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{ "questions": [ { "scenario": "You are responding to a 55-year-old male who collapsed at a local gym. The AED is available, and you have started CPR immediately. After 2 minutes of compressions, the AED analyzes the rhythm and indicates ventricular fibrillation. The team is following the Compression Performance Resuscitation procedure.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Continue CPR and prepare for defibrillation", "Stop CPR and allow the patient to breathe", "Administer oxygen via bag-valve mask", "Perform a needle thoracostomy"], "correctAnswer": "Continue CPR and prepare for defibrillation", "explanation": "According to the protocol, immediately after identifying ventricular fibrillation with the AED, the next step is to continue CPR and prepare for defibrillation. The Compression Performance Resuscitation procedure emphasizes the importance of uninterrupted chest compressions and prompt defibrillation. The protocol states, 'Immediately initiate rhythm assessment when AED/defibrillator available and shock, if indicated' (Ref. CP10, CP11).", "protocolSection": "BLS section on immediate defibrillation", "criticalThinking": "It's crucial to remember that two minutes of 'priming CPR' is no longer recommended. Immediate defibrillation is critical in cases of ventricular fibrillation.", "sourceExcerpt": "Immediately initiate rhythm assessment when AED/defibrillator available and shock, if indicated (Ref. CP10, CP11)", "references": ["CP10", "CP11"] }, { "scenario": "You are on scene with a 60-year-old female who has been in cardiac arrest for approximately 10 minutes. Advanced life support is en route. The patient is in asystole. You have administered 2 doses of epinephrine and have not seen any return of spontaneous circulation.", "question": "What should be the next step in this situation?", "choices": ["Administer amiodarone", "Continue CPR and prepare for another epinephrine dose", "Stop resuscitation efforts", "Perform a needle thoracostomy"], "correctAnswer": "Stop resuscitation efforts", "explanation": "According to the protocol, if there is no response after a minimum of 20 minutes of EMS resuscitation efforts without any rhythm changes or increase in EtCO2, resuscitation efforts should be ceased. The protocol states, 'Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response' (Ref. CS10).", "protocolSection": "ALS section on cessation of resuscitation efforts", "criticalThinking": "It's important to recognize the time limits for resuscitation efforts and to follow protocol guidelines to ensure appropriate care.", "sourceExcerpt": "Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response (Ref. CS10)", "references": ["CS10"] }, { "scenario": "You are performing ALS care on a 45-year-old male in cardiac arrest. The patient is in ventricular fibrillation. You have performed three defibrillation attempts without success. The patient remains in V-fib.", "question": "What is the next step in the management of this patient?", "choices": ["Administer amiodarone", "Perform a vector change defibrillation", "Stop resuscitation efforts", "Administer magnesium sulfate"], "correctAnswer": "Perform a vector change defibrillation", "explanation": "According to the protocol, if the patient remains in V-fib despite antiarrhythmic drug therapy and at least three defibrillation attempts, a vector change defibrillation should be performed. The protocol states, 'If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation' (Ref. CP12, CT5).", "protocolSection": "ALS section on defibrillation for V-fib", "criticalThinking": "It's important to follow the escalation protocol for defibrillation in cases of refractory ventricular fibrillation.", "sourceExcerpt": "If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation (Ref. CP12, CT5)", "references": ["CP12", "CT5"] }, { "scenario": "You are on scene with a patient who has been in cardiac arrest for several minutes. The patient is showing signs of suspected hyperkalemia. What should be the next step?", "question": "Based on the protocol, what is the most appropriate intervention?", "choices": ["Administer dextrose", "Administer sodium bicarbonate and calcium chloride", "Perform a needle thoracostomy", "Administer naloxone"], "correctAnswer": "Administer sodium bicarbonate and calcium chloride", "explanation": "According to the protocol, for suspected hyperkalemia, the recommended intervention is to administer sodium bicarbonate 8.4% (100 mEq) and calcium chloride (1 gram) intravenous/intraosseous. The protocol states, 'Suspected hyperkalemia – sodium bicarbonate 8.4% (100 mEq) and calcium chloride (1 gram) intravenous/intraosseous (flush intravenous line between meds)'.", "protocolSection": "ALS section on addressing reversible causes", "criticalThinking": "Recognizing and addressing potential reversible causes of cardiac arrest is crucial for improving patient outcomes.", "sourceExcerpt": "Suspected hyperkalemia – sodium bicarbonate 8.4% (100 mEq) and calcium chloride (1 gram) intravenous/intraosseous (flush intravenous line between meds)", "references": [] }, { "scenario": "You are on scene with a 30-year-old male who has been in cardiac arrest for approximately 15 minutes. The patient is in pulseless electrical activity (PEA). You have administered the maximum dose of epinephrine. What should be the next step?", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Administer amiodarone", "Continue CPR and consider additional interventions", "Stop resuscitation efforts", "Perform a needle thoracostomy"], "correctAnswer": "Continue CPR and consider additional interventions", "explanation": "According to the protocol, after administering the maximum dose of epinephrine for asystole/PEA, the next step is to continue CPR and consider additional interventions. The protocol states, 'Administer 1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes. Maximum 3 doses.' After the maximum dose, continued CPR and further interventions should be considered.", "protocolSection": "ALS section on medication administration for PEA", "criticalThinking": "It's important to continue high-quality CPR and consider other potential reversible causes after the maximum dose of epinephrine.", "sourceExcerpt": "Administer 1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes. Maximum 3 doses", "references": [] } ] }

{ "questions": [ { "scenario": "You are responding to a 55-year-old male who has been in a motor vehicle accident. He is unconscious and you need to secure his airway and establish vascular access.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Administer oxygen", "Secure airway and establish vascular access", "Perform a rapid trauma assessment", "Call for advanced life support"], "correctAnswer": "Secure airway and establish vascular access", "explanation": "According to the Compression Performance Resuscitation procedure, the first priority in this scenario is to secure the patient's airway and establish vascular access. This protocol is designed to ensure the patient's immediate physiological needs are met, especially in a critical situation like a motor vehicle accident.", "protocolSection": "Secure airway and establish vascular access per Compression Performance Resuscitation procedure (Ref. CP9.1, CT3)", "criticalThinking": "Critical thinking here involves recognizing the urgency of securing the airway and vascular access in trauma cases to stabilize the patient's condition.", "sourceExcerpt": "• Secure airway and establish vascular access per Compression Performance Resuscitation procedure (Ref. CP9.1, CT3)", "references": ["CP9.1", "CT3"] }, { "scenario": "You are treating a patient with chronic kidney disease who is experiencing severe muscle weakness and palpitations.", "question": "Based on the protocol, what condition should you suspect?", "choices": ["Hyperkalemia", "Hypokalemia", "Hypoglycemia", "Hypercalcemia"], "correctAnswer": "Hyperkalemia", "explanation": "The protocol indicates that hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes, and those who take potassium sparing diuretics or potassium supplementation medications. Given the patient's chronic kidney disease, these symptoms are indicative of hyperkalemia.", "protocolSection": "• Hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes, and those who take potassium sparing diuretics or potassium supplementation medications", "criticalThinking": "Critical thinking here involves recognizing the patient's risk factors for hyperkalemia and correlating the symptoms with this condition.", "sourceExcerpt": "• Hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes, and those who take potassium sparing diuretics or potassium supplementation medications", "references": [] }, { "scenario": "You are attending to a patient who has been in cardiac arrest and is being resuscitated. You need to follow the appropriate medical directives.", "question": "Based on the protocol, what is the next step?", "choices": ["Continue CPR", "Administer epinephrine", "Consult Online Medical Control Physician", "Stop resuscitation"], "correctAnswer": "Consult Online Medical Control Physician", "explanation": "The protocol advises consulting the Online Medical Control Physician as needed or required during resuscitation efforts. This ensures that advanced medical guidance is incorporated into the patient's care.", "protocolSection": "• Consult Online Medical Control Physician as needed or required (Ref. CS10)", "criticalThinking": "Critical thinking here involves understanding when to seek additional medical guidance during critical resuscitation efforts.", "sourceExcerpt": "• Consult Online Medical Control Physician as needed or required (Ref. CS10)", "references": ["CS10"] }, { "scenario": "You are reviewing clinical guidelines for EMS. You need to ensure you are following the most current standards.", "question": "Where can you find the most current EMS clinical guidelines?", "choices": ["Local hospital website", "EMS agency handbook", "National EMS Organization website", "State health department"], "correctAnswer": "National EMS Organization website", "explanation": "The protocol directs you to the National EMS Organization website for the most current EMS clinical guidelines. This ensures that you are following the latest evidence-based practices.", "protocolSection": "• https://nasemso.org/projects/model-ems-clinical-guidelines/", "criticalThinking": "Critical thinking here involves recognizing the importance of staying up-to-date with the latest clinical guidelines.", "sourceExcerpt": "• https://nasemso.org/projects/model-ems-clinical-guidelines/", "references": [] }, { "scenario": "You are working with a patient who has a history of both renal failure and diabetes. You need to determine the next steps in their care.", "question": "Based on the protocol, what condition should be considered?", "choices": ["Hyperkalemia", "Hypotension", "Hyperglycemia", "Dehydration"], "correctAnswer": "Hyperkalemia", "explanation": "The protocol advises that hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes. Given the patient's history of both conditions, hyperkalemia is a likely consideration.", "protocolSection": "• Hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes, and those who take potassium sparing diuretics or potassium supplementation medications", "criticalThinking": "Critical thinking here involves recognizing the patient's risk factors for hyperkalemia due to their medical history.", "sourceExcerpt": "• Hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes, and those who take potassium sparing diuretics or potassium supplementation medications", "references": [] } ] }

