Pa ALS Protocol Review I

1. For which of the following cardiac drugs should the paramedic first ask the patient whether he or she is taking drugs for the treatment of erectile dysfunction?

Amiodarone

Nitroglycerine

Diltiazem

Adenosine

The paramedic should first ask the patient whether he or she is taking drugs for the treatment of erectile dysfunction before administering Nitroglycerine. This is because Nitroglycerine can interact with erectile dysfunction drugs, such as Viagra, causing a dangerous drop in blood pressure. Therefore, it is important to assess the patient's medication history and potential drug interactions before administering Nitroglycerine.

Explanation

The paramedic should first ask the patient whether he or she is taking drugs for the treatment of erectile dysfunction before administering Nitroglycerine. This is because Nitroglycerine can interact with erectile dysfunction drugs, such as Viagra, causing a dangerous drop in blood pressure. Therefore, it is important to assess the patient's medication history and potential drug interactions before administering Nitroglycerine.

2. Aspirin may be administered to a patient prior to obtaining a 12-lead electrocardiogram for patients experience an acute coronary syndrome.

True

False

Aspirin may be administered to a patient prior to obtaining a 12-lead electrocardiogram for patients experiencing an acute coronary syndrome. This is because aspirin is known to have antiplatelet properties and can help prevent the formation of blood clots in the arteries. In cases of acute coronary syndrome, where there is a risk of a blood clot causing a heart attack, administering aspirin can be beneficial in reducing the severity of the condition. Therefore, it is true that aspirin may be given to a patient before obtaining a 12-lead electrocardiogram in such cases.

Explanation

Aspirin may be administered to a patient prior to obtaining a 12-lead electrocardiogram for patients experiencing an acute coronary syndrome. This is because aspirin is known to have antiplatelet properties and can help prevent the formation of blood clots in the arteries. In cases of acute coronary syndrome, where there is a risk of a blood clot causing a heart attack, administering aspirin can be beneficial in reducing the severity of the condition. Therefore, it is true that aspirin may be given to a patient before obtaining a 12-lead electrocardiogram in such cases.

3. You must attempt to contact medical command prior to administering oxytocin to a patient with post-partum hemorrhage refractory to fundal massage.

True

False

It is important to contact medical command before administering oxytocin to a patient with post-partum hemorrhage refractory to fundal massage because oxytocin can have side effects and may not be appropriate for every patient. By contacting medical command, healthcare providers can ensure that they are following the appropriate protocols and guidelines for administering oxytocin in this specific situation. This step helps to ensure patient safety and optimize the effectiveness of the treatment.

Explanation

It is important to contact medical command before administering oxytocin to a patient with post-partum hemorrhage refractory to fundal massage because oxytocin can have side effects and may not be appropriate for every patient. By contacting medical command, healthcare providers can ensure that they are following the appropriate protocols and guidelines for administering oxytocin in this specific situation. This step helps to ensure patient safety and optimize the effectiveness of the treatment.

4. Which of the following drugs is administered slowly?

Atropine for bradycardia

Epinephrine in cardiac arrest

Ondansetron for nausea

Adenosine for symptomatic atrial flutter

Ondansetron is administered slowly because it is a medication used to treat nausea and vomiting. Administering it slowly allows for better absorption and reduces the risk of adverse effects. In contrast, drugs like Atropine, Epinephrine, and Adenosine are typically administered quickly due to their specific indications and the need for immediate effects.

Explanation

Ondansetron is administered slowly because it is a medication used to treat nausea and vomiting. Administering it slowly allows for better absorption and reduces the risk of adverse effects. In contrast, drugs like Atropine, Epinephrine, and Adenosine are typically administered quickly due to their specific indications and the need for immediate effects.

5. What is the value of the first digit for numbered protocols associated with respiratory conditions?

4

5

6

7

8

The value of the first digit for numbered protocols associated with respiratory conditions is 4.

Explanation

The value of the first digit for numbered protocols associated with respiratory conditions is 4.

6. For which of the following rhythms is atropine expected to have the least effect on heart rate, for good or bad?

Sinus bradycardia with a first degree heart block

Junctional rhythm

Sinus tachycardia with occasional ectopy

Third degree AV block

Atropine is a medication that increases heart rate by blocking the action of the vagus nerve, which normally slows down heart rate. In a third degree AV block, there is a complete blockage of the electrical signals between the atria and ventricles, resulting in a slow heart rate. Since atropine works by increasing heart rate, it would have the least effect on heart rate in this condition, as there is already a block in the conduction system.

Explanation

Atropine is a medication that increases heart rate by blocking the action of the vagus nerve, which normally slows down heart rate. In a third degree AV block, there is a complete blockage of the electrical signals between the atria and ventricles, resulting in a slow heart rate. Since atropine works by increasing heart rate, it would have the least effect on heart rate in this condition, as there is already a block in the conduction system.

