	SAGINAW VALLEY MEDICAL CONTROL AUTHORITY

ALS System Exam

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1: After being stung by a bee, a patient presents with a rash and wheezing. This patient is having a:: a. Mild allergic reaction
b. Moderate allergic reaction
c. Severe allergic reaction
d. Anaphylactic Shock
2: The above patient is given subcutaneous epinephrine. In addition to this, what other treatment modalities may be considered:: a. IV normal saline at TKO
b. Albuterol 2.5mg in 3cc solution via nebulizer
c. Methylprednisolone 125 mg IVP
d. Diphenhydramine 50mg IVP
e. All of the above
3: You arrive on the scene of a cardiac arrest, and the first responder agency has applied their AED, it is delivering one shock as you approach the patient, You should:: a. Disconnect the AED and apply your monitor
b. Immediately intubate the patient
c. Begin Chest Compressions at a rate of 30 compressions/2 breaths for 5 cycles
d. Wait for the AED to analysis the patient’s current rhythm.
4: You arrive to find a 65 year old man complaining of chest pain. He appears ashen and diaphoretic and has a history of coronary artery disease. Which of the following best describes the pre-hospital role for 12-lead EKG.: a. All chest pain patients should get a 12-lead EKG
b. Only those with chest pain who have a history of coronary artery disease should have a 12-lead EKG performed
c. 12-leads have no role in the pre-hospital setting
d. A paramedic’s assessment should guide the decision to perform a 12-lead EKG
5: (See Question 4) The above patient’s 12-lead EKG shows significant ST segment elevations in leads II, III, and aVF. He is most likely suffering from:: a. Aortic dissection
b. Cardiac tamponade
c. Anterior wall myocardial injury
d. Inferior wall myocardial injury
e. Unstable angina
6: (See Question 4) You cannot obtain IV access on the patient. He states that his pain is “unbearable”. Which of the following would be the best appropriate course to manage his pain:: a. Administer morphine sulfate IM
b. Reassure the patient, then continue attempts at an IV
c. Administer 0.4mg of sublingual nitroglycerin
d. Administer nitroglycerine paste to his chest wall
e. Contact medical control for further orders
7: (See Question 4) An IV line has been established. After administering a second 0.4mg sublingual nitroglycerine tablet to the above patient, you note that his blood pressure has dropped to 68/40. Which of the following would be the most appropriate course of action:: a. Give a third 0.4mg sublingual nitroglycerine
b. Give 300 cc fluid bolus of normal saline
c. Give IV morphine sulfate in 2mg increments
d. Start a dopamine drip
e. Contact medical control for orders
8: Which of the following best describes the role of nitroglycerine in heart attacks:: a. Nitroglycerine has less side effects than morphine
b. Nitroglycerine improves patient outcome in acute myocardial infarction
c. Nitroglycerine helps to distinguish cardiac from non-cardiac chest pain
d. Although its role as a pain reliever in acute coronary syndrome has been established, nitroglycerin has never been proven to improve outcomes
9: You are transporting a patient with cardiac chest pain who has an abnormal 12- lead EKG. You want to treat the pain with morphine right away, you would give:: a. None, you need to contact Medical Control for an order
b. 1 dose of up to 5 mg IV, after which you contact Medical Control.
c. 1 dose of up to 4 mg IV, after which you contact Medical Control.
d. 2 mg IV Slowly Q 3-5 minutes titrated to pain up to 6 mg total (3 doses).
10: You are called for a 2 yr old patient having a seizure. On arrival you find the patient seizing with obvious tonic-clonic movements. Which of the following would you assess first?: a. Capillary refill time
b. Blood glucose level
c. Rectal temperature
d. Blood pressure
11: (See Question 10) Prior to contacting Medical Control with the above patient report, you can administer:: a. Oxygen only
b. Diazepam 0.2 mg/kg IV or IO
c. Diazepam 2-4 mg IV or IO
d. Nothing, you need to contact Medical Control for any treatment.
