing orders in any adult protocol requiring advanced airway
management when definitive airway control is necessary for patients in imminent respiratory
compromise and / or failure; and where no other means of securing an airway can be obtained without
the use of sedative agents.
Paramedic
-If patient is exhibiting signs of respiratory compromise and / or the airway is not secure, pre-oxygenate
the patient via BVM or NRB and Nasal Cannula. Begin apneic oxygenation with NC at 15 lpm or
maximally tolerated rate, and continue until endotracheal tube or extraglottic airway is confirmed.
-IVofNSKVO
-Consider Fentanyl, up to 2 mcg / kg SLOW IV / IO, for pre-induction analgesia and in cases of elevated
intracranial
pressure, as long as the SBP is above than 90.
-Administer Etomidate 0.3 mg / kg over 30-60 sec IV / IO push OR Ketamine up to 1-2 mg / kg IVP / IO.
-Administer Succinylcholine 1.5mg / kg IV / IO push. (If Succinylcholine is contraindicated, administer
Rocuronium
1 mg / kg IV / IO push.)
-When paralysis is achieved, intubate the patient then confirm ET tube placement with lung sounds and
waveform
EtCO2. *(Maximum of 2 ETI attempts, interchanged with BVM ventilations.)*
-If attempts at intubation fail, insert Supraglottic airway via protocol.
-If unable to adequately oxygenate the patient by use of the above means, perform needle
cricothyrotomy as per
protocol to oxygenate.
, -Confirm ET tube or Supraglottic airway placement and attach a continuous EtCO2 monitor (ventilate to
maintain
EtCO2 between 35-45 mmHg), and secure the E
ADULT MEDICATION FACILITATED INTUBATION - Answer: This protocol is intended for use by agencies
authorized by their Service Medical Director and approved by the REMAC. Providers must have received
specialized training and are authorized in Medication Facilitated Intubation (MFI) prior to implementing
this protocol. INDICATIONS: Medication Facilitated Intubations may be utilized on standing orders in any
protocol requiring advanced airway management when definitive airway control is necessary for
patients in imminent respiratory comprise and / or failure; and where no other means of securing an
airway can be obtained without the use of sedative agents.
CONTRAINDICATIONS / PRECAUTIONS: The use of sedation agents is contraindicated in patients that
cannot be ventilated with a bag-valve-mask (BVM) due to anatomy, facial / airway trauma or other
reasons.
-Properly position the patient. Apply Pulse Oximetry and ECG monitor with high flow oxygen via NRB.
-Assemble and test all basic and advanced airway equipment including suction.
• If patient is exhibiting signs of respiratory compromise and / or the airway is not secure, pre-oxygenate
the patient via
BVM while applying laryngeal manipulation.•
-IVofNSKVO•
-Administer Etomidate 0.3 mg/kg over 30-60 sec IV push.
• When deep sedation is achieved, intubate the patient and then confirm ET tube placement with lung
sounds and
waveform EtCO2. (Maximum of 2 ETI attempts < 15 seconds, interchanged with BVM ventilations.)
• If attempts at intubation fail, insert Supraglottic via protocol. Must be unconscious or heavily sedated.
• If unable to adequately ventilate the patient by use of the above means, perform a needle
cricothyrotomy as per
protocol to oxygenate.
• Confirm ET tube or Combitube placement and attach a continuous EtCO2 monitor (ventilate to
maintain EtCO2 between 35-45 mmHg) and secure the ET tube via protocol.
-If addi
VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA - Answer: - Follow NYS BLS
protocols for cardiac arrest care.