7. Nitroglycerin may be administered to a patient prior to establishing IV access for patients experience an acute coronary syndrome.

True

False

Nitroglycerin should not be administered to a patient prior to establishing IV access for patients experiencing an acute coronary syndrome. IV access is essential in order to administer medications rapidly and effectively during an acute coronary syndrome. Nitroglycerin is commonly used to relieve chest pain in patients with acute coronary syndrome, but it is typically administered after IV access has been established.

Explanation

Nitroglycerin should not be administered to a patient prior to establishing IV access for patients experiencing an acute coronary syndrome. IV access is essential in order to administer medications rapidly and effectively during an acute coronary syndrome. Nitroglycerin is commonly used to relieve chest pain in patients with acute coronary syndrome, but it is typically administered after IV access has been established.

8. Which of the following drugs would not be administered via small volume nebulizer?

Epinephrine, 5 mL, 1:1000

Albuterol, 2.5 mg

Terbutaline, 0.25 mg

Ipratropium Bromide, 500 mcg

Terbutaline, 0.25 mg, would not be administered via small volume nebulizer because it is typically given as a subcutaneous or intravenous injection. Small volume nebulizers are used to administer medication in the form of a mist that is inhaled into the lungs. Terbutaline, on the other hand, is a beta-agonist bronchodilator that is commonly given as an injection to treat conditions such as asthma and preterm labor. Therefore, it would not be appropriate to administer terbutaline via small volume nebulizer.

Explanation

Terbutaline, 0.25 mg, would not be administered via small volume nebulizer because it is typically given as a subcutaneous or intravenous injection. Small volume nebulizers are used to administer medication in the form of a mist that is inhaled into the lungs. Terbutaline, on the other hand, is a beta-agonist bronchodilator that is commonly given as an injection to treat conditions such as asthma and preterm labor. Therefore, it would not be appropriate to administer terbutaline via small volume nebulizer.

9. For which of the following protocols is a fluid bolus of normal saline solution NOT indicated?

Allergic reaction

Burns

Systemic inflammatory response syndrome

Narrow complex tachycardia

A fluid bolus of normal saline solution is not indicated for narrow complex tachycardia because it is a condition characterized by a fast heart rate that originates from the normal electrical conduction system of the heart. It is generally not caused by a fluid imbalance or hypovolemia, which is why administering a fluid bolus would not be effective in treating this condition.

Explanation

A fluid bolus of normal saline solution is not indicated for narrow complex tachycardia because it is a condition characterized by a fast heart rate that originates from the normal electrical conduction system of the heart. It is generally not caused by a fluid imbalance or hypovolemia, which is why administering a fluid bolus would not be effective in treating this condition.

10. Suppose your 7 year-old ill-looking patient is tachypnic with hyperpyrexia. Your patient's mass is 20 kg. Which of the following interventions is not permitted per standing order?

4 mg ondansetron

400 mg acetaminophen

400 mL bolus of normal saline solution

40% oxygen delivered via simple face mask in blow-by configuration

The correct answer is 4 mg ondansetron. Ondansetron is a medication used to prevent nausea and vomiting. However, in this case, the patient is presenting with tachypnea (rapid breathing) and hyperpyrexia (high fever), which may indicate a serious underlying condition. Ondansetron is not indicated for these symptoms and would not address the primary issue at hand. Therefore, it is not permitted per standing order.

Explanation

The correct answer is 4 mg ondansetron. Ondansetron is a medication used to prevent nausea and vomiting. However, in this case, the patient is presenting with tachypnea (rapid breathing) and hyperpyrexia (high fever), which may indicate a serious underlying condition. Ondansetron is not indicated for these symptoms and would not address the primary issue at hand. Therefore, it is not permitted per standing order.

11. Which of the following is not one of the criteria that must be met to administer acetaminophen to a patient without online medical command?

Patient must be at least 3 months of age.

The patient’s temperature must exceed 100.4 degrees Fahrenheit.

The patient has not had a dose of acetaminophen within the last 4 hours.

Acetaminophen cannot be taken in conjunction with aspirin or other NSAIDs.

The given answer explains that one of the criteria that must be met to administer acetaminophen to a patient without online medical command is that it cannot be taken in conjunction with aspirin or other NSAIDs. This means that if a patient is already taking aspirin or other NSAIDs, they should not be given acetaminophen without consulting online medical command. The other criteria mentioned in the options, such as the patient's age, temperature, and recent dose of acetaminophen, are not mentioned as factors that would prevent the administration of acetaminophen without online medical command.