{ "questions": [ { "scenario": "You are responding to a 55-year-old male who collapsed suddenly at a local gym. Upon arrival, the patient is unresponsive, with occasional agonal gasps. You begin CPR immediately.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Continue CPR immediately", "Wait for a few minutes before starting CPR", "Attempt to identify a pulse before starting CPR", "Stop CPR and wait for advanced medical support"], "correctAnswer": "Continue CPR immediately", "explanation": "According to the protocol, agonal gasps may be present in the first minutes after sudden cardiac arrest and should not delay the initiation of aggressive resuscitation efforts including chest compressions. Therefore, you should continue CPR immediately.", "protocolSection": "• Agonal gasps may be present in the first minutes after sudden cardiac arrest and should not delay initiation of aggressive resuscitation efforts including chest compressions.", "criticalThinking": "It's important to recognize that agonal gasps are a sign of a critical situation and should not delay life-saving interventions.", "sourceExcerpt": "• Agonal gasps may be present in the first minutes after sudden cardiac arrest and should not delay initiation of aggressive resuscitation efforts including chest compressions.", "references": ["References: "] }, { "scenario": "You have been performing CPR on a patient for 20 minutes in the field with no response. There have been no rhythm changes and no increase in EtCO2 levels.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Continue CPR", "Attempt defibrillation", "Consult for cessation of resuscitation efforts", "Reassess the patient's airway"], "correctAnswer": "Consult for cessation of resuscitation efforts", "explanation": "The protocol states that after a minimum of 20 minutes of EMS resuscitation attempts without ANY response, a consult for cessation of resuscitation efforts should be made. Since there have been no rhythm changes and no increase in EtCO2, it is appropriate to consult for cessation.", "protocolSection": "• Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response (e.g., no rhythm changes, no increase in EtCO2, etc.)", "criticalThinking": "It's crucial to recognize when aggressive resuscitation efforts are no longer effective and to follow protocol to potentially prevent unnecessary prolongation of futile efforts.", "sourceExcerpt": "• Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response (e.g., no rhythm changes, no increase in EtCO2, etc.)", "references": ["References: "] }, { "scenario": "Your team is performing CPR on a patient in cardiac arrest. You are establishing a structured resuscitation approach.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Implement the Compression Performance Resuscitation procedure", "Continue CPR without any specific procedure", "Attempt to identify a rhythm", "Stop CPR and wait for advanced support"], "correctAnswer": "Implement the Compression Performance Resuscitation procedure", "explanation": "The protocol recommends establishing a Compression Performance Resuscitation procedure and Pit Crew Model (Ref. CP9.1, CT3). This structured approach should be implemented to optimize resuscitation efforts.", "protocolSection": "• Establish Compression Performance Resuscitation procedure and Pit Crew Model (Ref. CP9.1, CT3)", "criticalThinking": "Adopting a structured approach like the Compression Performance Resuscitation procedure can improve the quality of CPR and outcomes.", "sourceExcerpt": "• Establish Compression Performance Resuscitation procedure and Pit Crew Model (Ref. CP9.1, CT3)", "references": ["Ref. CP9.1, CT3"] }, { "scenario": "You are treating a patient in cardiac arrest and considering defibrillation as part of the resuscitation efforts.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Proceed with defibrillation", "Do not use defibrillation", "Attempt double sequential defibrillation", "Continue CPR"], "correctAnswer": "Do not use defibrillation", "explanation": "The protocol explicitly states that double sequential defibrillation is not authorized in Pinellas County EMS. Therefore, defibrillation should not be attempted in this manner.", "protocolSection": "• NOTE: Double sequential defibrillation is not authorized in Pinellas County EMS", "criticalThinking": "It's important to adhere to local protocols regarding specific resuscitation techniques.", "sourceExcerpt": "• NOTE: Double sequential defibrillation is not authorized in Pinellas County EMS", "references": ["References: "] }, { "scenario": "You are treating a patient in asystole or Pulseless Electrical Activity (PEA) and need to administer medications.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": ["Administer 1 mg Epinephrine every 3-5 minutes", "Administer 1 mg Epinephrine every 1-2 minutes", "Do not administer Epinephrine", "Administer a different medication"], "correctAnswer": "Administer 1 mg Epinephrine every 3-5 minutes", "explanation": "The protocol specifies that for asystole or Pulseless Electrical Activity, 1 mg Epinephrine (0.1 mg/mL concentration) should be administered intravenously/intraosseously every 3-5 minutes.", "protocolSection": "• Administer medications as indicated: o Asystole/Pulseless Electrical Activity:  1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes.", "criticalThinking": "Understanding the correct dosing and frequency of medications is crucial for effective resuscitation.", "sourceExcerpt": "• Administer medications as indicated: o Asystole/Pulseless Electrical Activity:  1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes.", "references": ["References: "] } ] }

{ "questions": [ { "scenario": "A 45-year-old patient is found unresponsive with no pulse. The EMS team arrives and begins CPR. The team leader decides to implement the Pit Crew Model to optimize resuscitation efforts.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Assign specific roles to each team member to ensure efficient CPR delivery.", "Continue CPR with whoever is available without assigning roles.", "Wait for additional resources before proceeding.", "Stop CPR and reassess the patient's condition." ], "correctAnswer": "Assign specific roles to each team member to ensure efficient CPR delivery.", "explanation": "The Pit Crew Model emphasizes assigning specific roles to each team member to ensure coordinated and efficient delivery of CPR, which improves compression performance and resuscitation outcomes.", "protocolSection": "CP9.1, CT3", "criticalThinking": "Effective team coordination is critical in high-stress situations like cardiac arrest. Ensuring each member knows their role reduces errors and improves patient outcomes.", "sourceExcerpt": "Establish Compression Performance Resuscitation procedure and Pit Crew Model (Ref. CP9.1, CT3)" }, { "scenario": "A 32-year-old patient is brought to the emergency department with suspected opioid overdose. The patient is unresponsive, with shallow breathing and pinpoint pupils. The initial dose of naloxone does not improve the patient’s condition.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer a higher dose of naloxone, as new synthetic opioids may require increased dosages.", "Discontinue naloxone and switch to alternative treatments.", "Administer the same dose of naloxone again and wait for further response.", "Initiate CPR immediately." ], "correctAnswer": "Administer a higher dose of naloxone, as new synthetic opioids may require increased dosages.", "explanation": "New synthetic opioids are often more potent and may require higher doses of naloxone to reverse their effects. The protocol supports escalating the dose if the initial dose is ineffective.", "protocolSection": "CP9.1, CT3", "criticalThinking": "It is essential to be aware of the evolving nature of opioid substances and adjust treatment strategies accordingly.", "sourceExcerpt": "New synthetic opioids may require higher doses of naloxone" }, { "scenario": "A 58-year-old patient experiences cardiac arrest at home. EMS arrives and successfully achieves Return of Spontaneous Circulation (ROSC). The patient is transported to the hospital and stabilized.", "question": "Based on the protocol, what is the most critical documentation step?", "choices": [ "Document the occurrence of ROSC and the patient’s last known status at the hospital.", "Document only the time of ROSC without details.", "Skip documentation and focus on patient care.", "Document only the initial cardiac arrest event." ], "correctAnswer": "Document the occurrence of ROSC and the patient’s last known status at the hospital.", "explanation": "Documenting ROSC and the patient’s status at the hospital is critical for continuity of care and legal purposes. It provides a clear record of the patient’s condition and treatment outcomes.", "protocolSection": "CP9.1, CT3", "criticalThinking": "Accurate and thorough documentation ensures proper follow-up and accountability in patient care.", "sourceExcerpt": "Document any occurrence of Return of Spontaneous Circulation (ROSC) and last known patient status at hospital, if transported" }, { "scenario": "A 60-year-old patient with a history of heart disease collapses in a public space. Bystanders initiate CPR until the EMS team arrives. The team leader decides to follow the Pit Crew Model during resuscitation.", "question": "Based on the protocol, what is the primary goal of implementing the Pit Crew Model?", "choices": [ "To improve coordination and efficiency of CPR delivery.", "To reduce the number of team members involved in CPR.", "To delay the initiation of CPR until all team members are present.", "To focus solely on defibrillation and minimize compression efforts." ], "correctAnswer": "To improve coordination and efficiency of CPR delivery.", "explanation": "The Pit Crew Model is designed to enhance team coordination and ensure effective delivery of CPR, which directly improves compression performance and resuscitation outcomes.", "protocolSection": "CP9.1, CT3", "criticalThinking": "Structured team approaches in emergencies lead to better patient outcomes by minimizing delays and errors.", "sourceExcerpt": "Establish Compression Performance Resuscitation procedure and Pit Crew Model (Ref. CP9.1, CT3)" }, { "scenario": "A 50-year-old patient is found unresponsive after a suspected overdose of a new synthetic opioid. Despite administering a standard dose of naloxone, the patient shows no improvement.", "question": "Based on the protocol, what is the most appropriate action?", "choices": [ "Administer a higher dose of naloxone, as new synthetic opioids may require increased dosages.", "Discontinue naloxone and focus on ventilatory support.", "Repeat the same dose of naloxone and reassess after 5 minutes.", "Administer an alternative medication immediately." ], "correctAnswer": "Administer a higher dose of naloxone, as new synthetic opioids may require increased dosages.", "explanation": "The protocol indicates that new synthetic opioids may require higher doses of naloxone. Escalating the dose is appropriate when initial treatment is ineffective.", "protocolSection": "CP9.1, CT3", "criticalThinking": "Emergency responders must stay updated on emerging drug trends and adjust treatment protocols accordingly.", "sourceExcerpt": "New synthetic opioids may require higher doses of naloxone" } ] }

```json { "questions": [ { "scenario": "A 65-year-old male with a history of renal failure and diabetes is brought to the emergency department with muscle weakness and an irregular heart rhythm. His potassium level is found to be elevated.", "question": "Based on the protocol, which condition should be suspected in this patient?", "choices": ["Hypokalemia", "Hyperkalemia", "Hypoglycemia", "Hypothermia"], "correctAnswer": "Hyperkalemia", "explanation": "Hyperkalemia should be suspected in patients with renal failure, diabetes, or those taking potassium-sparing diuretics or potassium supplements. This patient's history and symptoms align with hyperkalemia.", "protocolSection": "Hyperkalemia suspicion criteria", "criticalThinking": "Clinicians should also consider other signs of hyperkalemia, such as ECG changes, and initiate appropriate treatment immediately.", "sourceExcerpt": "Hyperkalemia should be suspected in patients with renal failure/dialysis or diabetes, and those who take potassium sparing diuretics or potassium supplementation medications" }, { "scenario": "A 45-year-old female experiences sudden cardiac arrest. During resuscitation, the team identifies possible reversible causes of the arrest.", "question": "Which of the following is NOT listed as a reversible cause of cardiac arrest in the protocol?", "choices": ["Hypoxia", "Hyperkalemia", "Hypoglycemia", "Hypertension"], "correctAnswer": "Hypertension", "explanation": "The protocol lists Hypoxia, Hyperkalemia, and Hypoglycemia as reversible causes of cardiac arrest, but Hypertension is not included in this list.", "protocolSection": "Reversible causes of cardiac arrest", "criticalThinking": "Identifying and addressing reversible causes promptly can improve the chances of successful resuscitation.", "sourceExcerpt": "Reversible causes of cardiac arrest: Hypoxia Hypovolemia Hypokalemia Hydrogen Ion (acidosis) Hypoglycemia Hypothermia Hyperkalemia Tension Pneumothorax Tamponade (cardiac) Thrombosis (coronary/pulmonary) Trauma Toxins" }, { "scenario": "A 50-year-old male collapses at home and CPR is initiated. After 20 minutes of resuscitation, Return of Spontaneous Circulation (ROSC) is achieved.", "question": "What is the next step according to the protocol?", "choices": ["Discontinue monitoring", "Document ROSC and patient status", "Administer additional epinephrine", "Transfer to a rehabilitation facility"], "correctAnswer": "Document ROSC and patient status", "explanation": "The protocol mandates documenting any occurrence of ROSC and the last known patient status, especially if the patient is transported to the hospital.", "protocolSection": "ROSC documentation requirements", "criticalThinking": "Accurate documentation ensures continuity of care and provides essential information for subsequent healthcare providers.", "sourceExcerpt": "Document any occurrence of Return of Spontaneous Circulation (ROSC) and last known patient status at hospital, if transported" }, { "scenario": "A 60-year-old male with a history of coronary artery disease experiences cardiac arrest. The resuscitation team is discussing the use of IV epinephrine.", "question": "According to the protocol, what is a key consideration in the use of IV epinephrine during cardiac arrest?", "choices": ["The patient's age", "The patient's weight", "Variability in its use", "The time of day"], "correctAnswer": "Variability in its use", "explanation": "The protocol highlights variabilities in the use of IV epinephrine in the management of cardiac arrest patients, emphasizing the need for standardized approaches.", "protocolSection": "Use of IV epinephrine in cardiac arrest", "criticalThinking": "Understanding these variabilities can help improve resuscitation outcomes by ensuring evidence-based practices are followed.", "sourceExcerpt": "2018 JEMS 'Variabilities in the Use of IV Epinephrine in the management of Cardiac Arrest Patients'" }, { "scenario": "A 30-year-old male presents with traumatic injuries following a car accident. He subsequently experiences cardiac arrest.", "question": "Which reversible cause of cardiac arrest is most relevant to his condition?", "choices": ["Hypoglycemia", "Trauma", "Hyperkalemia", "Hypothermia"], "correctAnswer": "Trauma", "explanation": "In the context of a traumatic injury, Trauma is identified as a reversible cause of cardiac arrest that should be addressed promptly.", "protocolSection": "Reversible causes of cardiac arrest", "criticalThinking": "Trauma-related cardiac arrest requires immediate attention to treat the underlying injury and stabilize the patient.", "sourceExcerpt": "Reversible causes of cardiac arrest: Hypoxia Hypovolemia Hypokalemia Hydrogen Ion (acidosis) Hypoglycemia Hypothermia Hyperkalemia Tension Pneumothorax Tamponade (cardiac) Thrombosis (coronary/pulmonary) Trauma Toxins" } ] } ```