12: (See Question 10) If the IV is not successful, and the patient continues to seize, you should:: a. Administer diazepam 0.5 mg/kg rectally, but only after contacting Medical Control
b. Administer diazepam 2-4 mg via rectal route, prior to Medical Control contact.
c. Administer diazepam 0.5 mg/kg via rectal route
d. Intubate the patient, then administer diazepam through the endotracheal tube
e. Transport patient priority 1 to the hospital, before any treatment is initiated.
13: You are dispatched to a 68 y/o male with difficulty breathing that started abruptly, shortly after going to bed for the night. He is very agitated and confused. He is coughing up pinkish colored sputum. Lung auscultation reveals bibasilar rales. What would you do next to this patient first?: a. Administer Nitroglycerine SL 0.4 mg up to 3 doses
b. Administer Albuterol 2.5 mg Inhaled
c. Administer Magnesium Sulfate 2 grams, slow IV push
d. None of the above, first check his vital signs, assess his airway and administer O2
14: Which of the following medications can be administered to the above patient without contacting Medical Control?: a. Furosemide 40 mg IVP
b. Furosemide 80 mg IVP
c. Lasix 1 mg/ kg IVP
d. None of the above can be given without prior authorization of Medical Control
e. Any of the above can be given prior to contacting Medical Control.
15: You are dispatched to a patient with shortness of breath. You arrive to find an 18 y/o female breathing 32 bpm with dry cough. Lung sounds reveal wheezing and the patient is having a hard time speaking in complete sentences but is able to show you an inhaler she uses. Which of the following should she receive prior to contacting Medical Control?: a. Epinephrine 1:1000 SQ (0.3 mg)
b. Lasix 40 mg IV
c. Albuterol 2.5 mg/3cc solution via Nebulizer
d. Atrovent 0.5-1.0 mg
16: You are dispatched to the scene of a chest stabbing. You arrive to find the victim in respiratory distress. His neck veins are distended, and he has absent lung sounds on the side of the wound. Which of the following is the likely cause of his symptoms?: a. Pericardial tamponade
b. Tension pneumothorax
c. Thoracic outlet syndrome
d. Myocardial infarction
17: The patient in the above scenario stops breathing. You note that his trachea is deviated away from the side of the wound. What should be done next?: a. Intubation
b. Needle decompression
c. Chest compressions
d. Pericardiocentesis
18: You are dispatched to an explosion at a chemical plant. You arrive to find a 53 y/o male patient who has chemical burns to his legs and chest. What is the most important thing to remember when dealing with chemical burns?: a. Immediate stabilization
b. IV therapy
c. Decontamination
d. Thorough irrigation
19: The above patient must be monitored closely for:: a. Airway compromise and breathing difficulties
b. Suicidal and bizarre behavior
c. Signs of shock and circulatory collapse
d. Blistering and skin contractions
20: You are called to a local prison for an assault. An inmate describes a severe headache of 2 hours duration. The patient has rapid deterioration in his neurological exam, and while in transport, he loses consciousness. His pupils, which were originally equal and reactive are now markedly asymmetrical. This sudden change in pupil sizes is most likely indicative of:: a. cerebral herniation
b. stroke
c. brain tumor
d. All of the above
21: You intubate the above patient. Which of the following best describes the approach to hyperventilation:: a. Appropriate only if signs of cerebral herniation
b. Hyperventilation is between 16 and 20 breaths per minute
c. Hyperventilation is between 24 and 30 breaths per minute
d. Both A and B
22: You find a known diabetic lying on his bathroom floor. His wife states that he was complaining of abdominal pain just minutes earlier and she thought he was using the toilet. He is unconscious, but breathing on his own. Which of the following best describes the pre-hospital recommendation for the administration of glucose?: a. To all patients with altered LOC regardless of their blood glucose level.
b. To patients with blood glucose levels < 100 mg/dl
c. To patients with blood glucose levels < 70 mg/dl
d. To known diabetics with any complaint of abdominal pain.