Explanation

The given answer explains that one of the criteria that must be met to administer acetaminophen to a patient without online medical command is that it cannot be taken in conjunction with aspirin or other NSAIDs. This means that if a patient is already taking aspirin or other NSAIDs, they should not be given acetaminophen without consulting online medical command. The other criteria mentioned in the options, such as the patient's age, temperature, and recent dose of acetaminophen, are not mentioned as factors that would prevent the administration of acetaminophen without online medical command.

12. Which of the following statements is false?

Standing orders permit administering narcotic analgesics to patients complaining of left lower flank pain associated with extensive renal calculus.

The statement "Standing orders permit administering narcotic analgesics to patients complaining of left lower flank pain associated with extensive renal calculus" is false. Standing orders typically do not permit the administration of narcotic analgesics for this specific condition, as the use of narcotics may worsen the symptoms or have other adverse effects. Instead, other non-narcotic pain management options are usually recommended for patients with renal calculus.

Explanation

The statement "Standing orders permit administering narcotic analgesics to patients complaining of left lower flank pain associated with extensive renal calculus" is false. Standing orders typically do not permit the administration of narcotic analgesics for this specific condition, as the use of narcotics may worsen the symptoms or have other adverse effects. Instead, other non-narcotic pain management options are usually recommended for patients with renal calculus.

13. Which of the following combinations of D50 and fluid results in the correct weight-based dose of 10% dextrose to a 10 kg pediatric patient?

10 mL of D50 mixed with 40 mL normal saline solution

10 mL of D50 mixed with 40 mL D5W

20 mL of D50 mixed with 80 mL normal saline solution

10 mL of D50 mixed with 90 mL normal saline solution

not-available-via-ai

Explanation

not-available-via-ai

14. Which of the following medications cannot be delivered intranasally per PA State protocol?

Epinephrine

Glucagon

Lorazepam

Fentanyl Citrate

Epinephrine cannot be delivered intranasally per PA State protocol. This means that according to the protocol set by the state of Pennsylvania, it is not recommended or allowed to administer epinephrine through the nasal route. The other medications listed, such as Glucagon, Lorazepam, and Fentanyl Citrate, may be administered intranasally according to the protocol.

Explanation

Epinephrine cannot be delivered intranasally per PA State protocol. This means that according to the protocol set by the state of Pennsylvania, it is not recommended or allowed to administer epinephrine through the nasal route. The other medications listed, such as Glucagon, Lorazepam, and Fentanyl Citrate, may be administered intranasally according to the protocol.

15. Which of the following is not a maximum protocol dose prior to contacting medical command?

20 mcg/kg/min of dobutamine for treatment of cardiogenic shock secondary to CHF

0.1 mg/kg of midazolam for treatment of seizures

35 mcg/min of epinephrine for treatment of bradycardia

5 mL/kg of D10 to a pediatric patient with glucose of 42 mg/dL

The correct answer is 35 mcg/min of epinephrine for treatment of bradycardia. This is because epinephrine is typically administered in doses of 1-10 mcg/min for bradycardia. The given dose of 35 mcg/min exceeds the usual maximum protocol dose and may lead to adverse effects such as increased heart rate and blood pressure. Therefore, it is not a recommended maximum protocol dose prior to contacting medical command.

Explanation

The correct answer is 35 mcg/min of epinephrine for treatment of bradycardia. This is because epinephrine is typically administered in doses of 1-10 mcg/min for bradycardia. The given dose of 35 mcg/min exceeds the usual maximum protocol dose and may lead to adverse effects such as increased heart rate and blood pressure. Therefore, it is not a recommended maximum protocol dose prior to contacting medical command.

16. Which of the following ALS drugs may have an ototoxic effect on the patient if delivered too quickly?

Morphine Sulfate

Midazolam

Furosemide

Ondansetron

Furosemide is a loop diuretic that is commonly used to treat edema and fluid retention. It works by inhibiting the reabsorption of sodium and chloride in the kidneys, leading to increased urine production. However, furosemide can also have ototoxic effects, meaning it can cause damage to the inner ear and result in hearing loss or tinnitus. This side effect is more likely to occur if furosemide is administered too quickly or in high doses. Therefore, it is important to monitor the administration of furosemide carefully to minimize the risk of ototoxicity.

Explanation

Furosemide is a loop diuretic that is commonly used to treat edema and fluid retention. It works by inhibiting the reabsorption of sodium and chloride in the kidneys, leading to increased urine production. However, furosemide can also have ototoxic effects, meaning it can cause damage to the inner ear and result in hearing loss or tinnitus. This side effect is more likely to occur if furosemide is administered too quickly or in high doses. Therefore, it is important to monitor the administration of furosemide carefully to minimize the risk of ototoxicity.

