SNHD PARAMEDIC PROTOCOLS UPDATED FINAL
EXAM ALL QUESTIONS AND ANSWERS SURE A+
✔✔What is the protocol for no (mild) evidence of anaphylaxis?
(Allergic Reaction Protocol 17, 18) - ✔✔- Vascular access
- DIPHENHYDRAMINE 50 mg IM/IV/IO/PO
- Reassess patient q5 min
✔✔What is the protocol for moderate/severe anaphylaxis?
(Allergic Reaction Protocol 17, 18) - ✔✔- EPINEPHRINE 1:1000 0.5 mg IM; may repeat
q15 mins up to max 1.5 mg
- ALBUTEROL 2.5 mg in 3 mL
- Vascular access 500 mL; may repeat up to 2000 mL
- DIPHENHYDRAMINE 50 mg IM/IV/IO/PO
** if the patient is in shock
→ PUSH DOSE EPINEPHRINE 1:100,000 10 mcg IV/IO, may repeat q2-5 to maintain
SBP>90 (1 mL of 100,000 of solution)
✔✔What are some things to consider with altered mental status/syncope?
(Altered Mental Status/Syncope Protocol 19, 20) - ✔✔- Hypoglycemia
,- Stroke
- Shock
- Seizure
- General Trauma
- Cardiac causes
- Poisoning/Overdose
✔✔What should medical causes should you consider for the patient's behavior?
(Behavioral Emergency Protocol 21, 22) - ✔✔- Hypoxia
- Intoxication/ Overdose
- Hypoglycemia/ Electrolytes
- Head Injury
- Postictal State
✔✔What is the IMC-RASS scale?
(Behavioral Emergency Protocol 21, 22) - ✔✔The IMC-RASS scale is used to
determine the level of agitation of person and risk for violence. The number determined
on the scale will determine the treatment and whether a medication is should be
administered, what type of medication and the dose.
✔✔What is the treatment for Mild-Agitated but cooperative/redirectable patient with a
IMC-RASS score of +1 or +2?
(Behavioral Emergency Protocol 21, 22) - ✔✔- Verbal de-escalation techniques
- Evaluate for and treat reversible causes
✔✔What is the treatment for Moderate-Agitated and danger to self/others patient with a
IMC-RASS score of +3 or +4?
(Behavioral Emergency Protocol 21, 22) - ✔✔- MIDAZOLAM 2.5-5 mg IN/IM/IV/IO; may
repeat x1 after 5 min at 2.5 mg
OR
- DROPERIDOL 2.5- 5 mg IV/IO or 5 mg IM
- Cardiac/ETCO2 monitoring
- Restraints
✔✔What is the treatment for Severe-Significantly agitated and presents serious
imminent danger to self/others patient with a IMC-RASS score of +3 or +4?
(Behavioral Emergency Protocol 21, 22) - ✔✔SELECT ONE
- KETAMINE 3-4 mg IM max total dose 400 mg
- MIDAZOLAM 2.5-10 mg IM and/or DROPERIDOL 5-10 mg IM
- Cardiac/ETCO2 monitoring
,- Restraints
✔✔What position should you never transport/restrain a patient in?
(Behavioral Emergency Protocol 21, 22) - ✔✔Prone position
✔✔What is a dystonic reaction and the treatment for it?
(Behavioral Emergency Protocol 21, 22) - ✔✔- Condition that causes involuntary
muscle movements or spasms in the face, neck and upper extremities
- Typically an adverse reaction to antipsychotic drugs such as Haloperidol
Treatment:
- DIPHENHYDRAMINE 50 mg IM/IV/IO
✔✔What are underlying causes of bradycardia should you consider and treat if
identified?
(Bradycardia Protocol 23, 24) - ✔✔- Hypoxia
- Hyperkalemia
- Hypothermia
- ACS
- Drug toxicity
✔✔What kind of patients may have a slow heart rate as their baseline?
(Bradycardia Protocol 23, 24) - ✔✔Athletes, patients on beta blockers, and young
healthy patients
✔✔Should you delay pacing while waiting for IV access?
(Bradycardia Protocol 23, 24) - ✔✔NO
✔✔What medication is unlikely to be effective and should be avoided in patients who
have had a heart transplant?