23: An IV is established on the above patient and he is given IV dextrose. There is no improvement in his LOC. What medication should you give next?: a. SoluMedrol 125 mg IVP
b. Magnesium Sulfate 2 gm slow IVP
c. Naloxone 2-4 mg IVP
d. Repeat Dextrose 25 gm IVP
24: (See question #22) The above patient stops breathing and you note that he has no pulse. What is the recommended dose of epinephrine in this case?: a. 1 mg of 1:10,000 IVP q 3-5 minutes
b. 2 mg of 1:10,000 diluted with Normal Saline to 10 ml concentration ET q 3-5 minutes
c. 10 mg IVP q 5 minutes
d. None of the above
25: (See question #22) The maximum dose of atropine for this patient is:: a. 3 mg
b. 0.1 mg / kg
c. 0.01 mg / kg
d. 5 mg
26: (See question #22) Later, you learn that the above patient had been complaining of severe lower back pain just prior to his abdominal pain and syncopal episode. These symptoms are concerning that the underlying cause for his death could have been:: a. Myocardial infarction
b. Hypoglycemic coma
c. Rupture abdominal aortic aneurysm
d. Perforated ulcer
27: You are called to an adult patient who complains of severe palpitations and chest pain. Cardiac monitor shows a narrow complex tachycardia. How would you treat this patient?: a. Cardizem 20 mg IVP
b. Synchronous cardioversion @ 100 joules, check pulse, check rhythm
c. Defibrillation @ 100 joules
d. Overdrive pacing
28: You confirm that the above patient is in supraventicular tachycardia. If the patient had stable vital signs and did not have chest pain or altered level of consciousness, you would have used which of the following:: a. Adenosine 0.01 mg / kg IVP
b. Verapamil 3 mg IVP
c. Adenosine 6 mg IVP
d. Adenosine 12 mg IVP
29: (See Question 28) If the above patient requires a second dose of medication, it should be given at:: a. Twice the original dose
b. The same as the original dose
c. 15 mg IVP
d. 25 mg IVP
30: You are called to the scene of an unconscious adult patient. You find the patient to be pulseless and apneic, and confirm he is in cardiac arrest. You choose to use Vasopressin at:: a. 0.1 mg / kg IVP
b. 1 mg / kg IVP
c. 20 U IVP
d. 40 U IVP
31: Regarding the above patient, the initial dose of vasopressin is ineffective. How frequently can it be admininstered?: a. Every 3 minutes
b. Every 5 minutes
c. One time only in place of the first dose of epinephrine
d. As often as necessary alternated with epinephrine
32: (See question #30) The patient is found to be in persistent ventricular fibrillation. Standard measures are taken, and ultimately a decision is made to administer amiodarone. What is the appropriate dose?: a. 150 mg IV drip
b. 200 mg IV drip
c. 300 mg IVP
d. 500 mg IVP
33: (See question #30) You have given Amiodarone in the above dose, and defibrillation has been successful. The patient should receive:: a. Lidocaine bolus 1 mg / kg followed by a drip @ 2 mg / min
b. Lidocaine bolus 1 mg / kg
c. Amiodarone drip @ 1 mg / min
d. Amiodarone bolus at half the original dose
34: You are transporting a 45 year old patient who complains of severe chest pain. He admits to using cocaine for the prior 24 hours. His blood pressure is 230/140. Which of the following medications is allowed by protocol to lower his blood pressure prior to contacting medical control?: a. Nitroglycerine SL 0.4 mg
b. Vasopressin 40 U IVP
c. Lasix 40 mg IVP
d. None of the above
35: Regarding the above case, which of the following best describes the approach in blood pressure management (assume normal is <140/90)?: a. His blood pressure should be reduced slowly, but should not be reduced greater than 10-15% of his systolic arterial pressure
b. His blood pressure should be reduced rapidly, until a normal blood pressure has been achieved
c. His blood pressure should be reduced rapidly, but should not be reduced greater than 25% of his systolic arterial pressure