```json { "questions": [ { "scenario": "A 45-year-old male collapses in a public area. EMS arrives and finds the patient unresponsive, pulseless, and in ventricular fibrillation (V-fib) on the ECG monitor. The team delivers three defibrillation attempts using escalating energy levels (200J, 300J, 360J) as per the Lifepak 15 manufacturer's recommendations, but the patient remains in V-fib. Antiarrhythmic drug therapy has also been administered.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue defibrillation at 360J", "Administer a second dose of antiarrhythmic medication", "Perform vector change defibrillation", "Terminate resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "The protocol indicates that if the patient remains in V-fib despite antiarrhythmic drug therapy and at least three defibrillation attempts, vector change defibrillation should be performed. This approach involves changing the position of the defibrillator pads to optimize electrical current delivery to the heart.", "protocolSection": "Ref. CP12, CT5", "criticalThinking": "Vector change defibrillation is a critical intervention when standard defibrillation fails. It ensures that the electrical current is delivered more effectively through the heart, potentially increasing the likelihood of successful resuscitation.", "sourceExcerpt": "If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation" }, { "scenario": "EMS is called to a 60-year-old female experiencing chest pain and difficulty breathing. Upon arrival, the patient is found unresponsive and in pulseless ventricular tachycardia (VT) on the ECG monitor.", "question": "According to the protocol, what is the initial energy setting for defibrillation in this scenario?", "choices": [ "100J", "200J", "300J", "360J" ], "correctAnswer": "200J", "explanation": "The protocol specifies using escalating energy settings for defibrillation, starting with 200J for ventricular fibrillation or pulseless ventricular tachycardia, as recommended by the manufacturer for the Lifepak 15.", "protocolSection": "Ref. CP12, CT5", "criticalThinking": "Starting with the correct energy setting is crucial for effective defibrillation. Escalating energy levels ensure that subsequent shocks are more likely to restore a normal rhythm if the initial attempt fails.", "sourceExcerpt": "Use energy settings as recommended by manufacturer (escalating 200j, 300j, 360j for Lifepak 15)" }, { "scenario": "A 50-year-old male is found unresponsive and pulseless at home. EMS arrives and identifies the patient is in V-fib after attaching the ECG monitor. After three defibrillation attempts and antiarrhythmic drug therapy, the patient's rhythm has not changed.", "question": "What should EMS do next according to the protocol?", "choices": [ "Continue defibrillation at the same energy level", "Administer a second antiarrhythmic drug", "Perform vector change defibrillation", "Declare the patient deceased" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "The protocol states that if the patient remains in V-fib after three defibrillation attempts and antiarrhythmic drug therapy, vector change defibrillation should be performed to optimize electrical current delivery.", "protocolSection": "Ref. CP12, CT5", "criticalThinking": "Vector change defibrillation is a critical step in refractory V-fib cases and may improve the chances of successful resuscitation by altering the electrical pathway.", "sourceExcerpt": "If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation" }, { "scenario": "EMS responds to a 55-year-old male in cardiac arrest. The patient is found in ventricular fibrillation (V-fib) on the ECG monitor. After administering three defibrillation attempts and antiarrhythmic drug therapy, the patient remains in V-fib.", "question": "According to the protocol, what intervention should be considered next?", "choices": [ "Increase the energy setting to 400J", "Switch to an alternative defibrillator model", "Perform vector change defibrillation", "Terminate resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "The protocol indicates that vector change defibrillation should be performed if the patient remains in V-fib after three defibrillation attempts and antiarrhythmic drug therapy. This technique aims to improve the effectiveness of the electrical shock.", "protocolSection": "Ref. CP12, CT5", "criticalThinking": "Vector change defibrillation is a valuable technique in refractory V-fib cases and should be considered before terminating resuscitation efforts.", "sourceExcerpt": "If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation" }, { "scenario": "A 65-year-old female is in cardiac arrest and found in ventricular fibrillation (V-fib) by EMS. The team attempts defibrillation three times at 200J, 300J, and 360J, respectively, but the patient remains in V-fib. Antiarrhythmic drug therapy has also been administered.", "question": "What is the next step as per the protocol?", "choices": [ "Continue defibrillation at 360J", "Administer a second antiarrhythmic drug", "Perform vector change defibrillation", "Terminate resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "The protocol specifies that vector change defibrillation should be performed after three unsuccessful defibrillation attempts and antiarrhythmic drug therapy in cases of refractory V-fib.", "protocolSection": "Ref. CP12, CT5", "criticalThinking": "Vector change defibrillation is a critical intervention in refractory V-fib cases and may improve outcomes by enhancing the delivery of electrical current to the heart.", "sourceExcerpt": "If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation" } ] } ```

```json { "questions": [ { "scenario": "A 65-year-old male collapses at home. EMS arrives and initiates CPR. After 20 minutes of resuscitation efforts, there are no rhythm changes, no increase in EtCO2, and no other signs of ROSC.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue resuscitation for another 10 minutes", "Consult for cessation of resuscitation efforts", "Administer epinephrine and continue CPR", "Transport the patient to the nearest hospital" ], "correctAnswer": "Consult for cessation of resuscitation efforts", "explanation": "After 20 minutes of EMS resuscitation efforts without any response (e.g., no rhythm changes, no increase in EtCO2), the protocol recommends consulting for cessation of resuscitation efforts.", "protocolSection": "1. Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response", "criticalThinking": "It is crucial to assess the effectiveness of resuscitation efforts and consider cessation if there is no response to avoid futile interventions.", "sourceExcerpt": "• Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response (e.g., no rhythm changes, no increase in EtCO2, etc.)" }, { "scenario": "A 45-year-old female is found unresponsive with agonal breathing. EMS arrives, and CPR is initiated. The team attaches a capnography device to monitor EtCO2.", "question": "Why is monitoring EtCO2 important in this scenario?", "choices": [ "To measure the patient's blood pressure", "To assess the effectiveness of chest compressions", "To determine the patient's blood glucose level", "To monitor the patient's core temperature" ], "correctAnswer": "To assess the effectiveness of chest compressions", "explanation": "Monitoring EtCO2 is crucial in CPR as it provides real-time feedback on the effectiveness of chest compressions and can indicate ROSC.", "protocolSection": "2. EtCO2 monitored", "criticalThinking": "Continuous EtCO2 monitoring can help guide resuscitation efforts and improve patient outcomes by ensuring high-quality CPR.", "sourceExcerpt": "• EtCO2 monitored" }, { "scenario": "A 38-year-old male experiences sudden cardiac arrest at a gym. EMS arrives and initiates CPR. The team follows the protocol for compression performance resuscitation.", "question": "How often should the team reassess the patient's rhythm during CPR?", "choices": [ "Every 1 minute", "Every 2 minutes", "Every 5 minutes", "Only when the patient shows signs of ROSC" ], "correctAnswer": "Every 2 minutes", "explanation": "The protocol states that the rhythm should be reassessed every 2 minutes during CPR to determine if defibrillation is indicated.", "protocolSection": "4. Continue Compression Performance Resuscitation and reassess rhythm every two (2) minutes and defibrillate when indicated", "criticalThinking": "Regular rhythm checks ensure timely defibrillation, which is critical in managing cardiac arrest.", "sourceExcerpt": "• Continue Compression Performance Resuscitation and reassess rhythm every two (2) minutes and defibrillate when indicated" }, { "scenario": "A 50-year-old male involved in a car accident presents with severe respiratory distress and decreased breath sounds on the left side. The EMS team suspects tension pneumothorax.", "question": "What is the most appropriate immediate intervention?", "choices": [ "Administer high-flow oxygen", "Perform needle thoracostomy", "Insert a chest tube", "Start intravenous fluids" ], "correctAnswer": "Perform needle thoracostomy", "explanation": "In cases of suspected tension pneumothorax, the protocol recommends performing a needle thoracostomy to relieve the pressure.", "protocolSection": "CT9, A5) o Suspected tension pneumothorax – Perform needle thoracostomy", "criticalThinking": "Prompt recognition and intervention are critical to prevent further hemodynamic compromise in tension pneumothorax.", "sourceExcerpt": "CT9, A5) o Suspected tension pneumothorax – Perform needle thoracostomy (Ref." }, { "scenario": "A 60-year-old female with a history of heart disease experiences sudden cardiac arrest at home. EMS arrives and starts CPR according to the PARAMEDIC2 trial guidelines.", "question": "What is the significance of following the PARAMEDIC2 trial guidelines in this scenario?", "choices": [ "To ensure the use of advanced airway management", "To improve the quality of chest compressions", "To guide the use of adrenaline in cardiac arrest", "To monitor the patient's neurological status" ], "correctAnswer": "To guide the use of adrenaline in cardiac arrest", "explanation": "The PARAMEDIC2 trial provides evidence-based guidelines on the administration of adrenaline during cardiac arrest, which can influence resuscitation outcomes.", "protocolSection": "3. https://warwick.ac.uk/fac/sci/med/research/ctu/trials/critical/paramedic2/", "criticalThinking": "Adhering to evidence-based guidelines like the PARAMEDIC2 trial can optimize treatment strategies and improve patient survival rates.", "sourceExcerpt": "• https://warwick.ac.uk/fac/sci/med/research/ctu/trials/critical/paramedic2/" } ] } ```

```json { "questions": [ { "scenario": "A 58-year-old male collapses at a grocery store. Witnesses report he was unresponsive and not breathing. Bystander CPR is initiated. EMS arrives on scene and finds the patient in ventricular fibrillation (V-fib).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of EPINEPHrine IV/IO immediately", "Initiate 2 minutes of priming CPR before defibrillation", "Perform immediate defibrillation followed by CPR", "Administer amiodarone 300 mg IV/IO without defibrillation" ], "correctAnswer": "Perform immediate defibrillation followed by CPR", "explanation": "The protocol highlights the critical importance of early defibrillation for ventricular fibrillation. 'Priming CPR' is no longer recommended. Immediate defibrillation is the priority, followed by CPR and reassessment every two minutes.", "protocolSection": "ALS (Ventricular Fibrillation/Pulseless Ventricular Tachycardia)", "criticalThinking": "Early defibrillation significantly improves survival rates in V-fib. Delaying defibrillation for priming CPR is outdated and can reduce the likelihood of ROSC." }, { "scenario": "A 45-year-old female with a history of end-stage renal disease collapses at home. EMS arrives and finds her in asystole. Bystander CPR is in progress.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of EPINEPHrine IV/IO every 3–5 minutes", "Administer sodium bicarbonate 8.4% and calcium chloride IV/IO", "Perform immediate defibrillation", "Administer naloxone 2 mg IV/IO" ], "correctAnswer": "Administer sodium bicarbonate 8.4% and calcium chloride IV/IO", "explanation": "The patient’s history of end-stage renal disease suggests hyperkalemia as a reversible cause of cardiac arrest. Sodium bicarbonate and calcium chloride are indicated to address hyperkalemia in this scenario.", "protocolSection": "ALS (Addressing Reversible Causes: Hyperkalemia)", "criticalThinking": "Suspicion of hyperkalemia should be high in patients with renal failure. Immediate treatment of reversible causes is critical to improving outcomes in cardiac arrest." }, { "scenario": "A 32-year-old male with a history of opioid use disorder is found unresponsive and pulseless. Bystander CPR is initiated, and EMS arrives on scene. The patient is in pulseless electrical activity (PEA).