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SNHD Paramedic Adult Protocols: Questions and Correct Answers, Exams of Nursing

A comprehensive guide for paramedics on how to handle various adult medical emergencies, including sexual assault transportation destinations, general adult trauma assessments, treatment for suspected tbi, adult abdominal/flank pain, adult allergic reactions, adult burns, adult respiratory distress, adult seizures, adult shock, causes of hypovolemic shock, adult smoke inhalation, adult stemi, adult stroke, and race protocol for stroke. It includes questions and correct answers, graded for understanding.

Typology: Exams

2023/2024

Available from 05/13/2024

kareey
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SNHD Paramedic Adult Protocols
Questions and correct Answers|Graded
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SNHD Paramedic Adult Protocols
Questions and correct Answers
Sexual Assault Transportation Destinations -
<13 y/o= Sunrise
13-18 y/o= Sunrise or UMC
>18 y/o= UMC
Waiting Room Criteria -
HR= 60-100 // RR= 10-20
SBP= 100-180 // DBP= 60-100
SPO02= >94% // AOX4
Received only 1 single dose of analgesia and or anti-emetic
Does not require EKG monitoring
Maintains a sitting position
General Adult Trauma Assessment:
GCS <8 -
- Ventilation Management BVM if SPO2 <94
- No palpable pulse= IV, 1L NS
- Secondary Assessment
- Pain management
General Adult Trauma Assessment:
GCS >8 -
- Keep SPO2 >94%
- IV
- Secondary Assessment
- Pain management
Treatment for suspected TBI -
Raise head of bed 30 degrees and maintain ETCO2 at 35
Adult abdominal/ flank pain, N/V -
12 lead EKG if age 35 or older
Adult abdominal/ flank pain, N/V
with signs of hypovolemia -
IV
500ml NS bolus; up to 2000ml
Adult abdominal/ flank pain, N/V
with nausea/ vomiting -
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Questions and correct Answers|Graded

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SNHD Paramedic Adult Protocols

Questions and correct Answers

Sexual Assault Transportation Destinations - ✅<13 y/o= Sunrise 13-18 y/o= Sunrise or UMC

18 y/o= UMC Waiting Room Criteria - ✅HR= 60-100 // RR= 10- SBP= 100-180 // DBP= 60- SPO02= >94% // AOX Received only 1 single dose of analgesia and or anti-emetic Does not require EKG monitoring Maintains a sitting position General Adult Trauma Assessment: GCS <8 - ✅- Ventilation Management BVM if SPO2 <

  • No palpable pulse= IV, 1L NS
  • Secondary Assessment
  • Pain management General Adult Trauma Assessment: GCS >8 - ✅- Keep SPO2 >94%
  • IV
  • Secondary Assessment
  • Pain management Treatment for suspected TBI - ✅Raise head of bed 30 degrees and maintain ETCO2 at 35 Adult abdominal/ flank pain, N/V - ✅12 lead EKG if age 35 or older Adult abdominal/ flank pain, N/V with signs of hypovolemia - ✅IV 500ml NS bolus; up to 2000ml Adult abdominal/ flank pain, N/V with nausea/ vomiting -

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✅Zofran 4mg ODT/IM/IV Droperidol 1.25mg IM/IV/IO Adult abdominal/ flank pain, N/V consider these 2 things.. - ✅ACS and chest pain Adult Allergic Reaction with no airway involvement - ✅- IV

