REMAC ALS Protocols

Question 1

What protocol is 500-A?

Answer 1

Smoke Inhalation

Question 2

In the Smoke Inhalation protocol, how many IV infusions of Normal Saline (0.9% NS) should be given?

Answer 2

Two IV infusions of Normal Saline (0.9% NS) should be given.

Question 3

After exposure to smoke in an enclosed space, Patients may begin to experience these symptoms:
- Hypotension (not attributable to other obvious causes)
- AMS
- Coma
- Seizures
- Respiratory Arrest
- Cardiac Arrest
These patients should be administered which medications?

Answer 3

Hydroxocobalamin and Sodium Thiosulfate.

Question 4

In the Smoke Inhalation Protocol, prior to the administration of Hydroxocobalamin, how many blood samples should be obtained?

Answer 4

Three blood samples using tubes provided in the Cyanide toxicity kit.

Question 5

In the Smoke Inhalation protocol, in the event of continued hypotension (SBP <90mmHg)
What are the 3 medication choices that can be administered?

Answer 5

Epinephrine
10 mcg IV bolus
Repeat Epi 10 mcg IV Bolus every 5 minutes.
Titrations to a SBP greater than 90mmHg.

Norepinephrine
2 mcg/min IV DRIP
If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until the desired therapeutic effects are achieved or adverse effects appear. (Max dose 20 mcg/min)

Dopamine
5 mcg/kg/min IV DRIP
If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until the desired therapeutic effects are achieved or adverse effects appear. (Max dose is 20 mcg/kg/min)

Question 6

What protocol is 500-B?

Answer 6

Cyanide Exposure

Question 7

What protocol is 502?

Answer 7

Obstructed Airway

Question 8

In the Obstructed Airway protocol, how would you open the patient’s airway to visualize the foreign body?

Answer 8

You would open the patient’s airway using a Laryngoscope.

Question 9

In the Obstructed Airway protocol, after performing direct Laryngoscopy, how would you remove the foreign body?

Answer 9

You would remove the foreign body using Magill Forceps

Question 10

In the Obstructed Airway protocol, after removal of the foreign body, what should you do?

Answer 10

Immediately after removing or attempting to remove the foreign body, you will Intubate the patient.

Question 11

In the Obstructed Airway protocol, if you are unable to ventilate the patient after intubating via direct visualization, what steps should you take?

Answer 11

a. Note the Endotracheal Tube depth. b. Deflate the Endotracheal Tube cuff. c. Advance the Endotracheal Tube to its deepest depth.
d. Return the Endotracheal Tube to its original depth.
e. Re-inflate the Endotracheal Tube cuff and attempt ventilation again.
f. If unable to effectively ventilate the patient using the above maneuvers, immediately initiate transport.

Question 12

What protocol is 503?

Answer 12

Non-Traumatic Cardiac Arrest.

Question 13

What protocol is 503-A?

Answer 13

V-FIB/Pulseless V-TACH

Question 14

In the V-FIB/Pulseless V-TACH protocol, what joule setting should you use to defibrillate the patient?

Answer 14

Defibrillate using the Maximum joule setting possible (may vary depending on the defibrillator in use).

Question 15

In the V-FIB/Pulseless V-TACH protocol, If the patient has a pacemaker, how far from the pacemaker should you place the Defibrillator pads?

Answer 15

At least one (1) inch away.

Question 16

In the V-FIB/Pulseless V-TACH protocol, After defibrillating the patient, what should you do immediately right after?

Answer 16

After defibrillating the patient, immediately resume CPR.

Reassess after 2 minutes of CPR.

Question 17

In the V-FIB/Pulseless V-TACH protocol, How many mg of Epinephrine should be administered and which concentration should be used?

Answer 17

1 mg (10 mL of a 1:10,000) of Epinephrine should be administered IV/IO Bolus.

Question 18

In the V-FIB/Pulseless V-TACH protocol, If there is no change in the rhythm after the administration of Epinephrine . Which medication should be administered and how many mg of it?

Answer 18

If there is no change in the rhythm, 300 mg of Amiodarone should be administered IV/IO Bolus.

Question 19

In the V-FIB/Pulseless V-TACH protocol, If there is no change in the rhythm,

How often should Epinephrine be administered?

How many mg of Epi should be given and at what concentration?

Answer 19

If there is no change in the rhythm within 3-5 minutes, administer Epinephrine 1 mg (10 mL of a 1:10,000) IV/IO Bolus, every 3-5 minutes.

Question 20

In the V-FIB/Pulseless V-TACH protocol, Medical Control Option A states if V-FIB or pulseless V-TACH recurs, a repeat dose of what medication can be given?

Answer 20

A repeat dose of 150 mg of Amiodarone IV/IO Bolus may be given if V-FIB or Pulseless V-TACH recurs.

Question 21

In the V-FIB/Pulseless V-TACH protocol, Medical Control Option B consists in administering what medication at 44-88 mEq IV/IO Bolus?

Answer 21

Option B: Administer 44-88 mEq of Sodium Bicarbonate IV/IO Bolus. Repeat doses of 44 mEq of Sodium Bicarb IV/IO Bolus may be given every 10 minutes.

