2021 TRAA STANDING ORDERS (Paramedic) Flashcards
- You are caring for a 34 yom patient presenting with bizarre/destructive behavior who is also extremely confused and unable to communicate aside from yelling out random sounds or words. You and your partner have concluded that this patient is presenting with excited delirium. There is no IV established at this time in which you decide to administer Ketamine IM. Your patient is 100 kg. What is your dose for Ketamine IM for this patient?
Answer: 300 mg
See page # 35 of the TRAA 2021.1.1 Standing Orders Book
- You are caring for a 72 yom patient who has suffered 27% burns to his torso and arms. You have decided to administer Dilaudid for pain management purposes. What is your dose of Dilaudid for this patient?
Answer: 0.5 mg every 10 minutes to a max of 1 mg
See page # 45 of the TRAA 2021.1.1 Standing Orders Book
- A pt who has suffered 27% burns does not respond to pain management efforts and his pain is not improving. You have opted to use Ketamine for sedation since his severe discomfort was not relieved by pain medications. What is your dose for Ketamine for this patient via IV administration?
Answer: 1 mg/kg, may repeat once without OLMC orders.
See page # 17-18 of the TRAA 2021.1.1 Standing Orders Book
- You are caring for a 62 yom patient who is in cardiac arrest. Your Advanced EMT offers to administer the Epinephrine. The Advanced EMT’s dose of Epinephrine for this cardiac arrest is __________ mg(s) to a max total of __________ mg(s).
Answer: 1 , 4
See page # 21 of the TRAA 2021.1.1 Standing Orders Book
You have administered an initial 6 mg dose of Adenosine to your 46 yof patient in SVT. The patient returned to SVT after presenting in a sinus rhythm for a brief period of time in which your administered another dose of 12.0mg Adenosine. The patient remains stable in SVT after two doses of Adenosine. What is your next step?
Answer: Contact OLMC
See page # 26 of the TRAA 2021.1.1 Standing Orders Book
For a Priority 2 call, the minimum equipment that must be taken to the patient to ensure effective patient management is:
Answer: Cardiac Monitor, Oxygen Bag, First-In Bag, and Cot
See page # 136 of the TRAA 2021.1.1 Standing Orders Book
True or False: A multi system blunt trauma patient, such as from a high velocity crash or significant fall, who is unable to follow commands due to combativeness, intoxication, or decreased mental status, should remain on the backboard until handoff at the ED.
Answer: True
See page # 54 of the TRAA 2021.1.1 Standing Orders Book
The load limit for the Pedi-Mate device is:
Answer: 10-40 lbs
See page # 139 of the TRAA 2021.1.1 Standing Orders Book
Your 76 yof patient is presenting with rales and difficulty in breathing. You opt to treat your patient with Nitro and CPAP administration. What is your dose of Nitro and your CPAP maximum setting for this patient?
Answer: SL every 5 minutes if dyspnea persists but B/P remains elevated, 10 cm/H2O
See page # 30 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a hypoglycemic patient in which their blood glucose level was 23 mg/DL. You should administer up to 250.0 ml of D10W until:
Answer: The patient’s mental status is normal and until the blood glucose is above 80 mg/DL
See page # 31 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a 58 yom patient who presents as cool, pale, and diaphoretic. Pt has a history of HTN, high cholesterol, two stents placed, and ESRD. Vitals are noted to be 80/40 mmHg, 52 bpm, 22rr, at 90% O2 saturations. Upon inspection of his EKG, you note the patient has no P waves present and a wide QRS complex. Your treatment of choice for this patient is:
Answer: Calcium Chloride 1 gram along with Sodium Bicarbonate 50 mEq
See page # 32 of the TRAA 2021.1.1 Standing Orders Book
You respond to a 23 yof who has just given birth to a 4 kg baby boy. You have done all the necessary assessment procedures (dry, stimulate, APGAR, etc.). You note that the newborn’s heart rate is at 40 bpm. The newborn is presenting with bradycardia. Your partner begins ventilation and CPR. The dose of Epinephrine to be given is?
Answer: 0.04 mg IV/IO
See page # 42-43 of the TRAA 2021.1.1 Standing Orders Book
Your 89-year-old patient presents with a temp of 102, blood pressure of 82 mmHg systolic, heart rate of 120, and a respiratory rate of 30. You suspect sepsis. So far, a fluid bolus has not helped this patient. What is the dose of Epi via drip that may be given?
Answer: 1 mcg/min titrate to a MAP > 65
See page # 50 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a patient who is C-STAT & FAST positive. These patients may be eligible for intervention for up to __________ hours.
