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SNHD EMT PARAMEDIC PROTOCOL EXAM LATEST 2025/
ACTUAL EXAM 300 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
What is the purpose of the manual? - answer-To provide guidance for all prehospital care providers and emergency department physicians within the Clark County EMS system What is the goal of the manual? - answer-To standardize prehospital patient care in Clark County. The protocols are - answer-Guidelines, nothing contained in these protocols shall be constructed to expand the scope of practice of any licensed attendant beyond that which is identified in the CC Emergency Medical Services Regulations and these protocols Nothing within these protocols is meant to - answer-Delay rapid patient transport to a receiving facility. Patient care should be rendered while en-route Order of protocols - answer-General assessment protocol must be followed in the specific sequence noted. For all other treatment protocols, the algorithm defines the care every patient should receive, usually in the order described.
A patient is any individual that meets at least one of the following criteria - answer- A person who has a complaint or mechanism suggestive of potential illness or injury A person who has obvious evidence of illness or injury A person identified by an informed 2nd or 3rd party caller as requiring evaluation for potential illness or injury Pediatric patient considerations - answer-For patients < 18 yo, use the Pediatric Patient Destination protocol. Pediatric treatment protocols are to be used on children who have not yet experienced puberty. Signs of puberty include chest or underarm hair on males, and any breast development on females. The protocols demonstrate a - answer-Commitment to a consistent approach to quality patient care
Code 3 returns, need for telemetry physician and as per protocol Transport per Disposition criteria, if applicable *Transport to closest facility for: airway emergencies (inability to adequately ventilate)
Contact with online medical control - answer-Should only be established by radio. Telephone contact may only be used if the call is routed via a recorded phone patch through FAO at 702- 382 - 9007 Pediatric patients shall be transported - answer-In accordance with the pediatric destination protocol Patients with evidence of a stroke shall be transported - answer-In accordance with the Stroke (CVA) Protocol Sexual assault victims <13 yo - answer-Shall be transported to Sunrise Hospital Sexual assault victims 13 yo to 18 yo - answer-Shall be transported to Sunrise or UMC Sexual assault victims >18 yo - answer-Shall be transported to UMC For sexual assault victims outside a 50 mile radius from the above facilities - answer-Transport to the nearest appropriate facility Waiting room criteria - answer-Excluding patients on a legal psychiatric hold, meeting all of the following criteria
- Normal vital signs
- Did not receive any parenteral medications during EMS transport except a single dose of analgesia and/or an antiemetic
- In the judgment of the paramedic, does not require continuous cardiac monitoring. Note: any ECG monitoring initiated by a transferring facility may not be discontinued by EMS personnel
- Can maintain a sitting position without adverse impact on their medical condition
- Is left with a verbal report to hospital personnel
Room air pulse oximetry
94% Alert and oriented x 4 Internal disaster - answer-Facility is to be bypassed for all patients except patients in cardiac arrest or in whom the ability to adequately ventilate has not been established General adult trauma assessment 1 - answer-General adult assessment Cervical stabilization General adult trauma assessment 2 - answer-GCS < 8 - > *Ventilation management: BVM if O2 < 94% GCS >8 - > Oxygen keep SPO2 > 94% General adult trauma assessment 3 - answer-Palpable radial pulse? Yes - > Vascular access No - > Vascular access - > 1 L NS or LR bolus IV/IO General adult trauma assessment 4 - answer-Secondary assessment: Suspected tension pneumothorax - > *Needle Thoracentesis Sucking chest wound - > Apply 3 sided occlusive dressing Control active hemorrhage - > *Hemorrhage control Obvious fractures - > Immobilize fractures; assess distal pulse
Suspected traumatic brain injury - > Raise head of bed 30 degrees and capnography
- ETCO2 35 mmHg Open wounds - > cover with gauze; wet trauma dressing for abdominal evisceration
General adult trauma assessment 5 - answer-Pain management Transport and radio contact to appropriate Trauma Center based on TFTC Abdominal/Flank Pain, nausea and Vomiting 1 - answer-General adult assessment 12 Lead ECG if age > 35 yo
torsion Abdominal/flank pain, nausea and vomiting signs and symptoms - answer-Pain location, tenderness, nausea, vomiting, diarrhea, dysuria, constipation, vaginal bleeding/discharge, pregnancy
Abdominal/flank pain, nausea and vomiting history - answer-Age, medical/surgical history, onset, quality, severity, fever, menstrual history Allergic reaction 1 - answer-General adult assessment Allergic reaction 2 - answer-Evidence of airway involvement/breathing difficulties? No-> vascular access - > diphenhydramine 50 mg IV/IM/IO/PO - > reassess pt a 5 min END Yes-> epinephrine 1:1,000 0.5 mg IM; may repeat a 15 min up to max 1.5 mg Allergic reaction 3 - answer-Patient in shock? No Albuterol: 2.5 mg SVN; repeat as needed Ventilation management Cardiac monitor IV access 500 cc NS or LR bolus; may repeat up to 2 L Diphenhydramine 50 mg IM/IV/IO/PO Allergic reaction 3b - answer-Patient in shock? Yes Ventilation management Albuterol 2.5 mg SVN; repeat as needed Cardiac monitor IV access 500 cc NS or LR bolus IV/IO; may repeat up to 2 L Diphenhydramine 50 mg IM/IV/IO/PO Push dose Epinephrine 1:100,000 5 mcg- 10 mcg IV/IO, may repeat 1 2 - 5 min to maintain SBP>90 (0.5 mL-1 mL of 1:100,000 solution) OR consider Dopamine 5 - 20 mcg/kg/min IV/IO, titrated to SBP>