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of EPINEPHrine IV/IO every 3–5 minutes", "Administer naloxone 2 mg IV/IO", "Perform immediate defibrillation", "Administer amiodarone 300 mg IV/IO" ], "correctAnswer": "Administer naloxone 2 mg IV/IO", "explanation": "Given the patient’s history of opioid use disorder, opioid overdose is a likely reversible cause of PEA. Naloxone should be administered to address this potential cause.", "protocolSection": "ALS (Addressing Reversible Causes: Opioid Overdose)", "criticalThinking": "Opioid overdose should always be considered in patients with a history of opioid use. Naloxone administration can be lifesaving in such cases." }, { "scenario": "A 60-year-old male collapses at home. EMS arrives and finds the patient in ventricular fibrillation (V-fib). Three defibrillation attempts and antiarrhythmic drug therapy have failed to convert the rhythm.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue defibrillation attempts with the same energy settings", "Perform vector change defibrillation", "Administer another dose of amiodarone 150 mg IV/IO", "Contact OLMC for cessation of resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "If the patient remains in V-fib despite antiarrhythmic drug therapy and at least three defibrillation attempts, vector change defibrillation is the next recommended step.", "protocolSection": "ALS (Ventricular Fibrillation/Pulseless Ventricular Tachycardia)", "criticalThinking": "Vector change defibrillation can improve the effectiveness of defibrillation in refractory cases. It’s important to follow protocol steps meticulously when standard interventions fail." }, { "scenario": "A 50-year-old female collapses at work. EMS arrives and finds the patient in asystole. After 20 minutes of resuscitation efforts, there is no rhythm change, no increase in EtCO2, and no ROSC.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue resuscitation efforts for another 10 minutes", "Contact OLMC for cessation of resuscitation efforts", "Administer an additional dose of EPINEPHrine 1 mg IV/IO", "Perform needle thoracostomy" ], "correctAnswer": "Contact OLMC for cessation of resuscitation efforts", "explanation": "After a minimum of 20 minutes of resuscitation efforts without any response (e.g., no rhythm changes, no increase in EtCO2), OLMC should be consulted for cessation of resuscitation efforts.", "protocolSection": "OLMC (Cessation of Resuscitation Efforts)", "criticalThinking": "Decisions to cease resuscitation efforts should be made in consultation with OLMC. Prolonged resuscitation without positive indicators is unlikely to result in a favorable outcome." } ] } ```

```json { "questions": [ { "scenario": "A 55-year-old male collapses at a grocery store. Bystanders initiate CPR and use an AED, which advises a shock. EMS arrives and finds the patient in ventricular fibrillation (V-fib). The team immediately begins high-quality chest compressions and prepares for defibrillation.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Perform 2 minutes of CPR before defibrillation", "Immediately defibrillate using 200j", "Administer 1 mg of epinephrine before defibrillation", "Wait for OLMC consultation before defibrillation" ], "correctAnswer": "Immediately defibrillate using 200j", "explanation": "The protocol emphasizes early defibrillation for ventricular fibrillation and pulseless ventricular tachycardia. 'Priming CPR' is no longer recommended. The first defibrillation should be performed immediately using the manufacturer-recommended energy setting (200j for Lifepak 15).", "protocolSection": "ALS: Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia", "criticalThinking": "Early defibrillation is critical in V-fib/VTach. Delaying defibrillation reduces the likelihood of ROSC. Ensure proper pad placement and follow manufacturer energy settings." }, { "scenario": "A 68-year-old female with a history of renal failure is found unresponsive. EMS arrives and identifies asystole on the monitor. High-quality CPR is initiated, and an IV line is established.", "question": "What medication should be administered first?", "choices": [ "Amiodarone 300 mg IV", "Epinephrine 1 mg IV", "Sodium bicarbonate 8.4% IV", "Magnesium sulfate 2 grams IV" ], "correctAnswer": "Epinephrine 1 mg IV", "explanation": "For asystole or pulseless electrical activity (PEA), the protocol recommends administering 1 mg of epinephrine every 3-5 minutes, up to a maximum of 3 doses. This is the first-line medication in this scenario.", "protocolSection": "ALS: Administer medications as indicated: Asystole/Pulseless Electrical Activity", "criticalThinking": "Epinephrine is a cornerstone of cardiac arrest management. In patients with renal failure, hyperkalemia should also be considered as a reversible cause, but epinephrine remains the first step." }, { "scenario": "A 45-year-old male is found unresponsive after a suspected opioid overdose. Bystanders administered intranasal naloxone prior to EMS arrival. The patient remains pulseless and apneic. CPR is initiated, and an line is established.", "question": "What is the appropriate dose and route of naloxone in this situation?", "choices": [ "2 mg intranasal", "2 mg IV, repeat every 3-5 minutes up to 6 mg", "4 mg IV, repeat every 5 minutes up to 8 mg", "0.4 mg IV, repeat every 2 minutes up to 2 mg" ], "correctAnswer": "2 mg IV, repeat every 3-5 minutes up to 6 mg", "explanation": "The protocol specifies that for opioid overdose in cardiac arrest, naloxone should be administered intravenously at 2 mg, repeated every 3-5 minutes as needed, up to a total of 6 mg (excluding previous intranasal doses).", "protocolSection": "ALS: Address potential reversible causes: Opioid overdose", "criticalThinking": "New synthetic opioids may require higher doses of naloxone. Ensure proper airway management and continue CPR while administering naloxone." }, { "scenario": "A 60-year-old male with a history of diabetes is found unresponsive. EMS arrives and identifies pulseless electrical activity (PEA). High-quality CPR is initiated, and an IV line is established. The patient’s blood glucose level is 30 mg/dL.", "question": "What is the most appropriate intervention for this patient?", "choices": [ "Administer epinephrine 1 mg IV", "Administer dextrose 10% 25 grams IV", "Administer sodium bicarbonate 8.4% IV", "Administer amiodarone 300 mg IV" ], "correctAnswer": "Administer dextrose 10% 25 grams IV", "explanation": "Hypoglycemia is a reversible cause of cardiac arrest. The protocol recommends administering dextrose 10% 25 grams IV for hypoglycemia, repeating once in 3-5 minutes if there is no effect.", "protocolSection": "ALS: Address potential reversible causes: Hypoglycemia", "criticalThinking": "Always consider reversible causes of cardiac arrest, especially in patients with a history of diabetes. Hypoglycemia should be corrected promptly while continuing CPR." }, { "scenario": "A 50-year-old male is found unresponsive after a suspected cyanide exposure. EMS arrives and identifies ventricular fibrillation. High-quality CPR is initiated, and an IV line is established. The patient remains in V-fib despite three defibrillation attempts and antiarrhythmic therapy.", "question": "What is the most appropriate next step?", "choices": [ "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams IV", "Administer Cyanokit IV", "Consult OLMC for cessation of resuscitation" ], "correctAnswer": "Administer Cyanokit IV", "explanation": "Cyanide exposure is a reversible cause of cardiac arrest. The protocol recommends administering Cyanokit intravenously for suspected cyanide exposure. This should be prioritized in this scenario.", "protocolSection": "ALS: Address potential reversible causes: Suspected cyanide exposure", "criticalThinking": "Cyanide exposure requires specific antidote therapy. Ensure proper identification of the exposure and administer Cyanokit promptly while continuing resuscitation efforts." } ] } ```

{ "questions": [ { "scenario": "A 45-year-old male collapses at a local gym. Bystanders initiate CPR immediately. Upon your arrival as an ALS provider, you find the patient in ventricular fibrillation (V-fib) after attaching the AED/defibrillator.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of epinephrine intravenously", "Perform manual defibrillation at 200 joules", "Administer 300 mg of amiodarone intravenously", "Continue CPR for 2 minutes before reassessing" ], "correctAnswer": "Perform manual defibrillation at 200 joules", "explanation": "The protocol emphasizes early defibrillation for ventricular fibrillation or pulseless ventricular tachycardia. Manual defibrillation should be performed immediately using the manufacturer’s recommended energy settings (200j for the first attempt). Epinephrine and amiodarone administration are secondary to defibrillation.", "protocolSection": "ALS: Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia", "criticalThinking": "Early defibrillation significantly improves outcomes in V-fib/pulseless VT. Delaying defibrillation to administer medications or perform CPR is not recommended unless defibrillation is unavailable." }, { "scenario": "A 60-year-old female with a history of diabetes and renal failure experiences a cardiac arrest. Bystanders administered CPR for 5 minutes. Upon your arrival, you find the patient in asystole.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of epinephrine intravenously every 3–5 minutes", "Administer sodium bicarbonate 8.4% and calcium chloride intravenously", "Perform needle thoracostomy", "Administer 300 mg of amiodarone intravenously" ], "correctAnswer": "Administer sodium bicarbonate 8.4% and calcium chloride intravenously", "explanation": "The protocol highlights hyperkalemia as a reversible cause of cardiac arrest, particularly in patients with renal failure or diabetes. Sodium bicarbonate and calcium chloride are indicated for suspected hyperkalemia. Epinephrine administration is also correct but secondary to addressing reversible causes.", "protocolSection": "ALS: Address potential reversible causes (hyperkalemia)", "criticalThinking": "Hyperkalemia should be strongly considered in patients with renal failure or diabetes. Addressing reversible causes is critical in asystole, as it may improve the likelihood of ROSC." }, { "scenario": "A 50-year-old male with a history of opioid use disorder experiences a cardiac arrest. Bystanders report he was unresponsive and not breathing before EMS arrival. You find the patient in pulseless electrical activity (PEA).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of epinephrine intravenously every 3–5 minutes", "Administer naloxone 2 mg intravenously", "Perform manual defibrillation", "Administer 300 mg of amiodarone intravenously" ], "correctAnswer": "Administer naloxone 2 mg intravenously", "explanation": "The protocol identifies opioid overdose as a reversible cause of cardiac arrest. Naloxone is the appropriate first-line treatment for suspected opioid overdose, which can lead to PEA. Epinephrine administration is also correct but secondary to addressing reversible causes.", "protocolSection": "ALS: Address potential reversible causes (opioid overdose)", "criticalThinking": "Opioid overdose is a common and reversible cause of PEA. Early administration of naloxone can reverse respiratory depression and improve outcomes." }, { "scenario": "A 55-year-old male experiences a cardiac arrest at home. Bystanders performed CPR and used an AED before EMS arrival. Upon your arrival as an ALS provider, you find the patient in ventricular fibrillation (V-fib) after three defibrillation attempts and amiodarone administration. The patient remains in V-fib.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer a second dose of 300 mg amiodarone", "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams intravenously", "Contact OLMC for cessation of resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "The protocol specifies that if the patient remains in V-fib despite antiarrhythmic drug therapy and at least three defibrillation attempts, vector change defibrillation should be performed. This technique can improve defibrillation success in refractory cases.", "protocolSection": "ALS: Perform vector change defibrillation if patient remains in V-fib despite antiarrhythmic drug therapy and at least three defibrillation attempts", "criticalThinking": "Vector change defibrillation is a specialized technique for refractory V-fib. It alters the electrical pathway of the shock, increasing the likelihood of successful defibrillation." }, { "scenario": "A 40-year-old female experiences a cardiac arrest in a public park. Bystanders initiated CPR, and you arrive as a BLS provider. After attaching the AED, it advises a shock, which you deliver. The patient remains in ventricular fibrillation (V-fib).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue CPR for 2 minutes before reassessing the rhythm", "Administer 1 mg of epinephrine intravenously", "Administer 300 mg of amiodarone intravenously", "Perform manual defibrillation at 300 joules" ], "correctAnswer": "Continue CPR for 2 minutes before reassessing the rhythm", "explanation": "The protocol states that after defibrillation, CPR should be continued for 2 minutes before reassessing the rhythm. Epinephrine and amiodarone administration are ALS interventions and are not within the BLS scope.", "protocolSection": "BLS: Continue Compression Performance Resuscitation and reassess rhythm every two (2) minutes", "criticalThinking": "CPR is essential after defibrillation to maintain perfusion and increase the likelihood of ROSC. Reassessing the rhythm every 2 minutes ensures timely interventions." } ] }

