BLS/ALS

Question 1

How many hours from a clearly determined time of symptom onset or time the patient was last seen in his/her usual state of health to be transported under stroke bypass?

Answer 1

6 hours

Question 2

What are the 7 contraindications of stroke bypass?

Answer 2

a. CTAS 1 and/or an uncorrected airway, breathing or circulation issue
b. Stroke symptoms resolved prior to paramedic arrival or assessment
c. Blood Glucose Level <3 mmol/L**
d. Seizure at the onset of symptoms or that is observed by the paramedic
e. Glasgow Coma Scale <10
f. Terminally ill or is in palliative care
g. Duration of transport to the Designated Stroke Centre will exceed two hours;

**Note: If symptoms persist after correction of blood glucose level, the patient is not contraindicated as per paragraph 3(c) above.

Question 3

Signs of cerebral herniation include a deteriorating GCS <9 with any of the following (3)

Answer 3

1. Dilated and unreactive pupils,
2. Asymmetric pupillary response, or
3. A motor response that shows either unilateral or bilateral decorticate or decerebrate posturing,

Question 4

if ETCO2 monitoring is unavailable, and measures to address hypoxemia and hypotension have been taken, and the patient shows signs of cerebral herniation as per paragraph 5(a)(ii) above, hyperventilate the patient as follows:

i. Adult: approximately __ breaths per minute
ii. Child: approximately __ breaths per minute
iii. Infant <1 year old: approximately __ breaths per minute

Answer 4

i. 20
ii. 25
iii. 30

Question 5

How many times can you give epi for allergic reaction ? and time between each dose?

Answer 5

2 times, 5 min apart

Question 6

Endotracheal Suctioning

• Indication : Pt’s have a endotracheal or tracheostomy tube AND Airway obstruction or increased secretions
• Conditions / Contraindication : NONE

1. Infant (___mmHg) 5 times maximum, Q1min
2. Child (____mmHg) 5 times maximum, Q1min
3. Adult (____mmHg) 5 times maximum, Q1min
   * * Pre-oxygenate and do not exceed 10 second of suctioning

Answer 6

1. 60-100
2. 100-120
3. 100-150

Question 7

Endotracheal Reinsertion

What are the indications (4)

Answer 7

• Existing tracheostomy with inner or outer cannula’s becoming removed from airway AND;
• Respiratory Distress AND;
• Inability to adequately ventilate AND;
• No family member or caregiver available or knowledgeable to replace the cannula

Conditions: NONE
Contraindications: Inability to landmark or visualize
Tx: Consider reinsertion, MAX ATTEMPTS 2

Question 8

Qxygen therapy standard

Regardless of SpO2 reading, paramedics will administer oxygen to the following patients (6)

Answer 8

Continuously administer high concentration oxygen for patients who have,

a. confirmed or suspected carbon monoxide or cyanide toxicity or noxious gas exposure,
b. upper airway burns,
c. scuba-diving related disorders,
d. ongoing cardiopulmonary arrest,
e. complete airway obstruction, and/or
f. sickle cell anemia with suspected vaso-occlusive crisis;

Question 9

Oxygen Therapy and COPD

If a patient with chronic obstructive pulmonary disease (COPD) has increased dyspnea, a decreased level of consciousness, an altered mental status, and/or has suffered major trauma, the paramedic shall:
1.
titrate oxygen administration to achieve an oxygen saturation between __-___%.

Answer 9

88-92%

Question 10

If signs of cerebral herniation are present following attempts to address hypoxemia and hypotension, hyperventilate the patient in order to maintain ETCO2 values of __-__mmHg.

Answer 10

30-35

Question 11

Do not delay treatment if doing so can prolong suffering or cause serious bodily harm

Answer 11

Refusal

Question 12

1. CTAS 1 and 2 patients have vitals recorded every__-__ minutes
2. Minimum of __ sets required unless contraindicated by short travel time

Re-assess ABC’s, AVPU every time patient is moved or if condition changes

Answer 12

1. 5-10 min

2. 2

Question 13

1. CTAS 1 and 2 patients have vitals recorded every__-__ minutes
2. Minimum of __ sets required unless contraindicated by short travel time

Re-assess ABC’s, AVPU every time patient is moved or if condition changes

Answer 13

1. 5-10 min

2. 2

Question 14

Air Ambulance Utilization

Upon meeting conditions explained, key is if patient is __ minutes or greater from appropriate definitive care

Answer 14

30 minutes

Question 15

DNR

Reassess pulse and respirations every 10-15 seconds for __ minutes on patient believed to be dead
Could “not honour” if patient changes mind at any point, or if family is agitated and unable to be reasoned with

Answer 15

5

When valid DNR is given, there shall be no basic or advanced life saving procedures, only comfort measures
No CPR, BVM, Airway insertion, Intubation, Defibrillation, Pacing, advanced resuscitation drugs - includes naloxone for overdose

