PA ALS Protocol Review II

2.

The patient is presenting with acute onset of generalized weakness. You suspect that the patient might be suffering from an ischemic stroke. Which of the following is least likely to increase your level of suspicion for this diagnosis?

Anisocoria
Facial Droop
Slurred Speech
Arm Drift

Correct Answer

A. Anisocoria

Explanation

Anisocoria is the condition where the pupils of the eyes are of unequal size. While an ischemic stroke can cause various symptoms such as facial droop, slurred speech, and arm drift, anisocoria is not typically associated with an ischemic stroke. Therefore, the presence of anisocoria would be least likely to increase suspicion for an ischemic stroke.

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3.

A hypoglycemic patient with a history of type I diabetes, initially presenting with altered mental status and BSG of 25 mg/dL, received 25 grams of 10% dextrose via IV. The patient’s BSG increased to 62 mg/dL and now appears conscious, alert, and oriented to the present events. This patient wishes to refuse transport. Can the ALS provider release this patient without contacting medical command?

Yes
No

Correct Answer

A. No

Explanation

No, the ALS provider cannot release this patient without contacting medical command. Although the patient's blood sugar level has increased and they appear conscious, alert, and oriented, it is important to consider the underlying condition of type I diabetes and the potential for further complications. The patient's altered mental status and low blood sugar level indicate a need for medical evaluation and monitoring. It is necessary to consult with medical command to ensure appropriate care and to discuss the patient's refusal of transport.

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4.

Flumazenil is an approved ALS drug for the treatment of benzodiazepine overdose.

True
False

Correct Answer

A. False

Explanation

Flumazenil is not an approved ALS drug for the treatment of benzodiazepine overdose. Flumazenil is actually a medication used to reverse the effects of benzodiazepines and is commonly used in emergency situations to treat benzodiazepine overdose. ALS (Amyotrophic Lateral Sclerosis) is a neurodegenerative disease and Flumazenil is not indicated for its treatment. Therefore, the statement is false.

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5.

The patient is presenting with a head injury following a significant trauma. The patient is hypotensive. What is the target systolic blood pressure associated with a bolus of normal saline solution?

70-90 mmHg
80-100 mmHg
> 90 mmHg
> 120 mmHg

Correct Answer

A. > 90 mmHg

Explanation

In this scenario, the patient is hypotensive, meaning their blood pressure is low. A bolus of normal saline solution is administered to increase the blood pressure. The target systolic blood pressure associated with this intervention is > 90 mmHg, meaning it should be higher than 90 mmHg. This is because a systolic blood pressure below 90 mmHg is considered low and may indicate inadequate perfusion to vital organs. Therefore, the goal is to raise the blood pressure to a level above 90 mmHg to improve organ perfusion and prevent further complications.

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6.

Which of the following drugs is not a pharmaceutical treatment of narrow complex tachycardias per PA protocol?

Diltiazem
Verapamil
Procainamide
Lidocaine

Correct Answer

A. Lidocaine

Explanation

Lidocaine is not a pharmaceutical treatment for narrow complex tachycardias per PA protocol. Lidocaine is primarily used for the treatment of ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation, rather than narrow complex tachycardias. Diltiazem, Verapamil, and Procainamide are commonly used pharmaceutical treatments for narrow complex tachycardias as per PA protocol.

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7.

What is the initial fluid bolus for a tachycardic, hyperpyretic adult patient with an extensive history of urinary tract infections that is now complaining of dysuria?

250-cc
500-cc
1000-cc
2000-cc

Correct Answer

A. 500-cc

Explanation

An initial fluid bolus of 500-cc is recommended for a tachycardic, hyperpyretic adult patient with a history of urinary tract infections and complaining of dysuria. This bolus helps to address the patient's increased heart rate and high fever, while also providing hydration. The 500-cc volume is appropriate as it is a moderate amount that can help alleviate symptoms without overwhelming the patient's system.

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8.