  • Benadryl 50mg IM/IV
  • Reassess in 5 min Adult Allergic Reaction with airway involvement - ✅- Epi 1:1,000 0.5mg IM may repeat in 15 min up to max 1.5mg
  • Albuterol 2.5mg SVN repeat as needed
  • Ventilation management
  • Cardiac monitor
  • IV= 500-2000L NS
  • Benadryl 50mg IM/IV Adult Allergic Reaction pt in shock - ✅- Epi 1:1,000 0.5mg IM may repeat in 15 min up to max 1.5mg
  • Albuterol 2.5mg SVN as needed
  • Cardiac monitor
  • IV= 500-2000L NS
  • Benadryl 50mg IM/IV
  • Push dose epi 5-10mcg IV, may repeat in 2-5 min to maintain SBP > Adult Allergic Reaction Severities - ✅- Mild= involve skin rashes, itchy sensation, or hives with no respiratory involvement
  • Moderate= skin disorders and may include some respiratory involvement like wheezing, yet pt still maintains good tidal volume
  • Severe= skin disorders, respiratory difficulty and may include hypotension Adult AMS/ Syncope with BGL <60 - ✅- Oral glucose if pt is awake
  • D10, 25g IV may repeat x1 in 5 min
  • Glucagon 1mg IM for no IV access Adult AMS/ Syncope with BGL >60 - ✅- Cardiac monitor
  • Consider NS 500-2000ml Adult AMS/ Syncope: unresponsive with respiratory depression and suspected narcotic OD -

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Adult Burns: Thermal Exposure - ✅- Stop the burning process with saline

  • Ventilation management
  • Cover with DRY sterile dressing
  • IV
  • NS 500-2000ml fluid bolus if signs of hypoperfusion or >10% BSA
  • Cardiac monitor
  • Pain management Adult Burns: Chemical/ Electrical Exposure - ✅- Cardiac monitor
  • Eye involvement= flush 10-15 min
  • IV
  • NS 500-2000ml fluid bolus if signs of hypoperfusion or 10% BSA
  • Pain management Burn Classifications - ✅1) superficial (1st degree)- epidermis/ red and painful
  1. partial thickness (2nd degree)- dermis & epidermis/ blistering
  2. full thickness (3rd degree)- subcutaneous layer and all layers above (don't irrigate it. Painless, charred or leathery skin Adult Burn: CO exposure - ✅- Treat with 100 O
  • If primary event was inhalation of O2, transport to ER equipped with a hyperbaric chamber Adult Burn: BSA Chart - ✅- Head and arms= 9%
  • Front torso= 18%
  • Back= 18%
  • Legs= 18%
  • Groin= 1% Adult Burn: Transport Criteria - ✅2nd or 3rd degree burns >20% BSA 2nd or 3rd degree burns >10% BSA in pts under 10 y/o or over 50 y/o Adult Burn: Parkland Formula -

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✅4ml x kg x BSA %= total fluids in 24hrs Give 1/2 the first 8 hours, remainder over next 16 hours H's - ✅Hypovolemia- volume infusion Hypoxia- O2/ventilation, CPR Hydrogen Ion- Ventilation, CPR Hypo/er K- Calcium, glucose, bicarb, albuterol Hypothermia- warming T's - ✅Tension Pneumo- needle decompression Tamponade, cardiac- volume infusion Toxins- agent specific antidote Thrombosis, pulmonary- volume infusion Thrombosis, coronary- Emergent PCI Adult Chest Pain/ Suspected ACS: Non-diagnostic 12 lead EKG - ✅- EKG within 5 min of pt contact

  • IV
  • O2/ SPO2 >94%
  • ASA 324mg PO
  • NTG 0.4mg SL, may repeat in 5 min x
  • Pain management
  • Zoran 4mg ODT/IM/IV
  • Droperidol 1.25mg IM/IV/IO Childbirth/ Labor: Normal Presentation - ✅- Puncture sac if not yet broken
  • Deliver/ support head
  • Suction mouth then nose
  • Deliver upper shoulder then lower
  • Delivery remainder of the baby
  • Clamp/ cut cord
  • Deliver placenta
  • Attempt IV Childbirth/ Labor: Limb Presentation - ✅- Place pt in left lateral recumbent
  • IV
  • Transport

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Heat Stroke - ✅- High body temp >104, hot dry skin, hypotension, AMS, coma