Question 16

IV Line Maintenance

Maximum rate is ___ml/hr, can only infuse ___, ___,___

PCP cannot transport paediatrics or neonates with any IV lines

Answer 16

200ml/hr

Thiamine, KCL, and multivitamin preparations

Question 17

Chemical Exposure

1. Acid, irrigate for __ minutes on scene
2. Alkali, __minutes on scene
3. Unkown, ___ minutes on scene

Answer 17

1. 10
2. 20
3. 20

Question 18

Cold Exposure

1. Absence of shivering usually indicates temperature below __ degrees

Answer 18

1. 32

• for mild to moderate hypothermia, (i.e. if shivering is present),
  a. wrap the patient’s body/affected parts in a blanket or foil rescue blanket, and
  b. provide external re-warming, as available (e.g. hot packs, hot water bottles) to axillae, groin, neck and head

Question 19

for severe hypothermia (i.e. no shivering present, unconscious patient with cold, stiff limbs, slow/absent pulse and respirations and no other signs of “obvious” death),

a. wrap the patient’s body/affected parts in a blanket or foil rescue blanket, and
b. when suction is required, do not perform vigorous suctioning or airway manipulation as it may trigger ventricular fibrillation; and

Answer 19

.

Question 20

Obstetrics

Pre-eclampsia bp?

Answer 20

> 140/90

Question 21

Parkland burn formula?

Superficial burns are not included when calculating TBSA **

Answer 21

4ml X TBSA (%) X body weight (kg)

Question 22

1. How do you treat all superficial burns?
2. 2nd degree burns estimated to involve <15%?
3. 2nd degree burns estimated to involve ≥15%?
4. 3rd degree burns?

Answer 22

1. Cover all 1st degree burns with moist sterile dressing and then cover with dry sheet or blanket;
2. Cover with moist sterile dressing and dry sheet or blanket
3. Cover all 2nd degree burns estimated to involve ≥15% of body surface area with dry, sterile dressing or sheet;
4. Cover all 3rd degree burns with dry, sterile dressing or sheet
   - if dressing digits, dress digits individually
   - leave blisters intact;

Question 23

ASA is used in patients with suspected ischemic chest pain for which reason?
(A) ASA has an analgesic effect
(B) ASA lowers SBP, reducing workload on myocardium
(C) ASA inhibits the chronotropic effects of stress
(D) ASA reduces myocardial excitability
(E) ASA reduces platelet aggregation

Answer 23

(E) ASA reduces platelet aggregation

Question 24

In which patient group is Salbutamol MDI contraindicated?
(A) Patients with a known or suspected fever
(B) In the setting of a declared febrile respiratory illness outbreak
(C) Patients with a history of SVT
(D) Both A and B
(E) None of the above

Answer 24

(E) None of the above

Question 25

A 34 year old female with a history of smoking one pack per day (PPD) for 19 years
presents with vomitus resembling coffee grounds. You know that this finding may be
indicative of which condition?
(A) Diaphragmatic herniation
(B) Esophageal varices
(C) Diverticulitis
Medic Sense A-EMCA Exam #1 #5 of #12
(D) Peptic ulcers
(E) Ulcerative colitis

Answer 25

(D) Peptic ulcers

Question 26

What is the mechanism of tissue necrosis associated with interstitial administration of
D50W
(A) Hypertonic solution causes a fluid shift into surrounding cells, causing cell death
(B) D50W is toxic to skin and muscle tissue
(C) The viscosity of D50W restricts blood flow at site of infiltration, leading to tissue
death
(D) D50W denatures adipose tissue, causing the production of toxic metabolites
(E) D50W is hypertonic, which pulls intracellular fluid resulting in cell death

Answer 26

(E) D50W is hypertonic, which pulls intracellular fluid resulting in cell death

Question 27

You recall that a comminuted fracture…
(A) Is the direct result of bone density pathologies such as osteoporosis
(B) Occurs at the result of radial loading of a bone
(C) Is an insult to the periosteum, commonly referred to as a ‘hairline fracture’
(D) Is damage to the spongy head of a bone at the articular surface
(E) Is a shattered segment of bone

Answer 27

(E) Is a shattered segment of bone

Question 28

You remember that a greenstick fracture is a:
(A) An incomplete fracture of an immature bone
(B) A fracture that occurs to a single bone within a double-bone compartment such as
the forearm or distal lower extremity
(C) A severe sprain that is often confused for a fracture
(D) A fracture of the epiphysis of a long bone
(E) A fracture which leads to shortening of a long bone

Answer 28

(A) An incomplete fracture of an immature bone

Question 29

On a 12-lead ECG, which leads indicate electrical activity at the septum?
(A) V1 only
(B) II, III, AvF
(C) I, AvL
(D) V1, V2
(E) V3, V4, V6

Answer 29

(D) V1, V2

Question 30

If hypothermic patient were to present in a shockable rhythm, how many defibrillation cycles would
be appropriate?
(A) 1
(B) 2
(C) 4
(D) 5, only if ROSC by the 4th defibrillation
(E) Defibrillation is contraindicated in hypothermic patients

Answer 30

(A) 1

Question 31

When applying a tourniquet, best practice is considered to be:
(A) Application as high as possible to the affected extremity
(B) Application directly to the site of vascular injury
(C) Do not apply to extremities with fracture
(D) Apply 2-3” proximal to site of injury
(E) A distal pulse should be faintly palpable after proper tourniquet application

Answer 31

(D) Apply 2-3” proximal to site of injury