Allergic reaction signs and symptoms - answer-Itching or hives, coughing/wheezing or respiratory distress, throat or chest constriction, difficulty swallowing, hypotension/shock, edema, nausea/vomiting Allergic reaction differential - answer-Urticarial (rash only), anaphylaxis (systemic effect), shock (vascular effect), angioedema (drug induced), aspiration/airway obstruction, asthma/COPD, CHF Allergic reaction recommended exam - answer-Mental status, skin, heart, lung Allergic reaction pearls - answer-Epinephrine is a first-line drug that should be administered in acute anaphylaxis (moderate/severe symptoms). IM epi (1:1000) should be administered in priority before or during attempts at IV or IO access Contact medical control for refractory anaphylaxis Consider ETCO monitoring Hypovolemia or distributive shock should be addressed with a fluid bolus prior to the administration of pressors Epinephrine should be used with caution in elderly patients, patients with known cardiovascular disease, or significant tachycardia or hypertension, and should be administered only when the patient's signs and symptoms are severe Allergic reaction severity - answer-Mild: Involve skin rashes, itchy sensation, or hives with no respiratory involvement Moderate: involve skin disorders and may include some respiratory involvement like wheezing, yet the patient still maintains good tidal volume air exchange Severe: involve skin disorders, respiratory difficulty, and may include hypotension Allergic reaction special considerations - answer-Always perform ECG monitoring when administering Epi
Consider dopamine for hypotension refractory to administration of Epi Provide oxygen and airway support as needed Altered mental status/syncope 1 - answer-General adult assessment
Altered mental status/syncope Differential - answer-Head trauma; CNS (stroke, tumor, seizure, infection); cardiac (MI, CHF); hypothermia; infection; thyroid; shock (septic, metabolic, traumatic); diabetes; toxicological or ingestion; acidosis/alkalosis; environmental exposure; hypoxia; electrolyte abnormality; psychiatric disorder Altered mental status/syncope Recommended exam - answer-Mental status, HEENT, skin, heart, lung, abdomen, back extremities, Neuro
Altered mental status/syncope Pearls - answer-Pay careful attention to the head exam for signs of injury Be aware of AMS as presenting sign of environmental toxin or Haz-Mat exposure, and protect personnel safety and that of other responders Do not let alcohol confuse the clinical picture; alcohol is not commonly a cause of total unresponsiveness to pain If narcotic overdose or hypoglycemia is suspected, administer narcan 0.4- 2 mg or glucose prior to advanced airway procedures Behavioral emergency 1 - answer-Scene safety General adult assessment Consider medical causes for the patients behavior: hypoxia, intoxication/overdose, hypoglycemia/electrolytes, head injury, post-ictal state Behavioral emergency 2 - answer-Suspected excited delirium? Yes - > (P) ketamine 2 mg/kg IV/IO or 2 - 4 mg/kg IM - > consider behavioral restraints; no prone position; consider law enforcement escort - > transport No - > next step Behavioral emergency 3 - answer-Implement the S.A.F.E.R model Threatened or acted in a way that suggests threat to self or others? Behavioral emergency threatened to harm self - answer-consider behavioral restraints; no prone position; consider law enforcement escort; consider a flight risk - > transport Behavioral emergency threatened to harm others - answer- 4 point restraints; hood if indicated; NO PRONE POSITION
- continue general adult assessment Behavioral emergency no threat to self or others - answer-Transport Excited Delirium Syndrome - answer-Medical emergency-combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent behavior, insensitivity to pain, hyperthermia, and increased strength Potentially life threatening, and associated with the use of physical control measures including restraints, TASER, or similar device Most common in male subjects with a history of serious mental illness and/or acute or chronic drug abuse, particularly stimulants Behavioral emergency history - answer-Situational crisis, psychiatric illness/medications, injury to self or threats to others, medic alert tag, substance abuse/overdose, diabetes Behavioral emergency signs and symptoms - answer-Anxiety, agitation, confusion; affect change, hallucinations; delusional thoughts, bizarre behavior; combative, violent; expression of suicidal/homicidal thoughts Behavioral emergency Differential - answer-AMS differential, alcohol intoxication, toxin/substance abuse, medication effect or overdose, withdrawal syndromes, depression, bipolar, schizophrenia, anxiety disorder Behavioral emergency recommended exam - answer-Mental status, skin, heart, lung, neuro Behavioral emergency pearls - answer-Law enforcement assistance should be requested on all calls involving potentially violent patients Under no circumstances are patients to be transported restrained in
prone position Consider all possible medical/trauma causes for behavior Do not irritate the patient with a prolonged exam EMS providers are mandatory reporters in regard to suspected abuse of any vulnerable person Consider ETCO2 monitoring
