2008 NYC REMAC - ALS Protocol Drill

RESPIRATORY ARREST
standing orders

RESPIRATORY ARREST
medical control options

OBSTRUCTED AIRWAY
standing orders

VF/PULSLESS VT
standing orders

VF/PULSLESS VT
standing order drugs

VF/PULSLESS VT
medical control drugs

PEA/ASYSTOLE
standing orders

PEA/ASYSTOLE
standing order drugs

PEA/ASYSTOLE
medical control options

Name the two drugs that are in both PEA and VF medical control options.

Name the four initial steps taken with suspected AMI patients.

AMI/MYOCARDIAL ISCHEMIA
standing order drugs

AMI/MYOCARDIAL ISCHEMIA
medical control drugs

AMI/CARDIOGENIC SHOCK
standing order drugs

AMI/CARDIOGENIC SHOCK
medical control options

True or False:
Cardiogenic Shock gets a 12 lead EKG.

Name the three initial steps taken for patients presenting with dysrhythmias.

SUPRAVENTRICULAR TACHYCARDIA
standing orders

SUPRAVENTRICULAR TACHYCARDIA
medical control options

True or False:
Amiodarone is given for SVT under standing orders.

True or False:
Diltiazem can be administered under medical control options for SVT.

True or False:
Adenosine may be used under standing orders to control a stable case of Rapid A-fib.

True or False:
Amiodarone can be used for A-flutter under medical control options.

ATRIAL FIB/ ATRIAL FLUTTER
standing orders

ATRIAL FIB/ ATRIAL FLUTTER
medical control options

True or False:
Medical control options for A-fib/flutter include calling for repeat cardioversion.

True or False:
Medical control options for SVT include calling for repeat cardioversion.

What are the two drugs that can be used for controlling both SVT and A-fib/flutter under medical control options?

Besides Diltiazem and Amiodarone, what other drug can be used to control SVT?

Besides Diltiazem and Amiodarone, what other drug can be used to control A-fib/A-flutter?

True or False:
You can call for fluids for VF under medical control options.

V-TACH / WIDE COMPLEX TACH w/PULSE
standing orders

Name the standing order drug that can be used to treat V-tach with a pulse.

V-TACH / WIDE COMPLEX TACH w/PULSE
medical control options

True or False:
Sodium Bicarbonate may be given for V-tach with a pulse under medical control options.

True or False.
You may call for Amiodarone under medical control options for V-tach with a pulse.

Besides sodium bicarb, name the drugs that can be given to V-tach with a pulse under medical control options.

BRADYDYSRHYTHMIAS/COMPLETE HEART BLOCK
standing orders

BRADYDYSRHYTHMIAS/COMPLETE HEART BLOCK
medical control options

True or False:
Medical control options for Bradycardia include epinephrine.

ACUTE PULMONARY EDEMA
standing orders

ACUTE PULMONARY EDEMA
standing order drugs

ACUTE PULMONARY EDEMA
medical control options

True or False:
Repeat Furosemide can be requested under medical control options for acute pulmonary edema.

ASTHMA/WHEEZING
standing orders drugs

ASTHMA/WHEEZING
medical control drugs

True or False:
Epi may be administered in adult asthma cases on standing orders.

COPD
standing orders

What two drugs are present in the standing orders for Asthma but not COPD?

COPD
medical control options

ANAPHYLACTIC REACTION
standing orders

ANAPHYLACTIC REACTION
standing order drugs

ANAPHYLACTIC REACTION
medical control drugs

True or False:
Methypredisolone is a standing order in asthma.

True or False:
Methypredisolone is a standing order in anaphylaxis.

True or False:
Dopamine is under medical control options for anaphylaxis.

ALTERED MENTAL STATUS
standing order drugs

ALTERED MENTAL STATUS
medical control options

SEIZURES
standing order drugs

SEIZURES
medical control drugs

True or False.
You can give Diazepam to sedate a statep seizure patient without calling medical control.