(Bradycardia Protocol 23, 24) - ✔✔Atropine
✔✔According to the bradycardia protocol, what is considered symptomatic bradycardia?
(Bradycardia Protocol 23, 24) - ✔✔Persistent HR < 50 causing:
- Altered mental status
- Hypotension
- Chest pain
, - Signs of shock
✔✔What is the treatment for Stable bradycardia with no high grade AV block or wide
complex?
(Bradycardia Protocol 23, 24) - ✔✔- ATROPINE 1 mg IV/IO
** if the treatment is effective
→ ATROPINE 1 mg IV/IO q3-5 min, total max dose 3 mg
** if the treatment is NOT effective
→ PUSH DOSE EPINEPHRINE 10 mcg IV/IO, may repeat q2-5 mins to maintain
HR/BP
✔✔What is the treatment of Unstable bradycardia and/or high grade AV block and/or
wide complex?
(Bradycardia Protocol 23, 24) - ✔✔- Transcutaneous pacing
*consider sedation and analgesia medications*
- PUSH DOSE EPINEPHRINE 10 mcg IV/IO, may repeat q2-5 mins to maintain HR/BP
✔✔What should you do for a thermal exposure burn?
(Burns Protocol 25, 26) - ✔✔Stop the burning process with water or saline
&
Remove smoldering clothing and jewelry
DO NOT remove stock clothing
&
Cover burned area with dry sterile dressing. DO NOT USE any ice, lotion, ointment or
antiseptic!
✔✔What should you do for a chemical/electrical exposure burn?
(Burns Protocol 25, 26) - ✔✔Remove jewelry constricting items, and expose burned
area
&
Identify entry and exit sites, apply sterile dressings
- if there is eye involvement, continuous saline flush in affected eyes. Flush with water
or NS for 10-15 mins
✔✔What is the fluid resuscitation in the Burns protocol?
(Burns Protocol 25, 26) - ✔✔For adults 13 years and older: NS or LR 500 mL fluid bolus
if signs or hypoperfusion, OR >20% BSA burn present; contact medical direction at burn
center for further drip rates or additional boluses
EXAM ALL QUESTIONS AND ANSWERS SURE A+
✔✔What is the protocol for no (mild) evidence of anaphylaxis?
(Allergic Reaction Protocol 17, 18) - ✔✔- Vascular access
- DIPHENHYDRAMINE 50 mg IM/IV/IO/PO
- Reassess patient q5 min
✔✔What is the protocol for moderate/severe anaphylaxis?
(Allergic Reaction Protocol 17, 18) - ✔✔- EPINEPHRINE 1:1000 0.5 mg IM; may repeat
q15 mins up to max 1.5 mg
- ALBUTEROL 2.5 mg in 3 mL
- Vascular access 500 mL; may repeat up to 2000 mL
- DIPHENHYDRAMINE 50 mg IM/IV/IO/PO
** if the patient is in shock
→ PUSH DOSE EPINEPHRINE 1:100,000 10 mcg IV/IO, may repeat q2-5 to maintain
SBP>90 (1 mL of 100,000 of solution)
✔✔What are some things to consider with altered mental status/syncope?
(Altered Mental Status/Syncope Protocol 19, 20) - ✔✔- Hypoglycemia
,- Stroke
- Shock
- Seizure
- General Trauma
- Cardiac causes
- Poisoning/Overdose
✔✔What should medical causes should you consider for the patient's behavior?
(Behavioral Emergency Protocol 21, 22) - ✔✔- Hypoxia
- Intoxication/ Overdose
- Hypoglycemia/ Electrolytes
- Head Injury
- Postictal State
✔✔What is the IMC-RASS scale?
(Behavioral Emergency Protocol 21, 22) - ✔✔The IMC-RASS scale is used to
determine the level of agitation of person and risk for violence. The number determined
on the scale will determine the treatment and whether a medication is should be
administered, what type of medication and the dose.
✔✔What is the treatment for Mild-Agitated but cooperative/redirectable patient with a
IMC-RASS score of +1 or +2?