A patient with a history of CHF is presenting with chest pain and very high blood pressure. The patient is on CPAP and does not tolerate its removal. Which of the following treatments is inappropriate?

An initial spray of NTG followed by three additional sprays so long as the systolic blood pressure remains above 100 mmHg
NTG drip at a rate of 5-100 mcg/min titrated to a systolic blood pressure greater than 100 mmHg
1-2 inches of NTG paste applied topically
3.0 mg of albuterol combined with 500 mcg ipratropium administered via small volume nebulizer if the patient is wheezing

Correct Answer

A. An initial spray of NTG followed by three additional sprays so long as the systolic blood pressure remains above 100 mmHg

Explanation

The patient is presenting with chest pain and very high blood pressure, which may indicate an acute coronary syndrome. The appropriate treatment for this condition includes NTG administration to relieve chest pain and lower blood pressure. However, the option of an initial spray of NTG followed by three additional sprays as long as the systolic blood pressure remains above 100 mmHg is inappropriate. In this situation, the patient's blood pressure is already very high, and further NTG administration may cause a significant drop in blood pressure, leading to hypotension and potential cardiovascular collapse. Therefore, this treatment option should be avoided.

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9.

Which of the following is not an appropriate pediatric dosing/route in the specified context?

1.5 mg albuterol combined with 250 mcg ipratropium administered via small volume nebulizer
5 mL 1:1000 epinephrine administered via small volume nebulizer for epiglottitis
20 mL/kg normal saline solution administered via IV for second and third degree burns covering 45% of the body surface area
0.1-0.3 mg/kg of diazepam administered perirectally for seizures

Correct Answer

A. 5 mL 1:1000 epinephrine administered via small volume nebulizer for epiglottitis

Explanation

Epinephrine is not an appropriate pediatric dosing/route for epiglottitis. Epiglottitis is a serious condition that can cause severe airway obstruction. In this situation, the preferred treatment is immediate intubation or tracheostomy, rather than using a nebulizer. Epinephrine may be used in other respiratory emergencies, such as croup, but it is not appropriate for epiglottitis.

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10.

Your adult patient is presenting with a stable, but irregular, narrow complex tachycardia. You have established IV access and obtained a 12-lead ECG that shows no ischemic changes. What is your next step per protocol?

Contact Medical Command
Valsava Maneuvers
6 mg of Adenosine via fast IV push
0.25 mg/kg of Diltiazem over 10 minutes

Correct Answer

A. Contact Medical Command

Explanation

The correct answer is to contact medical command. This is the appropriate step to take when encountering a stable, but irregular, narrow complex tachycardia in a patient. Contacting medical command allows for further guidance and direction from a higher medical authority, ensuring the best course of action is taken for the patient's condition. It is important to consult with medical command in order to provide the most appropriate and effective care for the patient.

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Pa ALS Protocol Review II

Under which of the following circumstances can diphenhydramine be administered without medical command orders?

Quiz Preview

The patient is presenting with acute onset of generalized weakness. You suspect that the patient might be suffering from an ischemic stroke. Which of the following is least likely to increase your level of suspicion for this diagnosis?

Flumazenil is an approved ALS drug for the treatment of benzodiazepine overdose.

The patient is presenting with a head injury following a significant trauma. The patient is hypotensive. What is the target systolic blood pressure associated with a bolus of normal saline solution?

Which of the following drugs is not a pharmaceutical treatment of narrow complex tachycardias per PA protocol?

What is the initial fluid bolus for a tachycardic, hyperpyretic adult patient with an extensive history of urinary tract infections that is now complaining of dysuria?

A patient with a history of CHF is presenting with chest pain and very high blood pressure. The patient is on CPAP and does not tolerate its removal. Which of the following treatments is inappropriate?

Which of the following is not an appropriate pediatric dosing/route in the specified context?

Your adult patient is presenting with a stable, but irregular, narrow complex tachycardia. You have established IV access and obtained a 12-lead ECG that shows no ischemic changes. What is your next step per protocol?