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?

6 mg of Adenosine via fast IV push

0.25 mg/kg of Diltiazem over 10 minutes

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

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

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

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

Pa ALS Protocol Review II

1.

Under which of the following circumstances can diphenhydramine be administered without medical command orders?
- A.
  
  Moderate Allergic Reactions
- B.
  
  Severe Dystonic Reactions
- C.
  
  Status Asthmaticus
- D.
  
  Schizophrenic Episodes
Correct Answer
A. Moderate Allergic Reactions

Explanation
Diphenhydramine can be administered without medical command orders in the case of moderate allergic reactions. This is because diphenhydramine is an antihistamine medication that can help alleviate symptoms such as itching, swelling, and rash caused by allergies. In moderate allergic reactions, the symptoms are not life-threatening or severe enough to require immediate medical intervention. However, for severe dystonic reactions, status asthmaticus, and schizophrenic episodes, medical command orders are necessary as these conditions may require specific treatments or interventions that should be overseen by a healthcare professional.

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2.

Which of the following drugs is not a pharmaceutical treatment of narrow complex tachycardias per PA protocol?
- A.
  
  Diltiazem
- B.
  
  Verapamil
- C.
  
  Procainamide
- D.
  
  Lidocaine
Correct Answer
D. 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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3.

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?
- A.
  
  Contact Medical Command
- B.
  
  Valsava Maneuvers
- C.
  
  6 mg of Adenosine via fast IV push
- D.
  
  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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4.

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?
- A.
  
  Anisocoria
- B.
  
  Facial Droop
- C.
  
  Slurred Speech
- D.
  
  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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5.

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.
  
  250-cc
- B.
  
  500-cc
- C.
  
  1000-cc
- D.
  
  2000-cc
Correct Answer
B. 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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6.

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?
- A.
  
  70-90 mmHg
- B.
  
  80-100 mmHg
- C.
  
  > 90 mmHg
- D.
  
  > 120 mmHg
Correct Answer
C. > 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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7.

Flumazenil is an approved ALS drug for the treatment of benzodiazepine overdose.
- A.
  
  True
- B.
  
  False
Correct Answer
B. 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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8.

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?
- A.
  
  Yes
- B.
  
  No
Correct Answer
B. 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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9.

Which of the following is not an appropriate pediatric dosing/route in the specified context?
- A.
  
  1.5 mg albuterol combined with 250 mcg ipratropium administered via small volume nebulizer
- B.
  
  5 mL 1:1000 epinephrine administered via small volume nebulizer for epiglottitis
- C.
  
  20 mL/kg normal saline solution administered via IV for second and third degree burns covering 45% of the body surface area
- D.
  
  0.1-0.3 mg/kg of diazepam administered perirectally for seizures
Correct Answer
B. 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.

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?
- A.
  
  An initial spray of NTG followed by three additional sprays so long as the systolic blood pressure remains above 100 mmHg
- B.
  
  NTG drip at a rate of 5-100 mcg/min titrated to a systolic blood pressure greater than 100 mmHg
- C.
  
  1-2 inches of NTG paste applied topically
- D.
  
  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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Pa ALS Protocol Review II

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

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

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?

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?

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?

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?

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

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

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?