Paramedic Protocol Exam

A 58-year-old male with a history of hypertension presents with crushing substernal chest pain radiating to his left arm, accompanied by nausea and profuse sweating. His blood pressure is 84/50, and a 12-lead ECG reveals ST elevation in leads II, III, and aVF. Which medication is contraindicated in this scenario?

• A. Aspirin

• B. Nitroglycerin

• C. Oxygen

• D. Morphine

You are treating a 76-year-old male who presents with dizziness, fatigue, and syncope. On arrival, he is conscious but confused. Vitals: HR 32, BP 78/42, RR 16, SpO2 95%. The cardiac monitor reveals a regular rhythm with a ventricular rate of 30 bpm and more P waves than QRS complexes. There is no consistent relationship between the P waves and QRS complexes. IV access is established, and oxygen is being administered. Transcutaneous pacing is available but not yet initiated. What is the most appropriate next intervention?

• Administer atropine 1 mg IV

• Begin transcutaneous pacing immediately

• Administer dopamine infusion at 2-10 mcg/kg/min

• Prepare for immediate transport without intervention

A 66-year-old male is found sitting on his porch complaining of palpitations and dizziness. He is diaphoretic, with a heart rate of 180 bpm and BP of 80/40. ECG reveals wide-complex tachycardia. What is the most appropriate treatment?

• A. Adenosine

• B. Cardioversion

• C. Amiodarone

• D. Vagal maneuvers

You are treating a 5-year-old cardiac arrest patient who weighs 40 lbs. What is the correct initial epinephrine dose?

• 0.18 mg

• 1.8 mg

• 0.5 mg

• 1.0 mg

A 10 kg child in cardiac arrest requires defibrillation. What is the correct first shock dose?

• 10 J

• 20 J

• 50 J

• 100 J

A 60-year-old male is found sitting on the couch complaining of substernal chest pain that began 20 minutes ago while walking. His vitals are stable: HR 88, BP 134/86, RR 18, SpO2 98% on room air. ECG is normal. You suspect ACS. What is the most appropriate initial intervention?

• Morphine

• Nitroglycerin

• Aspirin

• Heparin

EMS responds to a 62-year-old female found pulseless and unresponsive at a restaurant. CPR is in progress, and the monitor shows ventricular fibrillation. After three defibrillation attempts, the rhythm persists. What medication should be administered next?

• Amiodarone 150 mg

• Epinephrine 1 mg

• Amiodarone 300 mg

• Lidocaine 1 mg/kg

A 17-year-old male collapses during football practice. Bystanders begin CPR and an AED is applied, which advises a shock. What should you do next?

• Epinephrine

• Shock

• Rescue breathing

• Airway adjunct

A 44-year-old patient achieves ROSC after two shocks and one dose of epinephrine. Vitals: SpO2 96%, BP 92/64. What is your next step in care?

• Stop oxygen

• Ventilate at 20 bpm

• Maintain oxygenation and SBP > 90 mmHg

• Allow hypotension

Pediatric cardiac arrest is usually caused by primary cardiac arrhythmia.

• True

• False