True or False:
You can give Dextrose to a seizure patient under standing orders.

NON-CARDIOGENIC SHOCK
standing orders

True or False:
You should place a cardiac monitor on non-cardiogenic shock patient per standing orders.

NON-CARDIOGENIC SHOCK
medical control options

TRAUMATIC ARREST
standing orders

TRAUMATIC ARREST
medical control options

HEAD INJURIES
standing order drugs

True or False:
You can give Diazepam to a head injury patient on standing orders.

Name the drugs in the medical control options for head injuries that is used to control associated seizures.

HEAD INJURIES
medical control drugs

CHEMICAL EYE INJURIES
medical control options

CHEMICAL EYE INJURIES
standing orders

BURNS
standing orders

BURNS
medical control options

PAIN MANAGEMENT
medical control options

PAIN MANAGEMENT
standing orders

True or False:
You can give Morphine on standing orders for pain management in the case of an isolated extremity injury.

OBSTETRIC COMPLICATIONS
standing orders

OBSTETRIC COMPLICATIONS
medical control options

True or False:
You can give Oxytocin to a post-partum hemorrhage without contacting medical control.

What should be done before initiating resuscitation on a newborn with meconium.

NEONATE RESUSCITATION (NO MECONIUM)
standing orders

Name the one drug given during a neonate resuscitation on standing orders.

NEONATE RESUSCITATION (NO MECONIUM)
medical control options

True or False:
An IV/IO may be established on standing orders in the case of a neonate resuscitation.

PEDIATRIC RESPIRATORY ARREST
standing orders

What drug is given on standing orders for pediatric respiratory arrest cases?

PEDIATRIC RESPIRATORY ARREST
medical control options

True or False:
An IV/IO may be established on standing orders in pediatric respiratory arrest.

What is the only drug in the pediatric respiratory arrest protocol?

What drug is given under medical control options for pediatric respiratory arrest cases?

PEDIATRIC OBSTRUCTED AIRWAY
medical control options

PEDIATRIC OBSTRUCTED AIRWAY
standing orders

True or False:
You must call medical control to obtain permission to perform a crycothyrotomy on a pediatric obstructed airway.

PEDIATRIC CROUP/EPIGLOTTITIS
standing orders

True or False:
Passage of an NG/OG Tube is contraindicated in cases of pediatric epiglottitis.

True or False:
Intubation is contraindicated in cases of pediatric croup/epiglottitis.

PEDIATRIC NON-TRAUMATIC ARREST
standing orders

PEDIATRIC NON-TRAUMATIC ARREST
standing order drugs

PEDIATRIC NON-TRAUMATIC ARREST
medical control options

True or False:
Magnesium sulfate is in the medical control options for pediatric non-traumatic arrest.

What is Magnesium used for in the pediatric arrest protocol?

PEDIATRIC ASTHMA/WHEEZING
standing orders

True or False:
You can administer Metaproterenol on standing orders in pediatric asthma.

PEDIATRIC ASTHMA/WHEEZING
medical control options

True or False:
You can start an IV/IO on standing orders in cases of pediatric asthma.

How is Ipratropium Bromide administered in pediatric asthma cases?

PEDIATRIC ANAPHYLACTIC REACTION
standing orders

What is the one drug given for pediatric anaphylaxis?

PEDIATRIC ANAPHYLACTIC REACTION
medical control options

True or False:
It is permissible to start an IV/IO on standing orders for a pediatric patient in anaphylactic shock.

PEDIATRIC ALTERED MENTAL STATUS
standing orders

PEDIATRIC ALTERED MENTAL STATUS
standing order drugs

True or False:
It is permissible to start an IV/IO on a pediatric altered mental status on standing orders.

True or False:
Thiamine is administered after Dextrose to pediatric altered mental status patients.

True or False:
Thiamine is administered after Dextrose to altered mental status patients.

True or False:
You can administer Metaproterenol on standing orders for anaphylactic reactions.