(Behavioral Emergency Protocol 21, 22) - ✔✔- Verbal de-escalation techniques
- Evaluate for and treat reversible causes
✔✔What is the treatment for Moderate-Agitated and danger to self/others patient with a
IMC-RASS score of +3 or +4?
(Behavioral Emergency Protocol 21, 22) - ✔✔- MIDAZOLAM 2.5-5 mg IN/IM/IV/IO; may
repeat x1 after 5 min at 2.5 mg
OR
- DROPERIDOL 2.5- 5 mg IV/IO or 5 mg IM
- Cardiac/ETCO2 monitoring
- Restraints
✔✔What is the treatment for Severe-Significantly agitated and presents serious
imminent danger to self/others patient with a IMC-RASS score of +3 or +4?
(Behavioral Emergency Protocol 21, 22) - ✔✔SELECT ONE
- KETAMINE 3-4 mg IM max total dose 400 mg
- MIDAZOLAM 2.5-10 mg IM and/or DROPERIDOL 5-10 mg IM
- Cardiac/ETCO2 monitoring
,- Restraints
✔✔What position should you never transport/restrain a patient in?
(Behavioral Emergency Protocol 21, 22) - ✔✔Prone position
✔✔What is a dystonic reaction and the treatment for it?
(Behavioral Emergency Protocol 21, 22) - ✔✔- Condition that causes involuntary
muscle movements or spasms in the face, neck and upper extremities
- Typically an adverse reaction to antipsychotic drugs such as Haloperidol
Treatment:
- DIPHENHYDRAMINE 50 mg IM/IV/IO
✔✔What are underlying causes of bradycardia should you consider and treat if
identified?
(Bradycardia Protocol 23, 24) - ✔✔- Hypoxia
- Hyperkalemia
- Hypothermia
- ACS
- Drug toxicity
✔✔What kind of patients may have a slow heart rate as their baseline?
(Bradycardia Protocol 23, 24) - ✔✔Athletes, patients on beta blockers, and young
healthy patients
✔✔Should you delay pacing while waiting for IV access?
(Bradycardia Protocol 23, 24) - ✔✔NO
✔✔What medication is unlikely to be effective and should be avoided in patients who
have had a heart transplant?
(Bradycardia Protocol 23, 24) - ✔✔Atropine
✔✔According to the bradycardia protocol, what is considered symptomatic bradycardia?
(Bradycardia Protocol 23, 24) - ✔✔Persistent HR < 50 causing:
- Altered mental status
- Hypotension
- Chest pain
, - Signs of shock
✔✔What is the treatment for Stable bradycardia with no high grade AV block or wide
complex?
(Bradycardia Protocol 23, 24) - ✔✔- ATROPINE 1 mg IV/IO
** if the treatment is effective
→ ATROPINE 1 mg IV/IO q3-5 min, total max dose 3 mg
** if the treatment is NOT effective
→ PUSH DOSE EPINEPHRINE 10 mcg IV/IO, may repeat q2-5 mins to maintain
HR/BP
✔✔What is the treatment of Unstable bradycardia and/or high grade AV block and/or
wide complex?
(Bradycardia Protocol 23, 24) - ✔✔- Transcutaneous pacing
*consider sedation and analgesia medications*
- PUSH DOSE EPINEPHRINE 10 mcg IV/IO, may repeat q2-5 mins to maintain HR/BP
✔✔What should you do for a thermal exposure burn?
(Burns Protocol 25, 26) - ✔✔Stop the burning process with water or saline
&
Remove smoldering clothing and jewelry
DO NOT remove stock clothing
&
Cover burned area with dry sterile dressing. DO NOT USE any ice, lotion, ointment or
antiseptic!
✔✔What should you do for a chemical/electrical exposure burn?
(Burns Protocol 25, 26) - ✔✔Remove jewelry constricting items, and expose burned
area
&
Identify entry and exit sites, apply sterile dressings
- if there is eye involvement, continuous saline flush in affected eyes. Flush with water
or NS for 10-15 mins
✔✔What is the fluid resuscitation in the Burns protocol?
(Burns Protocol 25, 26) - ✔✔For adults 13 years and older: NS or LR 500 mL fluid bolus
if signs or hypoperfusion, OR >20% BSA burn present; contact medical direction at burn
center for further drip rates or additional boluses
