1300 Final Review

Question 1

(BLS) A paramedic shall monitor an intravenous (IV) line for a patient who has? (Part 1)

Answer 1

1) an IV line tkvo, as follows:

a: flow rate to maintain IV patency for pt <12 yrs age is 15 ml/hr of any isotonic crystalloid solution

b: flow rate to maintain IV patency for for patient _> 12 yrs age is 30-60 ml/hr of any isotonic crystalloid solution

Question 2

(BLS) A paramedic shall monitor an intravenous (IV) line for a patient who has? (Part 2)

Answer 2

2) an intravenous line for fluid replacement with

a) a max flow rate infused up to 2mL/kg/hr to a maximum of 200 mL/hr
b) thiamine, multivitamin preparations
c) drugs within his/her level of certification
d) potassium chloride (KCl) for patients _> 18 yrs of age, to a maximum of 10 mEq in a 250 mL bag

Question 3

(BLS) Unless within his/her level of certification, a paramedic shall request a medically
responsible escort in the event a patient requires an intravenous that:

Answer 3

a. that is being used for blood (or blood product) administration;
b. that is being used to administer potassium chloride to a patient who is <18 years of
age;
c. that is being used to administer medication (including pre-packaged medications)
d. that requires electronic monitoring or uses a pressurized intravenous fluid infuser, pump or central venous line; or
e. for a neonate or pediatric patient <2 years of age

Question 4

BLS Pre-transport for IV?

Answer 4

1. confirm physician’s written IV order with sending facility staff;
2. determine IV solution, IV flow rate, catheter gauge, catheter length, and cannulation site;
3. note condition of IV site prior to transport;
4. confirm amount of fluid remaining in bag;
5. determine amount of fluid required for complete transport time and obtain more fluid if applicable; and
6. document all pre-transport IV information on the Ambulance Call Report.

Question 5

BLS during transport, what should you consider?

Answer 5

1. monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required;
2. if the IV becomes dislodged or interstitial, discontinue the IV flow and remove the catheter with particular attention to aseptic technique; and
3. confirm condition of catheter if removed.

Question 6

Types of IV fluids?

Answer 6

Crystalloids: No proteins, contain sugar and water. Examples are Normal Saline and Lactated Ringer’s. Remains in intravascular space for SHORT amount of time. Easily passes capillary membrane

Colloids: Contain large molecules such as proteins. Does not easily pass capillary membranes. Examples are plasma substitutes, plasma, packed RBC’s, Dextran

Question 7

(BLS) Valid DNR Confirmation Standard?

Answer 7

1) Name of Patient (surname and first name)

2) Check box (a current plan of treatment exists & physician’s current opinion is that CPR…)

3) Check box for professional designation (M.D, RPN, RN)

4) Printed name of M.D, RPN, RN signing form

5) Signature of M.D, RPN, RN signing form

6) Date when form was signed

Question 8

What is Capnography?

Answer 8

• Amount of CO2 in exhaled air
• Normal range is 35-45 mmHg

Measured with 2 devices: Nasal prongs and ETCO2 inline BVM

Question 9

What should you consider if capnography is attached but you see no waveform?

Answer 9

Check the tube for appropriate placement

Question 10

What does a sudden spike in ETCO2 represent during CPR?

Answer 10

Signs of life. Spike is high because acidic blood is suddenly returned to lungs; high amounts of CO2 rush into alveoli

Question 11

Indications for STEMI Bypass Protocol?

Answer 11

1) > 18 yrs of age
2) Chest pain or equivalent consistent with cardiac ischemia/myocardial infarction
3) Time from onset <12 hours
4) 12-lead ECG shows 2mm elevation in V1-V3, 1mm elevation in 2 or more leads elsewhere, 12-Lead computer says STEMI and paramedic agrees

*Once activated, continue to follow protocol even if ECG normalizes

Question 12

Contraindication for STEMI Bypass Protocol?

Answer 12

1. CTAS 1 and the paramedic is unable to secure patient’s airway or ventilate.
2. 12-lead ECG is consistent with a LBBB, ventricular paced rhythm, or any other STEMI imitator.
3. Transport to a PCI centre ≥60 minutes from patient contact.**
4. Patient is experiencing a complication requiring PCP diversion:**
   a. Moderate to severe respiratory distress or use of CPAP.
   b. Hemodynamic instability or symptomatic SBP <90 mmHg at any point.
   c. VSA without ROSC.
5. Patient is experiencing a complication requiring ACP diversion:**
   a. Ventilation inadequate despite assistance.
   b. Hemodynamic instability unresponsive/not amenable to ACP treatment/management.
   c. VSA without ROSC.

Question 13

Mechanism of Nitro?

Answer 13

Dilates coronary vessels and decreases the heart’s workload. This is accomplished by reducing peripheral return of blood to the heart, and by lessening resistance of blood