True or False:
Albuterol is used for bronchospasm in pediatric anaphylactic reactions.

PEDIATRIC ALTERED MENTAL STATUS
medical control options

PEDIATRIC SEIZURES
standing orders

True or False:
You can start an IV/IO on a pediatric stat-ep without contacting medical control.

True or False:
You can administer rectal Diazepam on standing orders in the case of a pediatric stat-ep.

PEDIATRIC SEIZURES
medical control options

What three medical control option drugs are used to control seizures in pediatric patients?

PEDIATRIC DECOMPENSATED SHOCK
standing orders

True or False:
It is permissible to start an IV/IO on a pediatric patient in decompensated shock without contacting medical control.

PEDIATRIC DECOMPENSATED SHOCK
medical control options

True or false:
Amiodarone is in the pediatric decompensated shock medical contol options.

PEDIATRIC TRAUMATIC CARDIAC ARREST
standing orders

PEDIATRIC TRAUMATIC CARDIAC ARREST
medical control options

True or False:
You must call for IV/IO in pediatric traumatic cardiac arrest.

Name the pediatric protocols in which IV/IO may be established on standing orders.

Name the pediatric protocols in which you must call medical control to obtain permission to establish IV/IO access.

True or False:
For both pediatric "cardiac arrests" (traumatic and non-traumatic), it is permissible to establish an IV/IO on standing orders.

True or False:
For neonate resuscitation, it is permissible to start an IV/IO on standing orders.

True or False:
For the "big three" pediatric respiratory emergencies,
(1) Respiratory Arrest
(2) Asthma
(3) Anaphylaxis
you must call medical control before starting an IV/IO.

In addition to the "big three" pediatric respiratory emergencies, what is the only other time you must call medical control for permission to start an IV/IO?

What are the "Three C's" of pediatric decompensated shock?

What are the four signs of pediatric decompensated shock?

What are the "Three C's" of pediatric decompensated shock?

What are the four signs of pediatric decompensated shock?

In the pediatric patient, a systolic BP of below ______ OR signs of inadequate ______ pefusion indicate decompensated shock.

In the pediatric patient, a systolic BP of below ______ OR signs of inadequate ______ pefusion indicate decompensated shock.

What are the "Three C's" of pediatric decompensated shock?

What are the four signs of pediatric decompensated shock?

In the pediatric patient, a systolic BP of below ______ OR signs of inadequate ______ pefusion indicate decompensated shock.

In pediatrics, IV/IO may be established under standing orders for 3 ______ and 2 ______ emergencies.

Name the three pediatric circulatory emergecies that call for IV/IO on standing orders.

Name the two pediatric CNS emergecies that call for IV/IO on standing orders.

Aside from the "big three" respiratory emergencies, what is the only other case in which IV/IO requires prior approval of medical control?

EMOTIONALLY DISTURBED PATIENT
standing orders

EMOTIONALLY DISTURBED PATIENT
medical control options

True or False:
You may chemically restrain an EDP without consulting medical control.

CYANIDE TOXICITY / SMOKE INHALATION
standing orders

CYANIDE TOXICITY / SMOKE INHALATION
medical control or class order

You have a class order for the cyanide poisoning at an MCI, but you have a patient that needs RSI. Do you need to call medical control for sedation?

True or False:
Dopamine is a medical control option in the Cyanide Poisioning protocol.

In suspected cyanide poisonings, prior to administration of Hyroxocobalamin, if possible, obtain ______.

For suspected cyanide poisoning, in the event that only one IV line is established, administer only ______.

Sodium Thiosulfate, Dopamine, and Diazepam may not be administered via the same line as ______.

______ is a white crystalline powder that must be mixed in saline prior to administration.

You've exhausted standing orders for PEA/Asystole and are about to call medical control. What are the three conditions that should cross your mind that may be treatable under medical control options?

You've exhausted standing orders for a refractory V-fib. Aside from more Amiodarone for the arrhythmia itself, what other three conditions should cross your mind as potentially treatable through medical control options?