d. His blood pressure should be reduced slowly, and should not be reduced greater than 25% of his mean arterial pressure
36: A female patient presents in her ninth month of pregnancy with a headache. Her blood pressure is 175/110 and you note that she has pitting edema in her lower legs. While starting an IV, her body begins to convulse. What medication is most appropriate?: a. Nitroglycerine SL 0.4 mg
b. Lasix 40 mg IVP
c. Albuterol via nebulizer
d. Midazolam 0.05 mg / kg IVP, max of 5 mg
37: The above patient is currently suffering from:: a. Narcotic overdose
b. Amniotic fluid embolism
c. Pre-eclampsia
d. Eclampsia
e. Febrile Seizure
38: You are called for an adult patient who ingested an unknown quantity of acetaminophen. The patient is awake, alert and cooperative. Treatment should include:: a. Activated Charcoal 50 gm PO
b. Diphenhydramine 50 mg IVP
c. Magnesium Sulfate 2 gm IVP
d. No medications are indicated, establish airway, provide oxygen and support ventilations, as needed.
39: You are called for a young female patient who states she “can’t keep [her] head straight”. This started two hours after taking a new medicine for depression. Her vital signs are normal, but she has a very obvious fixed mal-positioning of her head and cannot move it from a flexion/rotation position. Which of the following medicines is likely to relieve her condition:: a. Naloxone 2 mg IVP
b. Lasix 40 mg IVP
c. Aspirin 324 mg PO
d. Diphenhydramine 50 mg IVP
40: You find an adult patient with decreased respirations after reportedly chewing on a fentanyl patch. What medication is most appropriate?: a. Morphine 2-4 mg IVP
b. Naloxone 10 mg IVP
c. Naloxone 2 mg IVP
d. Diphenhydramine 25 mg IVP
41: In which of the following cases would it be most appropriate to give nebulized Albuterol in the pre-hospital setting:: a. An 18-year-old male with a history of asthma who is having diffuse wheezing and tachypnea
b. An 83-year-old male from a nursing home with 3 days of leg swelling and and progressive shortness of breath
c. A 30-year-old female with normal lung sounds who presents with acute anxiety and tachypnea
d. A 63-year-old man who presents with acute respiratory failure, coughing up pink frothy sputum
42: You are called to the home of an elderly female who reportedly has had a stroke. When you arrive, you note that the patient has slurred speech, but is able to vocalize that she is having a bad headache. She has an obvious facial droop and you also elicit pronator drift. Which of the above characteristics is not part of the Cincinnati Pre-Hospital Stroke Assessment?: a. Complaint of headache
b. Abnormal speech
c. Facial droop
d. Pronator drift
43: You arrive at the scene of a bonfire. You assess a patient who apparently threw a can of spray paint into the fire and it exploded on him. He has full thickness burns that cover the entirety of his upper limbs (including upper arms, forearms, and hands). Approximately what percentage of body surface area has been burned?: a. 9%
b. 18%
c. 27%
d. 45%
44: Regarding the above case, how should the burns be dressed in the pre-hospital setting?: a. Clean, dry dressings should be applied
b. Cool, wet dressings should be applied
c. No dressings should be applied
d. Vaseline gauze dressings should be applied
45: You arrive at the scene of a head-on motor vehicle accident. The drivers of both vehicles are ambulatory at the scene, even though both of the cars are severely damaged and a passenger has been killed on impact. One of the drivers smells strongly of alcohol. The other driver has a badly contused forehead, disfigured forearm, and does not make sense when talking to you. Neither complains of neck pain. Which of the drivers should have his cervical spine immobilized:: a. The driver intoxicated with alcohol
b. The driver with the disfigured forearm and head injury
c. Neither
d. Both