Answer: 24 hours
See page #52 of the TRAA 2021.1.1 Standing Orders Book
A multiple-casualty incident that severely taxes local EMS personnel and resources, requires the activation of the Disaster Response Team, and may require mutual aid from outside organizations, is considered to be a:
Answer: High-impact incident
See page # 133-134 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a 78 yof experiencing COPD exacerbation. Part of your treatment for this patient includes a nebulizer treatment consisting of Albuterol and Atrovent. As per scope of practice within TRAA standing orders, who can administer this nebulizer treatment to the patient?
Answer: Paramedic, Advanced EMT, and EMT Basic
See page # 15 of the TRAA 2021.1.1 Standing Orders Book
For I-Gels, the appropriate size should be chosen by utilizing the patient’s:
Answer: Ideal body weight
See page # 99-102 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a burn patient whose B/P remains 80/40 mmHg post the initial fluid bolus. You may administer additional boluses of __________ mls, repeating the bolus __________ times, as per standing order.
Answer: 500 , 3
See page # 17-18 of the TRAA 2021.1.1 Standing Orders Book
You respond to a 2 yom child who has a hx of V-Tach due to a congenital heart defect. This pt is unstable and you will need to perform synchronized cardioversion. The patient weighs 25 kg. What is your initial Joules setting for the Lifepack?
Answer: 25 joules
See page # 74 of the TRAA 2021.1.1 Standing Orders Book
The normal respiratory rate for an infant (1-12 months), as per the normal pediatric vitals chart in the standing orders is?
Answer: 30 – 60 rr/min
See page # 68,70, or 81 of the TRAA 2021.1.1 Standing Orders Book
A 12-Lead EKG is required for all patients who present with signs/symptoms consistent with cardiac related problems, i.e. syncope, weakness, arrhythmias, CHF, SOB, atypical AMI symptoms, and non-traumatic chest pain in anyone greater than the age of ________.
Answer: 25
See page # 119 of the TRAA 2021.1.1 Standing Orders Book
You are caring for an 8-month-old male patient presenting with seizure activity. Due to patient still actively seizing, you decide to administer Versed IN. What is your dose of Versed for this patient who weighs 6 kg?
Answer: 1.2 mg IN
See page # 79 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a patient that is presenting with chest pain and dizziness. You and your partner obtain a 12 lead in which you interpret the patient to be presenting with a lateral wall MI. Which leads pertain to the lateral wall when viewing your 12-Lead?
Answer: I, aVL, V5 & V6
See page # 119 of the TRAA 2021.1.1 Standing Orders Book
You are caring for a 62 yof patient complaining of epigastric pain. You plan to obtain a 12-Lead EKG due to her atypical possible cardiac presentation and due to her being a female. When interpreting the 12-Lead, you recall that STEMI criteria involves _________ mm of ST elevation in __________ or more contiguous leads.
Answer: 1.0 , 2
You are utilizing the mnemonic PAILS from the procedure section of your SO book to detect reciprocal changes for your patient who is presenting with an anterior wall MI. You would anticipate that the reciprocal changes would be noted in which leads?
Answer: II, III, and aVF
See page # 119-121 of the TRAA 2021.1.1 Standing Orders Book
ETCO2 should be applied to any advanced airway no later than how many seconds/minutes after placement?
Answer: 1 minute
See page #84-86 of the TRAA 2021.1.1 Standing Orders
An intubation attempt is defined as:
Answer: Insertion of a laryngoscope blade into the mouth for orotracheal methods
See page # 9-11 of the TRAA 2021.1.1 Standing Orders Book
You have successfully intubated an adult patient whom is in respiratory arrest (not cardiac arrest). You have decided to use a PEEP valve to help maintain oxygenation. What should you set your PEEP valve at?
Answer: 5 cm/H2O
See page # 9-11 of the TRAA 2021.1.1 Standing Orders Book
In the traumatic arrest patient, you may contact OLMC after ________ minutes of resuscitation efforts to discuss the need to continue active resuscitation efforts.
Answer: 20 minutes
See page # 59-61 of the TRAA 2021.1.1 Standing Orders Book
The fire department has just removed your patient from a house fire. You find your patient to have burns to approximately 36% body surface area with partial and full-thickness burns throughout. Their blood pressure remains greater than 100 systolic. How many ml of normal saline should you bolus this patient?