What two drugs appear in the medical control options for both V-fib and PEA/Asystole?

______ must be treated prior to initiation of a 12 lead EKG.

In cases of suspected MI, perform, record and evaluate a 12-lead EKG on any patient that is ______ (i.e., systolic BP greater than ______).

12-lead EKG only appears in what three protocols?

Before each administration of Nitroglycerin, check the patient's ______ and ______ to ensure the patient is ______.

Nitro may NOT be administered to patients with a systolic BP of less than ______ unless...

STEMI patients are those that have ST elevation in ______ leads (___mm in the limb leads, ___mm in the chest leads), or a new ______.

Following Morphine administration, if ______ developes, administer Naloxone.

Etomidate is used for ______.

Each time Etomidate is used for RSI, it can be followed by ______ or ______ for continued sedation.

Each time Etomidate appears in a protocol, ______ and ______ are ammended to it for continued sedation.

Which two drugs always appear as an adjunct to Etomidate?

Whenever Etomidate is indicated, what two drugs follow as part of the same medical control option.

Whenever Morphine is indicated, which PRN drug option will appear next?

When administering Dopamine, if there is ______ in hemodynamic status, the infusion rate may be increased until ______ or ______.

In a patient with ______ SVT, perform synchonized cardioversion.

In a patient with ______ SVT, administer adenocard.

Acronym for identifying unstable arrhythmias in adults.

List the components of HAPSA for identifying unstable arrhythmias in adults.

List the components of HAD for identifying unstable arrhythmias in pediatrics.

Acronym for identifying unstable arrhythmias in pediatrics.

What are the only two differences between the SVT and A-fib/A-flutter protocols?

What is the initial treatement for unstable SVT?

What is the initial treatment for stable SVT?

What is the initial treatment for unstable A-fib/A-flutter?

What is the initial treatment for stable A-fib/A-flutter?

True or False:
Stable A-fib/flutter can only be treated under medical control options.

Name the two methods of treating STABLE A-fib/flutter.

What is the first line of treatment for stable bradycardia?

What is the first treatment option for Bradycardia/Complete Heart Block with decompensated shock?

What is the second treatment option for Bradycardia/Complete Heart Block wih decompensated shock?

In cases of adult asthma, administer epinephrine on standing orders to patients with signs of ______.

True or False:
Magnesium sulfate is given on standing orders in cases of adult asthma.

True or False:
Methylprednisolone and Dexamethazone are in the medical control options in the adult asthma protocol.

True or False:
Epi may be given on standing orders to patients with excacerbation of COPD.

True or False:
Epi is intially given down the ET tube in adult anaphylaxis.

What is the first drug treatment option under standing orders in adult anaphylaxis.

In adult anaphylaxis, what can be done under standing orders for the patient with bronchospasms?

True or False:
Nebulized Metaproterenol may be given under standing orders in adult anaphylaxis.

IV epinephrine and fluids are given to adult anaphylaxis patients under standing orders if the patient has signs of ______.

Diphenhydramine may be given on standing orders in the adult anaphylaxis patient provided...

In adult anaphylaxis, ______ and ______ drips may be given under ______ to improve hemodynamic status.

A glucometer (if available) may be used to document blood glucose level... (when)

If the glucometer reading is above ______, dextrose may be withheld.

True or False:
Always administer thiamine along with Glucagon.

What is the one drug that may be repeated under medical control options for Adult Altered Mental Status?

In Adult Altered Mental Status, Naloxone may be administered ____ or ____ if IV access has not been established.

True or False:
Naloxone may be administered IN to pediatric AMS.

What is the first drug given for ongoing or recurring seizures in adults?

The adult seizure protocol applies to seizures that are ______ or ______.

What is the second drug given in the adult seizure protocol?

True or False:
Etomidate may be used to treat adult seizures.

True or False:
You must call for Valium to treat ongoing seizure activity.

True or False:
Midazolam IV may be given for ongoing seizures under standing orders.