{ "questions": [ { "scenario": "A 55-year-old male collapses in a park. Bystanders initiate CPR and use an AED, which advises a shock. EMS arrives and finds the patient in ventricular fibrillation. BLS measures have been initiated, and the ALS team is now on scene.", "question": "Based on the protocol, what is the most appropriate next step for the ALS team?", "choices": [ "Continue CPR and wait for the next AED analysis", "Perform manual defibrillation with the recommended energy settings", "Administer 1 mg of EPINEPHrine intravenously", "Establish vascular access and secure the airway" ], "correctAnswer": "Perform manual defibrillation with the recommended energy settings", "explanation": "The protocol states that for ventricular fibrillation, immediate manual defibrillation is critical. The recommended energy settings should be used as per the manufacturer's guidelines.", "protocolSection": "ALS • Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia", "criticalThinking": "Early defibrillation is crucial in ventricular fibrillation to maximize the chance of ROSC. Delaying defibrillation can reduce the likelihood of successful resuscitation." }, { "scenario": "A 68-year-old female with a history of renal failure collapses at home. EMS arrives and finds her in asystole. BLS measures are in place, and the ALS team is preparing to intervene.", "question": "What medication should be administered first according to the protocol?", "choices": [ "Amiodarone 300 mg intravenously", "EPINEPHrine 1 mg intravenously", "Sodium bicarbonate 8.4% intravenously", "Calcium chloride 1 gram intravenously" ], "correctAnswer": "EPINEPHrine 1 mg intravenously", "explanation": "For asystole, the protocol recommends administering 1 mg of EPINEPHrine intravenously every 3-5 minutes.", "protocolSection": "ALS • Administer medications as indicated: o Asystole/Pulseless Electrical Activity", "criticalThinking": "EPINEPHrine is a first-line medication in asystole to stimulate cardiac activity. Other medications like sodium bicarbonate and calcium chloride are considered if hyperkalemia is suspected." }, { "scenario": "A 45-year-old male with a history of diabetes collapses at work. EMS arrives and finds him in pulseless electrical activity (PEA). BLS measures are initiated, and the ALS team is on scene.", "question": "What potential reversible cause should be considered first in this patient?", "choices": [ "Hypoglycemia", "Hypothermia", "Tension Pneumothorax", "Toxins" ], "correctAnswer": "Hypoglycemia", "explanation": "Given the patient's history of diabetes, hypoglycemia should be considered as a potential reversible cause of PEA.", "protocolSection": "ALS • Address potential reversible causes: o Hypoglycemia", "criticalThinking": "In patients with diabetes, hypoglycemia is a common and easily reversible cause of PEA. Immediate treatment with dextrose can be life-saving." }, { "scenario": "A 30-year-old male is found unresponsive in a car with a needle in his arm. EMS arrives and finds him in cardiac arrest with agonal gasps. BLS measures are initiated, and the ALS team is on scene.", "question": "What medication should be administered immediately according to the protocol?", "choices": [ "Amiodarone 300 mg intravenously", "EPINEPHrine 1 mg intravenously", "Naloxone 2 mg intravenously", "Magnesium sulfate 2 grams intravenously" ], "correctAnswer": "Naloxone 2 mg intravenously", "explanation": "Given the context of a possible opioid overdose, the protocol recommends administering naloxone immediately.", "protocolSection": "ALS • Address potential reversible causes: o Opioid overdose", "criticalThinking": "Opioid overdose is a reversible cause of cardiac arrest. Naloxone can rapidly reverse the effects of opioids and should be administered as soon as possible." }, { "scenario": "A 50-year-old female collapses in a shopping mall. EMS arrives and finds her in ventricular fibrillation. BLS measures are initiated, and the ALS team is on scene. After three defibrillation attempts and administration of amiodarone, the patient remains in ventricular fibrillation.", "question": "What is the next step according to the protocol?", "choices": [ "Continue with the same defibrillation settings", "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams intravenously", "Consult OLMC for cessation of resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "If the patient remains in ventricular fibrillation despite antiarrhythmic drug therapy and at least three defibrillation attempts, the protocol recommends performing vector change defibrillation.", "protocolSection": "ALS • Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia", "criticalThinking": "Vector change defibrillation can be effective in refractory ventricular fibrillation by altering the electrical pathway and improving the chance of successful defibrillation." } ] }

{ "questions": [ { "scenario": "A 56-year-old male collapses in public. Bystanders initiate CPR while waiting for EMS. On arrival, the patient is unresponsive, apneic, and pulseless. The AED identifies ventricular fibrillation. Bystanders state they have already delivered one shock before EMS arrived.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "A. Immediately deliver another shock at the same energy level", "B. Start 2 minutes of CPR before assessing rhythm and delivering a shock", "C. Deliver a shock at the next energy level (300J) and resume CPR", "D. Administer 1 mg epinephrine intravenously" ], "correctAnswer": "C. Deliver a shock at the next energy level (300J) and resume CPR", "explanation": "The protocol emphasizes early defibrillation for ventricular fibrillation. Since the AED has already delivered one shock, the next step is to deliver a shock at the escalating energy level (300J for a Lifepak 15) and immediately resume CPR. 'Priming CPR' is no longer recommended.", "protocolSection": "ALS: Perform manual defibrillation as indicated", "criticalThinking": "Ensure proper rhythm analysis and energy escalation as per manufacturer guidelines. Avoid delays in defibrillation, as it significantly impacts survival rates." }, { "scenario": "A 72-year-old female with a history of diabetes and renal failure is found unresponsive. Initial rhythm is asystole. CPR is initiated, and an IV line is established. No ROSC is achieved after 2 rounds of CPR.", "question": "According to the protocol, what medication should be administered next?", "choices": [ "A. Sodium bicarbonate 8.4% (100 mEq)", "B. Epinephrine 1 mg IV", "C. Amiodarone 300 mg IV", "D. Magnesium sulfate 2 grams IV" ], "correctAnswer": "B. Epinephrine 1 mg IV", "explanation": "For asystole or pulseless electrical activity, the protocol recommends administering 1 mg epinephrine IV/IO every 3-5 minutes, with a maximum of 3 doses. Sodium bicarbonate would only be indicated if hyperkalemia is suspected.", "protocolSection": "ALS: Asystole/Pulseless Electrical Activity medication administration", "criticalThinking": "Consider reversible causes, such as hyperkalemia in patients with renal failure, but follow the medication sequence as outlined in the protocol." }, { "scenario": "A 45-year-old male presents in cardiac arrest. Initial rhythm is pulseless ventricular tachycardia. After 3 defibrillations and epinephrine administration, the rhythm persists. Amiodarone 300 mg was administered with no effect.", "question": "What is the next appropriate step per the protocol?", "choices": [ "A. Administer lidocaine 1.5 mg/kg IV", "B. Perform vector change defibrillation", "C. Administer magnesium sulfate 2 grams IV", "D. Consult OLMC for cessation of resuscitation" ], "correctAnswer": "B. Perform vector change defibrillation", "explanation": "The protocol states that if a patient remains in ventricular fibrillation or pulseless VT despite antiarrhythmic therapy and at least 3 defibrillation attempts, vector change defibrillation should be performed.", "protocolSection": "ALS: Vector change defibrillation for refractory V-fib/VT", "criticalThinking": "Vector change defibrillation can improve shock success by altering the electrical pathway. Ensure proper pad placement and energy settings." }, { "scenario": "A 38-year-old female is found unresponsive with agonal breathing. Bystanders report she has a history of opioid use. Initial rhythm is asystole. CPR is initiated, and an IV line is established.", "question": "What intervention should be prioritized per the protocol?", "choices": [ "A. Administer naloxone 2 mg IV", "B. Administer epinephrine 1 mg IV", "C. Perform needle thoracostomy", "D. Administer dextrose 10% 25 grams IV" ], "correctAnswer": "A. Administer naloxone 2 mg IV", "explanation": "Given the patient’s history of opioid use, naloxone should be administered immediately to address the potential reversible cause of opioid overdose. Epinephrine is also indicated but is secondary to treating the underlying cause.", "protocolSection": "ALS: Opioid overdose medication administration", "criticalThinking": "Always consider reversible causes of cardiac arrest, especially in patients with known or suspected substance use. Naloxone can be life-saving in opioid-related arrests." }, { "scenario": "A 65-year-old male with a history of dialysis is in cardiac arrest. Initial rhythm is pulseless electrical activity. CPR is initiated, and an arterial blood gas reveals severe acidosis.", "question": "What reversible cause should be addressed per the protocol?", "choices": [ "A. Hypoglycemia", "B. Hyperkalemia", "C. Tension pneumothorax", "D. Hypovolemia" ], "correctAnswer": "B. Hyperkalemia", "explanation": "The patient’s history of dialysis and severe acidosis suggests hyperkalemia as a likely reversible cause. The protocol recommends sodium bicarbonate and calcium chloride for suspected hyperkalemia.", "protocolSection": "ALS: Suspected hyperkalemia medication administration", "criticalThinking": "Hyperkalemia is a common cause of cardiac arrest in dialysis patients. Addressing it promptly can improve outcomes. Ensure proper medication administration and IV line flushing." } ] }

{ "questions": [ { "question_text": "In the context of CPR, what does 'null' signify when used to describe a patient's condition?", "answer_1": "The patient is breathing normally", "answer_2": "The patient has no pulse or breathing", "answer_3": "The patient is conscious and alert", "correct_answer": "The patient has no pulse or breathing", "explanation": "In CPR, 'null' is often used to indicate the absence of vital signs, such as no pulse or breathing, which necessitates immediate intervention." }, { "question_text": "What is the primary purpose of using a null hypothesis in medical research?", "answer_1": "To prove a treatment is effective", "answer_2": "To assume no effect or difference between groups", "answer_3": "To confirm a medical diagnosis", "correct_answer": "To assume no effect or difference between groups", "explanation": "The null hypothesis assumes that there is no significant effect or difference between groups, which researchers aim to test and potentially reject." }, { "question_text": "When interpreting a null result in a diagnostic test, what does it typically indicate?", "answer_1": "The test is inconclusive", "answer_2": "The test detected the condition", "answer_3": "The test did not detect the condition", "correct_answer": "The test did not detect the condition", "explanation": "A null result in a diagnostic test usually means that the condition or marker being tested for was not detected." }, { "question_text": "In airway management, what does a null response to an oropharyngeal airway insertion suggest?", "answer_1": "The airway is properly secured", "answer_2": "The patient is unconscious", "answer_3": "The airway obstruction persists", "correct_answer": "The airway obstruction persists", "explanation": "A null response to oropharyngeal airway insertion may indicate that the airway obstruction is still present and requires further intervention." }, { "question_text": "What is the significance of a null set in medical data analysis?", "answer_1": "It indicates missing data", "answer_2": "It represents a complete dataset", "answer_3": "It signifies no relevant data points", "correct_answer": "It signifies no relevant data points", "explanation": "A null set in medical data analysis indicates that there are no relevant data points or observations for the specific analysis being conducted." }, { "question_text": "How is a null hypothesis utilized in clinical trials?", "answer_1": "To predict patient outcomes", "answer_2": "To assume no difference between treatment and control groups", "answer_3": "To confirm the efficacy of a new drug", "correct_answer": "To assume no difference between treatment and control groups", "explanation": "In clinical trials, the null hypothesis is used to assume that there is no difference between the treatment and control groups, which is tested against the alternative hypothesis." }, { "question_text": "What does a null finding in a radiology report typically imply?", "answer_1": "The presence of abnormalities", "answer_2": "No significant findings or abnormalities", "answer_3": "An inconclusive result", "correct_answer": "No significant findings or abnormalities", "explanation": "A null finding in a radiology report usually indicates that no significant abnormalities or findings were detected in the imaging study." }, { "question_text": "In the context of pharmacology, what does a null effect of a drug generally mean?", "answer_1": "The drug is highly effective", "answer_2": "The drug has no therapeutic effect", "answer_3": "The drug has significant side effects", "correct_answer": "The drug has no therapeutic effect", "explanation": "A null effect in pharmacology refers to a situation where the drug does not produce any therapeutic effect on the condition it is intended to treat." }, { "question_text": "What is the implication of a null response to defibrillation in a cardiac arrest patient?", "answer_1": "The patient's heart rhythm has been restored", "answer_2": "The patient remains in a shockable rhythm", "answer_3": "The patient has regained consciousness", "correct_answer": "The patient remains in a shockable rhythm", "explanation": "A null response to defibrillation suggests that the patient's heart rhythm has not been restored and they remain in a shockable rhythm, requiring further intervention." }, { "question_text": "How is the concept of 'null' applied in the assessment of neurological function?", "answer_1": "To describe normal neurological status", "answer_2": "To indicate the absence of specific reflexes or responses", "answer_3": "To confirm brain death", "correct_answer": "To indicate the absence of specific reflexes or responses", "explanation": "In neurological assessments, 'null' is often used to describe the absence of specific reflexes or responses, which may indicate a neurological deficit or condition." } ] }