Answer: 500 ml
See page # 17-18 of the TRAA 2021.1.1 Standing Orders Book
You find your 62 year old patient sitting behind his desk at an office building. He is complaining of feeling faint. His skin is pale and diaphoretic. His blood glucose is 124. You find his heart rate to be 38/min. He takes no medicine. His ECG is shown. A 0.5mg dose of Atropine is given without any change. What is the total amount of Atropine that may be given?
Answer: 3.0 mg
See page # 19 of the TRAA 2021.1.1 Standing Orders Book
You respond to a 49 year old obese male patient complaining of chest pain. Oxygen should be given:
Answer: If oxygen saturation is <=93%
See page # 23-24 of the TRAA 2021.1.1 Standing Orders Book
Your 49 yom patient takes medications for erectile dysfunction. He took Viagra 12 hours ago. In regards to Nitroglycerin, you should:
Answer: Withhold nitroglycerin
See page # 23-24 of the TRAA 2021.1.1 Standing Orders Book
Glucagon may be repeated after ____ minutes if no result is obtained in your hypoglycemic patient
Answer: 15 minutes
See page # 31 of the TRAA 2021.1.1 Standing Orders Book
Your 23 year old female diabetic patient was found unconscious. You have started an IV and are administering D10W. You should titrate to normal mental status and glucose of ___________ with D10W up to 250ml.
Answer: > 80
See page # 31 of the TRAA 2021.1.1 Standing Orders Book
You get called to Broadway Joe’s for a patient that is confused, exhibiting bizarre and destructive behavior, and is hot to the touch. His girlfriend states that someone gave him an unknown substance and he “smoked it out back.” Right now, the patient is being restrained by 4 police officers and 4 firefighters. You estimate that he weighs 220 pounds. What is the dose of ketamine that you can give this patient without an IV ?
Answer: 300 mg IM
See page # 35 of the TRAA 2021.1.1 Standing Orders Book
Your adult patient is exhibiting signs of excited delirium. He weighs 220 pounds. What is the dose of versed that may be given?
Answer: Up to 10mg
See page # 35 of the TRAA 2021.1.1 Standing Orders Book
Your patient is hypothermic and in v-fib. The ambient air temperature outside is 28 degrees Fahrenheit. In regards to defibrillation, how many shocks may be given?
Answer: 1
See page # 37 of the TRAA 2021.1.1 Standing Orders Book
To make an Epinephrine drip as stated in TRAA protocol, you place _______ into a ______ bag of Normal Saline.
Answer: 1 mg Epi into a 1,000 ml bag of NS
See page # 51 of the TRAA 2021.1.1 Standing Orders Book
You just witnessed the miracle of childbirth. Time of delivery is 03:04. When should you record APGAR scores?
Answer: 03:05 and 03:09
See page # 42-43 of the TRAA 2021.1.1 Standing Orders Book
Your 19 year old male patient is unconscious after snorting heroin. How much Narcan may be given, in total throughout run, to this patient by standing order?
Answer: There is no maximum total of Narcan
See page # 44 of the TRAA 2021.1.1 Standing Orders Book
Your 36 year old female patient is complaining of abdominal pain that she rates 10 out of 10. She is in obvious discomfort and can’t get comfortable on the cot. How many times may you repeat Dilaudid for this patient by standing order?
Answer: 0
See page # 45-46 of the TRAA 2021.1.1 Standing Orders Book
What is the maximum dose of Fentanyl that may be given at one time?
Answer: 100 mcg
See page # 45-46 of the TRAA 2021.1.1 Standing Orders Book
Your patient has suffered severe burns and you decide that they need to be sedated beyond what pain medication will provide. You pull out the Ketamine for sedation. You estimate that your patient weights 60kg. How much ketamine will you administer IV?
Answer: 60 mg
See page # 48 of the TRAA 2021.1.1 Standing Orders Book
Your 89 year old patient presents with a temp of 102, blood pressure of 82 systolic, heart rate of 120, and a respiratory rate of 30. You suspect sepsis. So far, a fluid bolus has not helped this patient. What is the dose of Epinephrine via drip that may be given by standing order?
Answer: 1.0 mcg/min
See page # 50 of the TRAA 2021.1.1 Standing Order Book
Using the C-STAT test, what must accompany eye gaze for C-STAT to be positive?
Answer: Nothing. Eye gaze makes the patient automatically CSTAT +
See page # 52 of the TRAA 2021.1.1 Standing Orders Book
Your 19 year old, male trauma patient has a blood pressure of 84. At this time, you do not suspect a head injury. What should you maintain systolic blood pressure at?