For ongoing seizures, when is Midazolam given and by what route?

True or False.
Thiamine may be given to adult seizure patients.

True or False.
Lorazepam, Diazepam and Midazolam may all be given IM to a seizure patient in the event that IV access is unavailable.

True or False.
In adult seizure cases, Lorazepam may be given by either IV or IM.

In patients in traumatic cardiac arrest, ______ is the highest priority!

In cases of traumatic arrest, excluding patients with ______, begin cardiac monitoring.

You would not place the monitor on a patient in traumatic cardiac arrest if ______ is present.

If V-fib or pulseless V-tach are present in traumatic cardiac arrest, you would...

What are the two cardiac arrhythmias in traumatic arrest that may be medically treated?

The Head Injuries protocol applies to patients with head trauma who have a Glascow Coma Scale score of ___ or lower.

According to the Head Injuries protocol, you should intubate patients with a Glascow Coma Score of less than ___, if less invasive methods of airway management are ineffective.

Lidocaine is given immediately ______ intubation in head injury cases to minimize the increase in intracranial pressure.

(before/after)

In the Head Injuries protocol, name the two drugs used to control seizures.

In the Head Injuries protocol, Diazepam/Lorazepam may be given on standing orders to control seizures.

In the Head Injuries protocol, name the three drugs used for RSI.

In the Head Injuries protocol, Diazepam/Lorazepam may be given if seizure activity ______ or ______.

In the Chemical Eye Injury protocol, Proparacaine or Tetracaine administered for the purpose of...

In the Burns protocol, perform RSI when these two situations are anticipated.

In the Burns protocol, perform cardiac monitoring for patients with ______.

In the Burns protocol, Morphine is given for the purpose of ______.

True or False:
In the Burns protocol, Morphine is given on standing orders.

Morphine may be administered for severe pain management of an isolated extremities injury provided the systolic BP is greater than ______ mm Hg.

In the Emotionally Disturbed Patient protocol, in order to protect the patient's airway, consider placing the patient in a ______ position.

Name the three drug options for chemically restraining an Emotionally Disturbed Patient.

Severe pre-eclampsia is characterized by a systolic BP of ______ mm Hg or higher and a diastolic BP of ______ mm Hg or higher.

Name the drug used to treat pre-eclampsia.

Name the drug used to treat post-partum hemorrhage.

True or False:
In patients with pre-eclampsia and a sever post-partum hemorrage, you should administer Oxytocin first.

Do not administer Oxytocin if ______ has not been expelled.

Failure to respond to Oxytocin may indicate that ______ or ______ remain within the uterus.

For neonate resuscitation with thick meconium, directly suction the ET tube via a ______ while slowly withdrawing the ET tube.

In neonate resuscitation with thick meconium, repeat suctioning procedure until...

In neonate resuscitation with thick meconium, do NOT replace the ET tube once the airway has been cleared unless the neonate remains...

Perform airway clearing procedures of thick meconium for neonates requiring resuscitation who are...

Do not intubate the neonate unless other methods of airways management are...

If abdominal distention occurs during neonate resuscitation...

In neonate resuscitation, if CPR has been initiated, and the heart rate remains less than ___ beats per minute and not rapidly increasing after ___ seconds of CPR, perform ___.

What is the only drug used in neonate resuscitation?

What is the first drug administered on standing orders for neonate resuscitation?

Summarize the essence of the medical control options for neonate resuscitation.

The pediatric respiratory arrest protocol applies to pediatric patients in actual or impending respiratory arrest, OR those who are ______ and ____.

What is the only drug used in the Pediatric Respiratory Arrest protocol?

True or False:
You must call for sedation to perform RSI on a pediatric respiratory arrest.

True or False:
There are no provisions for sedation for intubation, cardioversion or pacing in any of the pediatric protocols.

A pediatric patient has SVT. What can be done?

Can a pediatric patient be paced?

A pediatric patient has V-tach with a pulse. What can be done?