{ "questions": [ { "question_text": "What is the first step in assessing a patient in an emergency situation?", "answer_1": "Check for responsiveness", "answer_2": "Assess breathing", "answer_3": "Check for a pulse", "correct_answer": "Check for responsiveness", "explanation": "The first step is to determine if the patient is responsive by gently shaking and asking if they are okay." }, { "question_text": "How should you open the airway of an unresponsive patient?", "answer_1": "Head-tilt, chin-lift maneuver", "answer_2": "Jaw-thrust maneuver", "answer_3": "Place them in a seated position", "correct_answer": "Head-tilt, chin-lift maneuver", "explanation": "The head-tilt, chin-lift maneuver is the standard method for opening the airway unless spinal injury is suspected." }, { "question_text": "What is the recommended compression-to-ventilation ratio for adult CPR?", "answer_1": "15:2", "answer_2": "30:2", "answer_3": "5:1", "correct_answer": "30:2", "explanation": "For adult CPR, the compression-to-ventilation ratio is 30 chest compressions followed by 2 ventilations." }, { "question_text": "What is the primary purpose of using an AED?", "answer_1": "To monitor heart rate", "answer_2": "To restart a stopped heart", "answer_3": "To deliver a shock to correct certain arrhythmias", "correct_answer": "To deliver a shock to correct certain arrhythmias", "explanation": "An AED is used to analyze heart rhythm and deliver a shock to restore a normal rhythm in cases of ventricular fibrillation or ventricular tachycardia." }, { "question_text": "What is the normal range for an adult’s respiratory rate?", "answer_1": "8–12 breaths per minute", "answer_2": "12–20 breaths per minute", "answer_3": "20–30 breaths per minute", "correct_answer": "12–20 breaths per minute", "explanation": "A normal respiratory rate for an adult is typically between 12 and 20 breaths per minute." }, { "question_text": "What is the recommended depth for chest compressions during CPR?", "answer_1": "At least 1 inch", "answer_2": "At least 2 inches", "answer_3": "At least 3 inches", "correct_answer": "At least 2 inches", "explanation": "For effective CPR, chest compressions should be performed at a depth of at least 2 inches in adults." }, { "question_text": "What is the primary sign of a tension pneumothorax?", "answer_1": "Severe chest pain", "answer_2": "Tracheal deviation", "answer_3": "Decreased breath sounds", "correct_answer": "Tracheal deviation", "explanation": "Tracheal deviation is a key sign of tension pneumothorax, indicating life-threatening pressure buildup in the chest." }, { "question_text": "What is the first step in controlling severe bleeding?", "answer_1": "Apply a tourniquet", "answer_2": "Apply direct pressure", "answer_3": "Elevate the injured limb", "correct_answer": "Apply direct pressure", "explanation": "The first and most effective step in controlling severe bleeding is to apply direct pressure to the wound." }, { "question_text": "What is the most common cause of cardiac arrest in adults?", "answer_1": "Respiratory failure", "answer_2": "Ventricular fibrillation", "answer_3": "Hypovolemic shock", "correct_answer": "Ventricular fibrillation", "explanation": "Ventricular fibrillation, a chaotic and ineffective heart rhythm, is the most common cause of cardiac arrest in adults." }, { "question_text": "What is the first medication typically administered in a cardiac arrest situation?", "answer_1": "Amiodarone", "answer_2": "Epinephrine", "answer_3": "Atropine", "correct_answer": "Epinephrine", "explanation": "Epinephrine is the first medication administered during cardiac arrest to improve blood flow to the heart and brain." } ] }

{ "questions": [ { "question_text": "What is the primary purpose of reassessing a patient after initial treatment?", "answer_1": "To confirm the patient's identity", "answer_2": "To evaluate the effectiveness of interventions", "answer_3": "To complete documentation", "correct_answer": "To evaluate the effectiveness of interventions", "explanation": "Reassessment helps determine if the treatment is working or if adjustments are needed." }, { "question_text": "Which of the following is the correct order of the primary assessment sequence?", "answer_1": "Breathing, Airway, Circulation", "answer_2": "Airway, Breathing, Circulation", "answer_3": "Circulation, Breathing, Airway", "correct_answer": "Airway, Breathing, Circulation", "explanation": "The ABC sequence ensures that life-threatening airway and breathing issues are addressed before circulation." }, { "question_text": "What is the first step in managing a patient with suspected spinal injury?", "answer_1": "Assess for bleeding", "answer_2": "Immobilize the spine", "answer_3": "Administer oxygen", "correct_answer": "Immobilize the spine", "explanation": "Spinal immobilization prevents further injury to the spinal cord." }, { "question_text": "Which of the following is a sign of inadequate breathing?", "answer_1": "Clear and equal breath sounds", "answer_2": "Use of accessory muscles", "answer_3": "Normal respiratory rate", "correct_answer": "Use of accessory muscles", "explanation": "Accessory muscle use indicates the patient is struggling to breathe effectively." }, { "question_text": "What is the most appropriate action for a patient experiencing anaphylaxis?", "answer_1": "Administer aspirin", "answer_2": "Administer epinephrine", "answer_3": "Apply a tourniquet", "correct_answer": "Administer epinephrine", "explanation": "Epinephrine is the first-line treatment for anaphylaxis as it reverses severe allergic reactions." }, { "question_text": "What is the recommended compression-to-ventilation ratio for adult CPR?", "answer_1": "15:2", "answer_2": "30:2", "answer_3": "25:2", "correct_answer": "30:2", "explanation": "The 30:2 ratio ensures adequate chest compressions and ventilations during CPR." }, { "question_text": "Which of the following is a contraindication for nitroglycerin administration?", "answer_1": "Chest pain", "answer_2": "Low blood pressure", "answer_3": "High blood sugar", "correct_answer": "Low blood pressure", "explanation": "Nitroglycerin can lower blood pressure further, which is dangerous for hypotensive patients." }, { "question_text": "What is the first step in controlling external bleeding?", "answer_1": "Apply a tourniquet", "answer_2": "Apply direct pressure", "answer_3": "Elevate the limb", "correct_answer": "Apply direct pressure", "explanation": "Direct pressure is the most effective first step to stop external bleeding." }, { "question_text": "Which of the following is a symptom of shock?", "answer_1": "Hypertension", "answer_2": "Pale, cool, and clammy skin", "answer_3": "Decreased heart rate", "correct_answer": "Pale, cool, and clammy skin", "explanation": "These are classic signs of shock due to reduced blood flow to the skin." }, { "question_text": "What is the primary purpose of the recovery position?", "answer_1": "To immobilize the spine", "answer_2": "To maintain an open airway and prevent aspiration", "answer_3": "To reduce pain", "correct_answer": "To maintain an open airway and prevent aspiration", "explanation": "The recovery position helps keep the airway clear and prevents choking on vomit or secretions." } ] }

```json { "questions": [ { "question": "What is the first step in the primary assessment of a patient?", "answers": [ {"text": "Check for breathing", "correct_answer": false}, {"text": "Ensure scene safety", "correct_answer": true}, {"text": "Assess circulation", "correct_answer": false}, {"text": "Check responsiveness", "correct_answer": false} ] }, { "question": "Which of the following is a sign of shock?", "answers": [ {"text": "High blood pressure", "correct_answer": false}, {"text": "Rapid, weak pulse", "correct_answer": true}, {"text": "Flushed skin", "correct_answer": false}, {"text": "Increased urine output", "correct_answer": false} ] }, { "question": "What is the correct compression-to-ventilation ratio for adult CPR when two rescuers are present?", "answers": [ {"text": "15:2", "correct_answer": false}, {"text": "30:2", "correct_answer": true}, {"text": "5:1", "correct_answer": false}, {"text": "10:2", "correct_answer": false} ] }, { "question": "What is the purpose of a tourniquet in emergency care?", "answers": [ {"text": "To reduce swelling", "correct_answer": false}, {"text": "To control severe bleeding", "correct_answer": true}, {"text": "To immobilize a fracture", "correct_answer": false}, {"text": "To measure blood pressure", "correct_answer": false} ] }, { "question": "Which of the following is a symptom of a myocardial infarction?", "answers": [ {"text": "Chest pain or discomfort", "correct_answer": true}, {"text": "Sudden headache", "correct_answer": false}, {"text": "Abdominal cramps", "correct_answer": false}, {"text": "Numbness in the legs", "correct_answer": false} ] }, { "question": "What is the normal respiratory rate for an adult at rest?", "answers": [ {"text": "8-12 breaths per minute", "correct_answer": false}, {"text": "12-20 breaths per minute", "correct_answer": true}, {"text": "20-30 breaths per minute", "correct_answer": false}, {"text": "30-40 breaths per minute", "correct_answer": false} ] }, { "question": "Which of the following is a key step in managing a patient with a suspected spinal injury?", "answers": [ {"text": "Immediately move the patient to a stretcher", "correct_answer": false}, {"text": "Stabilize the head and neck manually", "correct_answer": true}, {"text": "Apply heat to the affected area", "correct_answer": false}, {"text": "Ask the patient to sit up", "correct_answer": false} ] }, { "question": "What is the primary role of an EMT during a mass casualty incident?", "answers": [ {"text": "Provide definitive care to all patients", "correct_answer": false}, {"text": "Triage patients and prioritize care", "correct_answer": true}, {"text": "Evacuate the scene immediately", "correct_answer": false}, {"text": "Document all injuries in detail", "correct_answer": false} ] }, { "question": "What is the recommended method to open the airway of an unresponsive patient?", "answers": [ {"text": "Head-tilt, chin-lift maneuver", "correct_answer": true}, {"text": "Jaw-thrust maneuver", "correct_answer": false}, {"text": "Inserting an oral airway", "correct_answer": false}, {"text": "Pushing on the chest", "correct_answer": false} ] }, { "question": "What is the best way to treat a patient with a chemical burn?", "answers": [ {"text": "Apply a generous amount of ointment", "correct_answer": false}, {"text": "Flush the affected area with copious amounts of water", "correct_answer": true}, {"text": "Cover the burn with a dry cloth", "correct_answer": false}, {"text": "Use ice to cool the burn", "correct_answer": false} ] } ] } ```

Here are some questions based on the content provided (even though the content is labeled as "null"): 1. **General Understanding**: - What could be inferred when the content is labeled as "null"? - How might one interpret the absence or lack of information in a given context? 2. **Technical Perspective**: - What does the term "null" signify in programming or database systems? - How does handling null values differ across various programming languages? 3. **Critical Thinking**: - What are the implications of receiving or processing null data in an application? - How can a system be designed to effectively manage or mitigate null values? 4. **Problem Solving**: - What steps would you take to troubleshoot an issue involving null data? - How would you validate or ensure the absence of null values in a dataset? 5. **Philosophical Angle**: - How does the concept of "null" relate to abstract ideas like nothingness or emptiness? - Can "null" be considered meaningful in certain contexts? If you provide more specific content, I can tailor the questions further!