  • Airway as indicated
  • AMS as indicated
  • Active cooling
  • IV 500-2000ml to effect SBP >
  • Cardiac Monitor Heat Cramps - ✅Benign muscle cramping caused by dehydration and is not associated with an elevated temp Heat Exhaustion - ✅Consists of dehydration, salt depletion, dizziness, fever, AMS, HA, cramping, N/V. V/S usually consist of tachycardia, hypotension, elevated temp Heat Stroke - ✅Consist of dehydration, tachycardia, hypotension, temperature >104F (40C) and AMS Active Cooling Measures - ✅Cold packs Ice Fanning AC Adult Hyperkalemia - ✅- Cardiac monitor/ 12 lead EKG
  • Albuterol 2.5mg in 3.0ml continuous SVN
  • Calcium Chloride 1.0g slow IVP
  • Bicarb 1.0 mEq/kg slow IVP What is contraindicated if a pt is taking Dig? - ✅Calcium Chloride Hyper-K is defined as a potassium level higher than what amount? - ✅5.5 mmol/L Potassium levels at what level will cause tall tented T waves? - ✅5.5-6.5 mmol/L Potassium levels at what level will cause a loss of P waves? - ✅6.5- 7.5 mmol/L Potassium levels at what level will cause widening QRS? -

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✅7.5-8.5 mmol/L Potassium levels at what level will continue to cause QRS widening approaching the sine wave? - ✅>8.5 mmol/L Adult Pregnancy: Exhibiting Seizures - ✅- Mag Sulfate 4.0g in 50cc over 10 min

  • If refractory to Mag, give Versed 0.1mg/kg IN/IM/IV/IO may repeat in 5 min at 0.05mg/kg OR
  • Diazepam 5mg IV; may repeat in 5 min; additional doses require orders Adult Pregnancy: Exhibiting Pre-Eclampsia - ✅- Mag Sulfate 2g in 50cc over 10 min
  • Transport to appropriate facility What indicates pre-eclampsia? - ✅- Severe HA
  • Vision changes
  • RUQ pain In the setting of pregnancy, HTN is defined as what? - ✅- SBP >140 or DBP >
  • Relative increase of 30 systolic and 20 diastolic from pts normal pre-pregnancy BP Adult OD/ Poisoning: Opiate OD - ✅- Airway
  • IV
  • Cardiac monitor
  • Narcan 2mg IN/IM/IV may repeat to a max dose of 10mg
  • Reassess and transport Adult OD/ Poisoning: Cyanide - ✅- Airway
  • IV
  • Cardiac monitor
  • Hydroxocobalamin 5.0g IV over 15 min if available
  • Reassess and transport Adult OD/ Poisoning: Dystonic Reaction -

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Acetaminophen S/S - ✅- Initial y normal or N/V

  • Tachypnea and AMS may occur later
  • Renal dysfunction
  • Liver failure or cerebral edema may manifest Depressants S/S - ✅- Decreased HR
  • Decreased BP
  • Decreased temp
  • Decreased RR Anticholinergics S/S - ✅- Increased HR
  • Increased temp
  • Dilated pupils
  • AMS changes Insecticides S/S - ✅- May include S/S of organophasphate poisoning Solvents S/S - ✅- N/V
  • Cough
  • AMS Stimulants S/S - ✅- Increased HR
  • Increased temp
  • Dilated pupils
  • Seizures
  • Possible violence TCA S/S - ✅- Decreased mental status
  • Dysrhythmias
  • Seizures
  • Hypotension
  • Coma/ Death Adult Pain Management: Ketamine - ✅Ketamine 0.2mg/kg IM/IN/ IV/ IO No repeat dose

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Adult Pain Management: Morphine - ✅Morphine 0.1mg/kg IM/IV; max single dose 10mg