17. For which of the following rhythms is the initial energy dose for cardioversion 50 joules?

Unstable atrial flutter

Unstable atrial fibrillation

Unstable ventricular tachycardia

Unstable pulsed ventricular fibrillation

The initial energy dose for cardioversion in unstable atrial flutter is 50 joules. Atrial flutter is a rapid and irregular rhythm in the atria of the heart. Unstable atrial flutter refers to a condition where the rhythm is causing hemodynamic instability or symptoms that are not tolerable by the patient. In such cases, cardioversion is required to restore normal sinus rhythm. The recommended initial energy dose for cardioversion in unstable atrial flutter is 50 joules.

Explanation

The initial energy dose for cardioversion in unstable atrial flutter is 50 joules. Atrial flutter is a rapid and irregular rhythm in the atria of the heart. Unstable atrial flutter refers to a condition where the rhythm is causing hemodynamic instability or symptoms that are not tolerable by the patient. In such cases, cardioversion is required to restore normal sinus rhythm. The recommended initial energy dose for cardioversion in unstable atrial flutter is 50 joules.

18. What is the appropriate protocol dose for an epinephrine drip in a 75 kg unstable bradycardic patient in which both atropine and pacing is ineffective?

7 mcg/min

7.5 mcg/min titrated upward until a systolic blood pressure of at least 100 mmHg is achieved

0.1 – 0.5 mcg/kg/min titrated until SBP > 90 mmHg

The appropriate protocol dose for an epinephrine drip in a 75 kg unstable bradycardic patient, in which both atropine and pacing is ineffective, is to begin at 7.5 mcg/min and increase slowly until either systolic blood pressure (SBP) is greater than 90 mmHg or until a maximum dose of 10 mcg/min is reached. This dosing strategy aims to achieve a SBP of at least 90 mmHg to improve the patient's hemodynamic stability. By starting at 7.5 mcg/min and titrating upward, the dose can be adjusted based on the patient's response to reach the desired SBP range.

Explanation

The appropriate protocol dose for an epinephrine drip in a 75 kg unstable bradycardic patient, in which both atropine and pacing is ineffective, is to begin at 7.5 mcg/min and increase slowly until either systolic blood pressure (SBP) is greater than 90 mmHg or until a maximum dose of 10 mcg/min is reached. This dosing strategy aims to achieve a SBP of at least 90 mmHg to improve the patient's hemodynamic stability. By starting at 7.5 mcg/min and titrating upward, the dose can be adjusted based on the patient's response to reach the desired SBP range.

19. Under which of the following circumstances is a dose of 2 mg of Lorazepam not consistent with off-line orders for a 100 kg patient?

Patient in an active, focal seizure in her legs who is conscious, alert, and oriented.

Patient complaining of severe vertigo.

Unrestrained agitated behavioral patient with no underlying medical conditions who continues to struggle despite attempts to use verbal techniques.

A dose of 2 mg of Lorazepam is not consistent with off-line orders for a 100 kg patient when the patient is complaining of severe vertigo. Lorazepam is a medication commonly used to treat anxiety, seizures, and insomnia. It is not typically indicated for the treatment of vertigo. Therefore, prescribing a high dose of Lorazepam for a patient complaining of severe vertigo would not be consistent with off-line orders.

Explanation

A dose of 2 mg of Lorazepam is not consistent with off-line orders for a 100 kg patient when the patient is complaining of severe vertigo. Lorazepam is a medication commonly used to treat anxiety, seizures, and insomnia. It is not typically indicated for the treatment of vertigo. Therefore, prescribing a high dose of Lorazepam for a patient complaining of severe vertigo would not be consistent with off-line orders.

20. Under which of the following circumstances would you contact medical command prior to administration of the associated drug?

Diltiazem, 0.25 mg/kg, for treatment of an regular narrow complex tachycardia in an adult patient

Adenosine, 0.1 mg/kg, for treatment of stable SVT in a pediatric patient

Lidocaine, 1.5 mg/kg, for treatment of a regular wide QRS rhythm in an adult patient

Amiodorone, 150 mg, for treatment of an irregular wide complex tachycardia in an adult patient

You would contact medical command prior to administration of Amiodarone, 150 mg, for treatment of an irregular wide complex tachycardia in an adult patient because Amiodarone is a potent antiarrhythmic medication with potential serious side effects. It can cause hypotension, bradycardia, and can prolong the QT interval, which can lead to life-threatening arrhythmias. Therefore, it is important to consult with medical command to ensure that the benefits of administering Amiodarone outweigh the potential risks in this specific patient.

Explanation

You would contact medical command prior to administration of Amiodarone, 150 mg, for treatment of an irregular wide complex tachycardia in an adult patient because Amiodarone is a potent antiarrhythmic medication with potential serious side effects. It can cause hypotension, bradycardia, and can prolong the QT interval, which can lead to life-threatening arrhythmias. Therefore, it is important to consult with medical command to ensure that the benefits of administering Amiodarone outweigh the potential risks in this specific patient.