The meaning of life is a question that has been pondered by philosophers, theologians, scientists, and thinkers throughout history, and it can have different interpretations depending on one's perspective. Here are a few approaches to consider: 1. **Philosophical Perspective**: Some philosophers, like existentialists, suggest that life has no inherent meaning and it is up to each individual to create their own purpose and meaning through their choices and actions. 2. **Religious and Spiritual Perspective**: Many religions and spiritual beliefs provide interpretations of the meaning of life, often centered around concepts like fulfilling a divine purpose, serving others, achieving enlightenment, or seeking a connection with a higher power. 3. **Scientific Perspective**: From a scientific viewpoint, life's meaning could be associated with survival, reproduction, and the perpetuation of genes, though this does not necessarily address deeper existential questions. 4. **Personal Perspective**: For many people, the meaning of life is tied to personal fulfillment, happiness, relationships, growth, knowledge, or contributing to something greater than oneself. Ultimately, the meaning of life is a deeply personal question, and it may vary widely from person to person based on their experiences, beliefs, and values.

```json { "questions": [ { "scenario": "A 55-year-old male collapses at the gym. Bystanders initiate CPR immediately, and EMS arrives within 5 minutes. The AED is attached, and the initial rhythm analysis shows ventricular fibrillation (VF).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue CPR for 2 minutes before defibrillation", "Administer 1 mg of EPINEPHrine intravenously", "Perform manual defibrillation at 200 joules", "Establish vascular access and secure the airway" ], "correctAnswer": "Perform manual defibrillation at 200 joules", "explanation": "The protocol emphasizes early defibrillation for ventricular fibrillation and pulseless ventricular tachycardia. The recommended first defibrillation energy setting is 200 joules, escalating as necessary.", "protocolSection": "ALS: 'Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia o Use energy settings as recommended by manufacturer (escalating 200j, 300j, 360j for Lifepak 15)'" }, { "scenario": "A 65-year-old female with a history of diabetes and renal failure is found unresponsive. Initial rhythm analysis shows asystole.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg of EPINEPHrine intravenously", "Perform manual defibrillation at 200 joules", "Administer sodium bicarbonate 8.4% (100 mEq) and calcium chloride (1 gram) intravenously", "Continue CPR for 2 minutes before reassessment" ], "correctAnswer": "Administer 1 mg of EPINEPHrine intravenously", "explanation": "For asystole and pulseless electrical activity, the protocol recommends administering EPINEPHrine 1 mg intravenous/intraosseous every 3–5 minutes, with a maximum of 3 doses.", "protocolSection": "ALS: 'Asystole/Pulseless Electrical Activity: o 1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes. Maximum 3 doses'" }, { "scenario": "A 40-year-old male is found unresponsive with agonal gasps. Initial rhythm analysis shows pulseless ventricular tachycardia (pVT). The first defibrillation attempt at 200 joules does not convert the rhythm.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue CPR for 2 minutes before reassessment", "Administer amiodarone 300 mg intravenously", "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams intravenously" ], "correctAnswer": "Administer amiodarone 300 mg intravenously", "explanation": "In cases of refractory ventricular fibrillation or pulseless ventricular tachycardia, the protocol recommends administering amiodarone 300 mg intravenous/intraosseous after at least 3 defibrillation attempts.", "protocolSection": "ALS: 'o If refractory, administer amiodarone 300 mg intravenous/intraosseous, then 150 mg intravenous/intraosseous in 3 – 5 minutes'" }, { "scenario": "A 30-year-old female with a history of opioid use disorder is found unresponsive with pinpoint pupils. Initial rhythm analysis shows pulseless electrical activity (PEA).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer naloxone 2 mg intravenously", "Administer dextrose 10% 25 grams intravenously", "Perform needle thoracostomy", "Administer EPINEPHrine 1 mg intravenously" ], "correctAnswer": "Administer naloxone 2 mg intravenously", "explanation": "In cases of suspected opioid overdose leading to pulseless electrical activity, the protocol recommends administering naloxone 2 mg intravenous/intraosseous, repeating every 3-5 minutes as needed.", "protocolSection": "ALS: 'o Opioid overdose – naloxone 2 mg intravenous/intraosseous, repeat every 3-5 min. as needed up to 6 mg (excluding previous intranasal doses)'" }, { "scenario": "A 50-year-old male with a history of heart disease is found unresponsive. Initial rhythm analysis shows ventricular fibrillation (VF). After three defibrillation attempts at escalating energies (200j, 300j, 360j) and administration of amiodarone, the rhythm remains unchanged.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Attempt vector change defibrillation", "Administer EPINEPHrine 1 mg intravenously", "Contact OLMC for further instructions", "Continue CPR for 2 minutes before reassessment" ], "correctAnswer": "Attempt vector change defibrillation", "explanation": "If the patient remains in ventricular fibrillation despite antiarrhythmic drug therapy and at least three defibrillation attempts, the protocol recommends performing vector change defibrillation.", "protocolSection": "ALS: 'o If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation (Ref. CP12, CT5)'" } ] } ```

```json { "questions": [ { "scenario": "You arrive on scene to find a 45-year-old male who has collapsed. Bystanders report he was unresponsive for 2 minutes prior to your arrival. Upon initial assessment, the patient has no pulse and is not breathing. The AED is applied, and the rhythm analysis shows ventricular fibrillation.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Begin 2 minutes of priming CPR before defibrillation", "Immediately defibrillate the patient", "Administer 1 mg of EPINEPHrine intravenously", "Secure the airway and establish vascular access" ], "correctAnswer": "Immediately defibrillate the patient", "explanation": "The protocol emphasizes that early defibrillation of ventricular fibrillation is CRITICAL and that 2 minutes of 'priming CPR' is no longer recommended. Immediate defibrillation is the most appropriate step.", "protocolSection": "PEARLS: Early defibrillation of ventricular fibrillation and pulseless ventricular tachycardia is CRITICAL. Two (2) minutes of 'priming CPR' is no longer recommended." }, { "scenario": "A 60-year-old female with a history of renal failure is found unresponsive. She has no pulse and is not breathing. The AED shows asystole. High-quality CPR is in progress, and an IV line has been established.", "question": "Based on the protocol, what medication should be administered next?", "choices": [ "Amiodarone 300 mg intravenously", "EPINEPHrine 1 mg intravenously", "Magnesium sulfate 2 grams intravenously", "Sodium bicarbonate 8.4% (100 mEq) intravenously" ], "correctAnswer": "EPINEPHrine 1 mg intravenously", "explanation": "For asystole or pulseless electrical activity, the protocol recommends administering 1 mg of EPINEPHrine intravenously every 3–5 minutes, with a maximum of 3 doses.", "protocolSection": "ALS: Asystole/Pulseless Electrical Activity: 1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes. Maximum 3 doses" }, { "scenario": "A 50-year-old male patient is in cardiac arrest with ventricular fibrillation. High-quality CPR is in progress, and the patient has been defibrillated twice without ROSC. An IV line has been established.", "question": "Based on the protocol, what is the next appropriate action?", "choices": [ "Administer magnesium sulfate 2 grams intravenously", "Administer amiodarone 300 mg intravenously", "Perform a vector change defibrillation", "Administer lidocaine 1.5 mg/kg intravenously" ], "correctAnswer": "Administer amiodarone 300 mg intravenously", "explanation": "If the patient remains in ventricular fibrillation despite defibrillation attempts and antiarrhythmic drug therapy, the protocol recommends administering amiodarone 300 mg intravenously.", "protocolSection": "ALS: Ventricular Fibrillation/Pulseless Ventricular Tachycardia: If refractory, administer amiodarone 300 mg intravenous/intraosseous, then 150 mg intravenous/intraosseous in 3 – 5 minutes" }, { "scenario": "A 35-year-old male patient is in cardiac arrest with pulseless electrical activity. High-quality CPR is in progress. The patient is known to have diabetes, and hypoglycemia is suspected.", "question": "Based on the protocol, what is the next appropriate action?", "choices": [ "Administer dextrose 10% 25 grams intravenously", "Administer sodium bicarbonate 8.4% (100 mEq) intravenously", "Administer naloxone 2 mg intravenously", "Perform needle thoracostomy" ], "correctAnswer": "Administer dextrose 10% 25 grams intravenously", "explanation": "If hypoglycemia is suspected in a patient with diabetes, the protocol recommends administering dextrose 10% 25 grams intravenously, and repeating once in 3-5 minutes if there is no effect.", "protocolSection": "ALS: Hypoglycemia – dextrose 10% 25 grams intravenous/intraosseous, repeat once in 3-5 min, if no effect" }, { "scenario": "A 70-year-old female patient is in cardiac arrest with asystole. High-quality CPR has been in progress for 20 minutes with no ROSC. No rhythm changes or increase in EtCO2 has been observed.", "question": "Based on the protocol, what is the next appropriate action?", "choices": [ "Continue CPR indefinitely", "Consult Online Medical Control Physician for cessation of resuscitation efforts", "Administer another dose of EPINEPHrine", "Perform a vector change defibrillation" ], "correctAnswer": "Consult Online Medical Control Physician for cessation of resuscitation efforts", "explanation": "The protocol recommends consulting Online Medical Control for cessation of resuscitation efforts after a minimum of 20 minutes of EMS resuscitation attempts without any response.", "protocolSection": "OLMC: Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response (e.g., no rhythm changes, no increase in EtCO2, etc.)" } ] } ```