  • May repeat dose in 10 min after the first until pain relieved or respiratory depression occurs Adult Pain Management: Fentanyl - ✅Fentanyl 1.0 msg/kg IN/IM/IV; max single dose 100mcg
  • May repeat dose after 10 min Adult Pain Management: Hydromorphone - ✅Hydromorphone 0.01mg/kg IM/IV; max single dose 1.0mg
  • May repeat dose after 10 min Adult Pulmonary Edema/ CHF: Hypotensive SBP <100mmHg - ✅- Airway
  • Keep O2 >94% // ETCO
  • Consider CPAP
  • 12 lead EKG
  • BP reassessment
  • Signs of cariogenic shock??
  • Dopamine 5-20mcg/kg/min; titrate to SBP >100mmHg Adult Pulmonary Edema/ CHF: Normotensive SBP >100mmHg - ✅- Airway
  • Keep O2 >94% // ETCO
  • Consider CPAP
  • 12 lead EKG
  • BP reassessment
  • NTG 0.4mg SL; may repeat in 5 min as long as HR >60 and SBP >100mmHg Adult Pulmonary Edema/ CHF: Hypertensive DBP >100mmHg - ✅- Airway
  • Keep O2 >94% // ETCO
  • Consider CPAP
  • 12 lead EKG
  • BP reassessment
  • NTG 1.6mg SL; may repeat in 5 min for DBP >100mmHg What effects will Dopamine have when administered at 2-10mcg/kg/min? - ✅- Increases myocardial contractility and HR

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  • Diazepam 5.0mg IM/IN/IV/IO Actively seizing and not>20 weeks pregnant or <6 weeks postpartum and BGL <60 - ✅- D10 25g IV; may repeat x1 in 5 min
  • Glucagon 1.0mg IM for no IV access IF PERSISTENT/RECURRENT SEIZURE
  • Glucose retest
  • Ventilation Management
  • IV
  • Cardiac monitor
  • Midazolam 0.1mg IM/IN/IV/IO up to max 5.0mg OR
  • Diazepam 5.0mg IM/IN/IV/IO Status Epilepticus Seizure - ✅Two or more seizures successively without an intervening lucid period, or a seizure lasting over 5 minutes Grand Mal Seizure - ✅Associated with loss of consciousness, incontinence, and oral trauma Focal Seizure - ✅Affect only part of the body and are not usually associated with a loss of consciousness Adult Shock: Non-Trauma, Non-cardiogenic - ✅- Keep SPO2 >94%
  • IV/ cardiac monitor/ ETCO -NS bolus 1000ml; may repeat x1 with no rales on lung exam
  • Push dose Epi 1:10,000 5-10mcg IV may repeat in 2-5 min to maintain SBP > OR
  • Dopamine 5-20mcg/kg/min; titrate to SBP >
  • Obtain capnography waveform Adult Shock: Cardiogenic - ✅- Keep SPO2 >94%
  • IV/ cardiac monitor/ ETCO
  • NS bolus 500ml; if no rales on lung exam, may repeat x
  • Push dose Epi 1:10,000 5-10mcg IV may repeat in 2-5 min to maintain SBP > OR
  • Dopamine 5-20mcg/kg/min; titrate to SBP >
  • Obtain capnography waveform What are some causes of hypovolemic shock? -

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✅Hemorrhage, trauma, GI bleeding, ruptured aortic aneurysm, or pregnancy related bleeding What are some causes of cardiogenic shock? - ✅Heart failure, MI, cardiomyopathy, myocardial contusion, toxins What are some causes of distributive shock? - ✅Sepsis, anaphylaxis, neurogenic, toxins What are some causes of obstructive shock? - ✅Pericardial tamponade, pulmonary embolus, tension pneumo What are some causes of adrenal insufficiency? - ✅- Addisons disease