Since there is no bradyarrhythmia protocol for children, what should be done for a child with a hemodynamically unstable bradyarrhythmia?

For infants and children under 9 years of age with a heart rate of less than 60 and signs of inadequate central perfusion...

For ______ and ______ with a heart rate of less than 60 and signs of inadequate central perfusion, perform CPR.

In cases of croup/epiglottitis, do NOT attempt ______. Use ______ ventillation.

In cases of croup/epiglottitis, pass an NG/OG tube if distention occurs, but do NOT attempt to pass an NG/OG tube in a ______ patient.

In pediatric non-traumatic cardiac arrest, if the defibrillator is unable to deliver the recommended dose...

What is the first drug administered in pediatric non-traumatic arrest?

Name the five conditions you would be looking to treat under medical control options for pediatric non-traumatic arrest.

In the Pediatric Asthma protocol, epinephrine may be administered to patients ___ year of age and older with _____, _____ or _____.

Name the four findings that characterize severe respiratory distress in children.

What does TADS stand for?

What acronym is used to remember the characteristics of severe respiratory distress in pediatrics?

In a child, ______ is an ominous sign that indicates that respiratory failure and arrest are imminent.

In the medical control options for Pediatric Asthma, what drug can be optionally administered in place of the repeat dose of IM Epi?

True or False:
A Bradycardic and decompensated pediatric being treated as an arrest can be given Atropine to increase the heart rate.

In pediatric asthma, ______ may be mixed with Albuterol as a medical control option.

What is the first drug administered in Pediatric Anaphylaxis?

When is diphenhydramine administered in pediatric anaphylaxis?

When is diphenhydramine administered in adult anaphylaxis?

Describe the essence of the medical control options for pediatric anaphylaxis?

The Pediatric Altered Mental Status protocol applies to pediatric patients in a ______, with evolving ______, or with ______ of unknown etiology.

What is always the first priority, according to the Pediatric Altered Mental Status protocol?

Any AMS secondary to what five conditions does the Pediatric AMS protocol state should be treated under other protocols?

What pharmocologic trio forms the basis for the pediatric AMS protocol?

True or False:
Thiamine appears in the Pediatric AMS protocol.

Under what protocol is Thiamine administered to children?

What drugs can be given in a Pediatric AMS case with no IV access?

Describe the medical control options for Pediatric AMS.

What is the very first drug administered to a pediatric seizure patient?

What is a simple word to describe the essence of the standing orders for pediatric seizures?

What is a simple word to describe the essence of the medical control options for pediatric seizures?

Name the three drugs that may be used to sedate a pediatric seizure patient.

By which route(s) may Lorazepam be administered to a pediatric seizure patient?

By which route(s) may Diazepam be administered to a pediatric seizure patient?

By which route(s) may Midazolam be administered to a pediatric seizure patient?

In pediatric patients, do not administer Lorazepam, Diazepam, or Midazolam if...

Patients in ______ shock should not be treated under the Pediatric Decompensated Shock protocol.

In cases of pediatric decompensated shock, if signs of hemorrhage or dehydration are NOT present, begin ______.

If a child is in decompensated shock due to bleeding or dehydration, you should skip ______.

What two possible situations may be treated under the medical control options for Pediatric Decompensated Shock?

Do not perform cardioversion in pediatric patients unless...

What is the highest priority for the pediatric patient in traumatic cardiac arrest?

True or False:
A needle decompression can be performed on children and infants under standing orders.

According to the Pediatric Traumatic Arrest protocol, do NOT pass an NG tube in patients with ______.

In Pediatric Traumatic Arrest, attempt to obtain vascular access no more than ______.

Use one world to describe the Pediatric Traumatic Arrest medical control options.

What is the appropriate joule setting for neonate defibrillation?

What is the difference between the treatment of PEA/Asystole versus VF/VT in the neonate?

True or False:
There is no cardiac monitoring in neonate resuscitation.

How is cardiac rhythm assessed and treated in neonate resuscitation?