46: According to SVMCA Practice Parameters, which of the following was NOT an indication to apply cervical spine immobilization:: a. Head injury
b. Intoxication
c. Passenger killed
d. Disfigured forearm
e. All of the above are absolute indications to immobilize the cervical spine
47: You are called to the scene of a pediatric drowning. A 5-year-old child is pulled from a cold (38 degrees F) river after being submerged for nearly 30 minutes. Which of the following best describes your initial approach to this patient?: a. Contact Medical Control for a Code 12
b. Assess for signs of lividity
c. Establish a definitive airway
d. Obtain a core temperature
48: Regarding the above patient, what would be the best way to obtain his core body temperature:: a. oral
b. rectal
c. axillary
e. core temperature has no role in this case
49: (See Question 47) The patient’s blood glucose level is 64. In pediatric cases, hypoglycemia should be treated when blood glucose reaches what level:: a. 100 mg / dl
b. 90 mg / dl
c. 80 mg / dl
d. 70 mg / dl
50: (See Question 47) The proper dose of IV Dextrose in this patient is:: a. Dextrose 50% @ 1 ml / kg
b. Dextrose 50% @ 2 ml / kg
c. Dextrose 25% @ 5 ml / kg
d. Dextrose 25% ½ amp
51: You arrive to find a 6-month-old in severe respiratory distress. The child shows signs of imminent respiratory failure and you decide to intubate him. Which of the following would be the correct dose of midazolam for sedation?: a. 0.1 mg / kg IVP
b. 1 mg / kg IVP
c. 2.5 mg IVP
d. 5 mg IVP
52: The child has gone pulseless. The proper IV dose of Epinephrine in the pediatric cardiac arrest is:: a. ½ amp q 5 min to a total of 3 mg
b. 1 mg initially followed by ½ amp q 5 min
c. 0.01 mg / kg of 1:10,000 IVP q 3-5 minutes
d. 0.1 mg / kg of 1:1000 IVP q 3-5 minutes
53: Regarding the above patient, you lose IV access and you decide to attempt intraosseous access. Which of the following is most correct about when to perform this procedure?: a. It should be done on all pediatric patients less than 2 years of age who require fluid resuscitation
b. It should only be done after 3 unsuccessful attempts at IV access or 90 seconds has elapsed in a child who needs emergent access
c. It should be performed only on direct order of Medical Control
e. It should be done on any trauma patient, regardless of age
54: You arrive on scene to find a patient who is pulseless and apneic. The body is cold and shows signs of rigor. The treatment indicated for this patient can be found under which of the following practice parameters?: a. Asystole
b. Managing Patients Found Dead on Scene (Code 12)
c. Bradycardia
d. Poisoning/Overdose
55: For the patient mentioned above you would:: a. Administer Epinephrine
b. Establish an airway
c. Apply the cardiac monitor
d. Request that PD on scene contact Medical Examiner to come to the scene.
56: You arrive on scene to find a patient who is pulseless and apneic. The patient is wearing a purple wrist band that clearly states she is DNR. Her daughter, the legal guardian is visibly upset. She is jumping up and down demanding that you do something for her mother. “You can’t just let her die”, she screams. Which of the following is the most appropriate action?: a. Ask her to step out of the room
b. Tell her that her mother is part of the DNR Program and therefore they can’t
c. Begin resuscitative efforts, including CPR, medications, etc.
d. Request that the Medical Examiner be sent to your location
57: You arrive on scene to find a patient in cardiac arrest with the first responder agency performing CPR. The cardiac monitor shows asystole. An airway is established along with IV access. In order to consider termination of efforts you must:: a. Administer Atropine and Epinephrine only
b. Ask permission from the family
c. Contact Medical Control
d. Assure all reasonable efforts have been accomplished, i.e. intubation, oxygenation, ACLS drugs, external pacing and then contact medical control