Question 22

How many H’s and how many T’s are there in your H’s and T’s mnemonic?

What is this mnemonic used for?

Answer 22

There are Seven (7) H’s
And
Five (5) T’s

Together they are 12 reversible causes of Cardiac Arrest.

Question 23

Name all the H’s in the H’s and T’s mnemonic.

Answer 23

1. Hypovolemia
2. Hypoxia
3. Hypothermia
4. Hypokalemia
5. Hyperkalemia
6. Hypoglycemia
7. Hydrogen Ion Excess (Acidosis)

Question 24

Name all the T’s in the H’s and T’s mnemonic.

Answer 24

1. Tension Pneumothorax
2. Tamponade; Cardiac
3. Toxins
4. Thrombosis; Cardiac
5. Thrombosis; Pulmonary

Question 25

In the V-FIB/Pulseless V-TACH protocol, Medical Control Option C consists in administering 2 mg IV/IO Bolus of what medication diluted in 10 mL of NS over 2 minutes?

Answer 25

Medical Control Option C: Administer 2 mg of Magnesium Sulfate IV/IO bolus, diluted in 10 mL of NS over 2 minutes.

“Mag in a Bag”

Question 26

In the V-FIB/Pulseless V-TACH protocol,
In case of HyperKalemia or Calcium Channel Blocker Overdose, Medical Control Option D consists in administering 1 gm IV/IO Bolus SLOWLY of what medication, followed by a NS flush?

Answer 26

Medical Control Option D:
In cases of HyperKalemia or Calcium Channel Blocker Overdose, administer 1 gm of Calcium Chloride SLOWLY, IV/IO Bolus. Follow with a NS flush.

Question 27

In the V-FIB/Pulseless V-TACH protocol, What is Medical Control Option E?

Answer 27

You are calling OLMC for a transport decision.

Question 28

In the PEA/Asystole protocol, Needle Decompression should be performed in the event what is suspected?

Answer 28

If a Tension Pneumothorax is suspected, Perform Needle Decompression.

Question 29

In the PEA/Asystole protocol, if a tension pneumothorax is suspected, what gauge needle should be used to perform Needle Decompression in an Adult?

Answer 29

14 gauge needle (3.25 inch)

Question 30

In the PEA/Asystole protocol, if a tension pneumothorax is suspected in an Adult, what gauge needle should be used to perform Needle Decompression in children?

Answer 30

18-20 gauge (0.8-1.6 inch) Needle

Question 31

In the PEA/Asystole protocol,how many mg of Epinephrine should be administered and at what concentration?

Answer 31

In PEA/Asystole, 1 mg of Epinephrine (10 mL of a 1:10,000 solution) IV/IO Bolus should be administered.

Question 32

In the PEA/Asystole protocol, if the glucometer reading is below 60 mg/dL, up to how many grams of dextrose can be administered?

Answer 32

If the glucometer reading is below 60 mg/dL, administer UP TO 25 gm of Dextrose, IV bolus.

Question 33

In the PEA/Asystole protocol, if there is no ROSC, Epinephrine should be repeated how often?

How many mg and at which concentration?

Answer 33

If there is no ROSC, administer Epinephrine 1 mg (10 mL of a 1:10,000 solution), IV Bolus every 3-5 minutes.

Question 34

In the PEA/Asystole protocol, After how many minutes of ALS standing orders should you consider contacting OLMC for additional orders?

Answer 34

After 20 minutes of ALS standing orders, consider contacting OLMC for additional orders, or termination of resuscitation.

Question 35

In the PEA/Asystole protocol, Medical Control Option A consists in Administering 44-88 mEq IV/IO Bolus of which medication?

Which of the Hs and Ts would this medication be ruling out?

Answer 35

Medical Control Option A:
Administer 44-88 mEq of Sodium Bicarbonate IV/IO Bolus.

This medication would be given to rule out Hydrogen Ion Excess (Acidosis).

Question 36

In the PEA/Asystole protocol, Medical Control Option B:

In cases of Hyperkalemia or Calcium Channel Blocker Overdose, 1 gm of what medication can be given IV/IO Bolus SLOWLY?

Answer 36

Medical Control Option B:
In cases of Hyperkalemia or Calcium Channel Blocker Overdose,
1 gm of Calcium Chloride is administered SLOWLY IV/IO Bolus followed by a NS Flush.

Question 37

In the PEA/Asystole protocol, Medical Control Option C consists in beginning a rapid IV/IO infusion of NS, up to how many Liters?

Answer 37

Medical Control Option C:

Begin rapid IV/IO infusion of Normal Saline, up to Three (3) liters.

Question 38

In the PEA/Asystole protocol, Medical Control Option D consists in calling for what?

Answer 38

Medical Control Option D:

Transport Decision.

Question 39

In the Drug Therapy of MI Protocol,

When and How often should you administer Nitroglycerin?

Answer 39

If Chest Pain persists, administer a Nitroglycerin tablet 1/150 gr. or spray 0.4 mg, sublingually every five (5) minutes.