Answer: 90-100 mmHg
See page # 55-57 of the TRAA 2021.1.1 Standing Orders Book
TXA is mixed by:
Answer: Adding 1.0 gram to 100 ml NS and dripping over 10 minutes
See page # 55-57 of the TRAA 2021.1.1 Standing Orders Book
Your 22 year old female patient is vomiting and complaining of abdominal pain. You have given 4mg of Zofran and there has been no relief for the patient. How long must you wait until repeating your dose?
Answer: 10 minutes
See page # 63 of the TRAA 2021.1.1 Standing Orders Book
Your pediatric burn patient has sustained substantial burns to 70% BSA. How much fluid do you give your patient?
Answer: 20 ml/kg
See page # 67-69 of the TRAA 2021.1.1 Standing Orders Book
Your infant patient is exhibiting symptomatic bradycardia at a rate of 50. Your next course of treatment after oxygenation/ventilation is:
Answer: Chest compressions
See page # 70 of the TRAA 2021.1.1 Standing Orders Book
Your pediatric patient presents in v-fib. At which energy level should you defibrillate at?
Answer: 2 then 10 Joules/kg
See page # 71-73 of the TRAA 2021.1.1 Standing Orders Book
Which mediation(s) are used for sedation of a pediatric patient?
Answer: Versed or Ketamine
See page # 78 of the TRAA 2021.1.1 Standing Orders Book
When using CPAP for asthma your 25 year old asthmatic patient presenting with expiratory wheezing, your maximum pressure is:
Answer: 5 cm/H2O
See page # 92 of the TRAA 2021.1.1 Standing Orders Book
At which age should you start doing a surgical cricothyrotomy instead of needle?
Answer: =>5
See page # 93-96 of the TRAA 2021.1.1 Standing Orders Book
You have a patient who presents unresponsive with pulses. They require ventilation assistance. What is your tidal volume and breaths per minute for this patient?
Answer: Tidal Volume 5-8 ml/kg: Rate 8-12 breaths/min
See page # 9-11 of the TRAA 2021.1.1 Standing Orders Book
You may consider moist dressings for comfort in a burn patient if they have less than _______ % of BSA (Body Surface Area) involved.
Answer: 10%
See page # 17-18 of the TRAA 2021.1.1 Standing Orders Book
Your patient presents in cardiac arrest with a rhythm of polymorphic V-tach. That is your dose for Magnesium Sulfate?
Answer: 1.0 grams – 2.0 grams IV/IO
See page # 20-21 of the TRAA 2021.1.1 Standing Orders Book
You are administering a Nitro SL according to our standing orders for chest pain. What is the max dose of Nitro allotted to administer?
Answer: Three doses of 0.4mg spray/tablet
See page # 23-24 of the TRAA 2021.1.1 Standing Orders Book
You arrive on scene to find a 56 yom patient possibly presenting in regular monomorphic V-Tach. The patient currently presents as stable. What is your first step medication to consider as per your Tachycardia protocol?
Answer: Adenosine 6.0 mg rapid IV followed by saline flush
See page # 26 of the TRAA 2021.1.1 Standing Orders Book
You are currently treating a patient for pulmonary edema. You would like to give Nitro SL. The patient’s B/P is currently 210/100 mmHg. Pt denied any use of phosphodiesterase inhibitors. What is your dose allotment of Nitro SL?
Answer: No set dose, every 5 minutes as long as patient’s B/P remains > 100 mmHg systolically
See page # 30 of the TRAA 2021.1.1 Standing Orders Book
What is the max amount of milliliters of D10% that can be administered to a patient with a glucose less than 60 mg/dl without contacting OLMC?
Answer: 250 ml
See page # 31 of the TRAA 2021.1.1 Standing Orders Book
Your patient meets you at the curb complaining of chest pain. A 12 lead ECG show a monomorphic v-tach. What is the dose of Amiodarone for this patient?
Answer: 150mg over 10 minutes
See page # 26 of the TRAA 2021.1.1 Standing Orders Book
Your partner and you arrive on scene of a 32 yof patient presenting as GCS=14. Her B/P is 126/66 mmHg, heart rate of 100 bpm, and respiratory rate of 28 rr/min. You check her glucose level to find her reading at 467 mg/dl. What is the initial fluid bolus that should be administered?
Answer: 250 ml
See page # 31 of the TRAA 2021.1.1 Standing Orders Book
Upon your arrival of the scene, you find an individual in FWPD custody. The patient presents extremely agitated and violent. You sedate the patient appropriately, place them on your stretcher and secure them with all straps. Pt is noted to now be a GCS=13, B/P is 200/100 mmHg, heart rate at 140 bpm. Pt is noted to be hot to touch and diaphoretic. You begin cooling the patient with ice packs in the groin, axilla, and neck. You decide you need to administer a fluid bolus as well. What is your IV fluid bolus amount per your Excited Delirium protocol?