  • Congenital Adrenal Hyperplasia
  • Long term administration of steroids Adult Smoke Inhalation - ✅- O2 100% NRB
  • Ventilation management
  • Cardiac monitor
  • IV/ NS bolus 500ml up to max 2000ml for hypoperfusion IF CARDIAC ARREST OF PROFOUND AMS....
  • Hydroxocobalamin 5.0g IV over 15 min
  • Transport to UMC Trauma Adult STEMI - ✅- 12 lead EKG within 5 min of pt contact
  • IV
  • Keep SPO2 >94%
  • ASA 324mg PO
  • NTG/ 0.4mg SL may repeat in 5 min x
  • Pain management
  • Consider anti-emetic for N/V Zofran 4mg ODT/IM/ IV OR Droperidol 1.25mg IM/IV/IO Adult Stroke: RACE= 1-4 - ✅- BGL
  • Document last known normal and a witness with phone number
  • Perform and document RACE score
  • BGL 60-400 rapid transport to approved stroke center
  • Tele
  • IV/ cardiac monitor/ 12 lead EKG

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  • Consider sedation; Etomidate 0.15mg/kg IV Adult Stable Tachycardia: Normal mental status, palpable radial pulse Wide Complex >0.12 sec Torsades - ✅- Cardiac monitor/ 12 lead
  • IV
  • Mag Sulfate 2gm IV in 50cc NS over 10 min
  • Defib @ 200, 300, 360
  • Consider sedation; Etomidate 0.15mg/kg IV Adult Unstable Tachycardia: Mental staus changes and no palpable pulse Narrow Complex <0.11 sec - ✅- Cardiac monitor
  • IV
  • Adenosine 12mg rapid IVP
  • Synchronized cardioversion; consider sedation Etomidate 0.15mg/kg IV
  • Repeat cardioversion and assess need for sedation
  • Transport Adult Unstable Tachycardia: Mental staus changes and no palpable pulse Torsades - ✅- Cardiac monitor
  • IV
  • Defib; consider sedation Etomidate 0.15mg/kg IV
  • Mag Sulfate 2gm IV in 50cc in 10 min
  • Repeat defib and assess need for sedation Adult Unstable Tachycardia: Mental staus changes and no palpable pulse Monomorphic VT - ✅- Cardiac monitor
  • IV
  • Synchronized cardioversion @ 100; consider sedation Etomidate 0.15mg/kg IV
  • Amiodarone 150mg in 50cc over 10 min
  • Repeat cardioversion or defib if VT not resolved; assess need for repeat sedation Adult Target Temperature Management/ Post Resuscitation

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ROSC with pt unresponsive to voice or pain - ✅- 12 lead EKG

  • Cardiac monitor
  • SPO2/ ETCO
  • IV
  • Neuro exam
  • Expose; ice packs to axilla and groin
  • Cold NS 250ml/hr up to 1L
  • Maintain ETCO2 at approx 40mmHg
  • Dopamine 5-20mcg/kg/min PRN titrate SBP >
  • Transport to approved hypothermia Center What are the approved hypothermia centers in SNV? - ✅Centennial Hills Desert Springs Mtn. View St. Rose Campuses Spring Valley Summerlin Sunrise Valley UMC What are the criteria for hypothermia resuscitation? - ✅- >18 y/o
  • Temp S/P ROSC >34C (93F)
  • No purposeful response to voice/ pain
  • BGL >
  • Sustained ETCO2 waveform in place
  • Cardiac arrest not due to trauma
  • Not pregnant Adult Ventilation Management - ✅- Basic airway maneuvers
  • Jaw thrust/ head tilt chin lift
  • NPA/ OPA as needed
  • Suction as needed
  • Consider C-spine
  • Consider AMS/ Syncope
  • O2 // BVM as needed
  • Consider sedation Etomidate 0.3mg/kg IV OR Ketamine 2mg/kg IV or 4mg/kg IM How do you maintain sedation according to the ventilation management protocol? - ✅- Midazolam 0.1mg/kg IV/IN/IM;