Answer: 1,000 ml bolus of NS
See page # 35 of the TRAA 2021.1.1 Standing Orders Book
You arrive on scene to find a 22 yof who has just delivered her child. Pt is Gravida=1 Para=1. You have cut the umbilical cord appropriately, dried and stimulated the newborn, and documented APGAR. Upon assessment of the newborn, you find their heart rate to be 32 bpm and their glucose level normal. You have your partner start ventilations & chest compressions due to the bradycardia and IV access has been obtained. What is your dose of Epinephrine for this newborn?
Answer: 0.01mg/kg Epi 1:10,000 IV/IO
See page # 42-43 of the TRAA 2021.1.1 Standing Orders Book
You have deemed your patient to present with sepsis. As per sepsis protocol, we may repeat fluid boluses to a total of _______ if the Mean Arterial Pressure (MAP) is less than _______.
Answer: 3,000.0 ml of NS , 65
See page # 50 of the TRAA 2021.1.1 Standing Orders Book
You and your Advanced EMT partner are caring for a 70 yof pt having bronchospasms. You would like to administer a breathing treatment. What medications can your Advanced EMT partner provide to this patient as per Bronchospasm protocol?
Answer: Albuterol and Atrovent
See page # 15-16 of the TRAA 2021.1.1 Standing Orders Book
What are your parameters for utilizing TXA?
Answer: B/P < 90 systolic, within 3 hours of injury, and/or sustained heart rate of 110 post trauma
See page # 54-57 of the TRAA 2021.1.1 Standing Orders Book
When clamping a newborn’s umbilical cord, you should clamp ________ from baby and then another ______ closer to the mother.
Answer: 6-8 inches , 2 inches
See page # 42-43 of the TRAA 2021.1.1 Standing Orders Book
Your patient is presenting with unstable regular monomorphic V-Tach. You would like to sedate your patient prior to synchronized cardioversion using Versed. What initial dose is acceptable as per Sedation protocol?
Answer: Up to 5 mg IV/IN/IM
See page # 48 of the TRAA 2021.1.1 Standing Orders Book
You arrive on scene to find a 14 month old baby crying in mom’s arms. The pt was born premature and has a hx of asthma. No other noted medical hx. The pt presents with expiratory wheezing in all fields. No stridor noted and no cough. You wish to administer a breathing treatment to the pt. The pt weighs 28 lbs. What is your initial dose of Albuterol for your breathing treatment?
Answer: 5 mg
See page # 65-66 of the TRAA 2021.1.1 Standing Orders Book
You respond to a 2 yom child who has a hx of V-Tach due to a congenital heart defect. This pt is unstable and you will need to perform synchronized cardioversion. The patient weighs 25.0 kg. What is your initial Joules setting for the Lifepack?
Answer: 25.0 joules
See page # 74 of the TRAA 2021.1.1 Standing Orders Book
When using CPAP per standing order, the patient must be over ______ years old and able to fit the CPAP mask.
Answer: 12
See page # 92 of the TRAA 2021.1.1 Standing Orders Book
The drip rate for TXA when given according to our standing order is:
Answer: 150 gtts/min
See page # 54-57 of the TRAA 2021.1.1 Standing Orders Book
You have a semi-conscious unstable patient whom you are unable to gain IV access by means of peripheral or EJ. You deem that the pt needs IO access. You know that pushing any fluids though the IO with the patient fully/semi-conscious can be painful. You decide to administer Lidocaine for this purpose. What is the allotted dose for Lidocaine via IO for pain prior to any bolus?
Answer: 20.0 – 40.0 mg IO
See page # 103-106 of the TRAA 2021.1.1 Standing Orders Book
A 12-Lead EKG is required for all patients who present with signs/symptoms consistent with cardiac related problems, i.e. syncope, weakness, arrhythmias, CHF, SOB, atypical AMI symptoms, and non-traumatic chest pain in anyone greater than the age of ________ .
Answer: 25
See page # 119-121 of the TRAA 2021.1.1 Standing Orders Book
What size ET adapter should be utilized when performing a needle Cricothyrotomy?
Answer: 3.0
See page # 93-96 of the TRAA 2021.1.1 Standing Orders Book
When should a Bariatric IO needle be utilized?
Answer: Adult proximal humerus, pediatric proximal humerus, and bariatric patients
See page # 103-106 of the TRAA 2021.1.1 Standing Orders Book