```json { "questions": [ { "scenario": "A 65-year-old male collapses at home. Bystanders initiate CPR immediately, and EMS arrives 5 minutes later. Upon assessment, the patient is unresponsive, pulseless, and the AED indicates ventricular fibrillation.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Perform 2 minutes of 'priming CPR' before defibrillation", "Administer 1 mg epinephrine intravenously", "Immediately defibrillate at 200j, then 300j, and then 360j if needed", "Wait for OLMC consultation before defibrillation" ], "correctAnswer": "Immediately defibrillate at 200j, then 300j, and then 360j if needed", "explanation": "The protocol emphasizes that early defibrillation for ventricular fibrillation is critical. 'Priming CPR' is no longer recommended, and defibrillation should be performed immediately at the recommended energy settings (200j, 300j, 360j).", "protocolSection": "ALS - Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia" }, { "scenario": "A 50-year-old female with a history of renal failure is found unresponsive and pulseless. The monitor shows asystole.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg epinephrine intravenously every 3–5 minutes", "Administer sodium bicarbonate 100 mEq and calcium chloride 1 gram intravenously", "Perform immediate defibrillation", "Administer amiodarone 300 mg intravenously" ], "correctAnswer": "Administer sodium bicarbonate 100 mEq and calcium chloride 1 gram intravenously", "explanation": "The protocol suggests addressing reversible causes of cardiac arrest. In this case, hyperkalemia should be suspected given the patient's history of renal failure. Administering sodium bicarbonate and calcium chloride is indicated to address this potential cause.", "protocolSection": "ALS - Address potential reversible causes: Suspected hyperkalemia" }, { "scenario": "A 30-year-old male is found unresponsive and pulseless. The monitor shows pulseless ventricular tachycardia. After three defibrillation attempts at escalating energy levels (200j, 300j, 360j), the rhythm persists.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg epinephrine intravenously", "Perform vector change defibrillation", "Administer amiodarone 300 mg intravenously", "Consult OLMC for cessation of resuscitation efforts" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "If the patient remains in ventricular fibrillation or pulseless ventricular tachycardia despite antiarrhythmic drug therapy and at least three defibrillation attempts, vector change defibrillation is recommended.", "protocolSection": "ALS - Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia" }, { "scenario": "A 40-year-old female with a history of diabetes is found unresponsive and pulseless. The monitor shows asystole. After 20 minutes of resuscitation efforts, there are no rhythm changes, no increase in EtCO2, and no other signs of improvement.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue resuscitation efforts indefinitely", "Consult OLMC for cessation of resuscitation efforts", "Administer dextrose 10% 25 grams intravenously", "Perform needle thoracostomy" ], "correctAnswer": "Consult OLMC for cessation of resuscitation efforts", "explanation": "The protocol recommends consulting OLMC for cessation of resuscitation efforts after a minimum of 20 minutes of EMS resuscitation attempts without ANY response (e.g., no rhythm changes, no increase in EtCO2).", "protocolSection": "OLMC - Consult for cessation of resuscitation efforts" }, { "scenario": "A 25-year-old male is found unresponsive and pulseless. The monitor shows ventricular fibrillation. After the first defibrillation attempt at 200j, the rhythm remains unchanged.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer 1 mg epinephrine intravenously", "Administer naloxone 2 mg intravenously", "Defibrillate again at 300j", "Perform needle thoracostomy" ], "correctAnswer": "Defibrillate again at 300j", "explanation": "The protocol recommends escalating energy levels for defibrillation (200j, 300j, 360j) if the rhythm persists after the first attempt. Therefore, the next step is to defibrillate again at 300j.", "protocolSection": "ALS - Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia" } ] } ```

{ "questions": [ { "scenario": "A 55-year-old male collapses suddenly in a public park. Bystanders initiate CPR and call 911. Upon EMS arrival, the patient is unresponsive, pulseless, and apneic. An AED is immediately applied and reveals ventricular fibrillation (V-fib).", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Perform 2 minutes of CPR before defibrillation", "Immediately defibrillate with recommended energy settings", "Administer 1 mg EPINEPHrine intravenously", "Secure airway and establish vascular access" ], "correctAnswer": "Immediately defibrillate with recommended energy settings", "explanation": "The protocol emphasizes that early defibrillation for ventricular fibrillation is critical. Two minutes of 'priming CPR' is no longer recommended. Immediate defibrillation with the manufacturer's recommended energy settings is the priority.", "protocolSection": "BLS: 'Immediately initiate rhythm assessment when AED/defibrillator available and shock, if indicated' and PEARLS: 'Early defibrillation of ventricular fibrillation and pulseless ventricular tachycardia is CRITICAL.'" }, { "scenario": "A 68-year-old woman with a history of renal failure is found unresponsive at home. EMS arrives and identifies pulseless electrical activity (PEA) on the monitor. Her family reports she missed her last dialysis session.", "question": "Based on the protocol, what is the most appropriate next step?", "correctAnswer": "Administer sodium bicarbonate and calcium chloride", "explanation": "Hyperkalemia should be suspected in patients with renal failure. The protocol recommends sodium bicarbonate and calcium chloride for suspected hyperkalemia as reversible causes of cardiac arrest.", "choices": [ "Administer sodium bicarbonate and calcium chloride", "Perform needle thoracostomy", "Administer amiodarone 300 mg intravenously", "Consult OLMC for cessation of resuscitation" ], "protocolSection": "ALS: 'Suspected hyperkalemia – sodium bicarbonate 8.4% (100 mEq) and calcium chloride (1 gram) intravenous/intraosseous' and PEARLS: 'Hyperkalemia should be suspected in patients with renal failure/dialysis.'" }, { "scenario": "A 42-year-old man is found unresponsive in his car with evidence of opioid use nearby. EMS arrives, identifies asystole on the monitor, and suspects an opioid overdose.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Administer naloxone 2 mg intravenously", "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams intravenously", "Consult OLMC for lidocaine administration" ], "correctAnswer": "Administer naloxone 2 mg intravenously", "explanation": "For suspected opioid overdose, the protocol recommends administering naloxone 2 mg intravenously and repeating every 3-5 minutes as needed, up to 6 mg.", "protocolSection": "ALS (cont.): 'Opioid overdose – naloxone 2 mg intravenous/intraosseous, repeat every 3-5 min. as needed up to 6 mg.'" }, { "scenario": "A 60-year-old male with a history of diabetes is found unresponsive at home. EMS arrives, identifies ventricular fibrillation, and administers three defibrillation attempts and amiodarone without success.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue defibrillation with the same energy settings", "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams intravenously", "Consult OLMC for cessation of resuscitation" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "If the patient remains in V-fib despite antiarrhythmic drug therapy and at least three defibrillation attempts, the protocol recommends performing vector change defibrillation.", "protocolSection": "ALS: 'If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation.'" }, { "scenario": "A 50-year-old woman is found unresponsive in her home. EMS arrives, identifies asystole on the monitor, and initiates resuscitation. After 20 minutes of resuscitation efforts, there are no rhythm changes, no increase in EtCO2, and no ROSC.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue resuscitation efforts for another 10 minutes", "Consult OLMC for cessation of resuscitation", "Administer EPINEPHrine 1 mg intravenously", "Perform needle thoracostomy" ], "correctAnswer": "Consult OLMC for cessation of resuscitation", "explanation": "The protocol states to consult for cessation of resuscitation efforts after a minimum of 20 minutes of EMS resuscitation attempts without any response (e.g., no rhythm changes, no increase in EtCO2, etc.).", "protocolSection": "OLMC: 'Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response.'" } ] }

```json { "questions": [ { "scenario": "A 55-year-old male collapses at a grocery store. Bystanders immediately call 911 and begin CPR. Upon arrival, you find the patient unresponsive, pulseless, and apneic. The AED is attached, and the rhythm is ventricular fibrillation.", "question": "Based on the protocol, what is the most appropriate next step?", "choices": [ "Continue CPR for 2 minutes before defibrillation", "Immediately deliver a shock at 200 joules", "Administer 1 mg of epinephrine intravenously", "Secure the airway with an extraglottic device" ], "correctAnswer": "Immediately deliver a shock at 200 joules", "explanation": "The protocol emphasizes the critical importance of early defibrillation for ventricular fibrillation. Two minutes of 'priming CPR' is no longer recommended.", "protocolSection": "BLS section: 'Immediately initiate rhythm assessment when AED/defibrillator available and shock, if indicated'" }, { "scenario": "A 68-year-old female with a history of diabetes and renal failure is found unresponsive by her family. Paramedics arrive and confirm cardiac arrest. Initial rhythm is asystole. BLS steps are completed, and an airway is secured.", "question": "According to the protocol, what medication should be administered next?", "choices": [ "Amiodarone 300 mg intravenously", "Epinephrine 1 mg intravenously", "Magnesium sulfate 2 grams intravenously", "Naloxone 2 mg intravenously" ], "correctAnswer": "Epinephrine 1 mg intravenously", "explanation": "For asystole or pulseless electrical activity, the protocol specifies administering 1 mg of epinephrine every 3–5 minutes, with a maximum of 3 doses.", "protocolSection": "ALS section: 'Asystole/Pulseless Electrical Activity: 1 mg EPINEPHrine every 3–5 minutes.'" }, { "scenario": "A 45-year-old male is found unresponsive after a suspected opioid overdose. Paramedics confirm cardiac arrest with pulseless electrical activity. BLS steps and airway management are completed.", "question": "What is the next appropriate intervention according to the protocol?", "choices": [ "Administer naloxone 2 mg intravenously", "Administer amiodarone 300 mg intravenously", "Deliver a shock at 200 joules", "Perform needle thoracostomy" ], "correctAnswer": "Administer naloxone 2 mg intravenously", "explanation": "For suspected opioid overdose, the protocol recommends administering naloxone 2 mg intravenously, repeating every 3–5 minutes as needed up to 6 mg.", "protocolSection": "ALS section: 'Opioid overdose – naloxone 2 mg intravenously, repeat every 3-5 min. as needed up to 6 mg.'" }, { "scenario": "A 72-year-old male with a history of coronary artery disease experiences sudden cardiac arrest at home. Paramedics arrive and find the patient in ventricular fibrillation. After three defibrillation attempts and administration of epinephrine, the rhythm persists.", "question": "What is the next step according to the protocol?", "choices": [ "Administer amiodarone 300 mg intravenously", "Perform vector change defibrillation", "Administer magnesium sulfate 2 grams intravenously", "Consult OLMC for further instructions" ], "correctAnswer": "Administer amiodarone 300 mg intravenously", "explanation": "For refractory ventricular fibrillation, the protocol recommends administering amiodarone 300 mg intravenously after three defibrillation attempts.", "protocolSection": "ALS section: 'If refractory, administer amiodarone 300 mg intravenous/intraosseous, then 150 mg in 3 – 5 minutes.'" }, { "scenario": "A 60-year-old female with a history of dialysis is found unresponsive by her caregiver. Paramedics confirm cardiac arrest with pulseless electrical activity. BLS steps and airway management are completed.", "question": "What additional intervention should be considered based on the patient's history?", "choices": [ "Administer naloxone 2 mg intravenously", "Administer sodium bicarbonate 8.4% and calcium chloride intravenously", "Perform needle thoracostomy", "Administer dextrose 10% intravenously" ], "correctAnswer": "Administer sodium bicarbonate 8.4% and calcium chloride intravenously", "explanation": "Hyperkalemia should be suspected in patients with renal failure. The protocol recommends administering sodium bicarbonate 8.4% and calcium chloride for suspected hyperkalemia.", "protocolSection": "ALS section: 'Suspected hyperkalemia – sodium bicarbonate 8.4% and calcium chloride intravenously.'" } ] } ```

{ "questions": [ { "question": "What is the recommended energy setting for the first defibrillation attempt using a Lifepak 15 device for ventricular fibrillation or pulseless ventricular tachycardia?", "choices": ["100j", "200j", "300j", "360j"], "correctAnswer": "200j", "explanation": "The protocol specifies using escalating energy settings of 200j, 300j, and 360j for defibrillation attempts with a Lifepak 15 device." }, { "question": "Which of the following medications is NOT indicated for asystole or pulseless electrical activity according to the protocol?", "choices": ["Epinephrine", "Amiodarone", "Naloxone", "Magnesium sulfate"], "correctAnswer": "Amiodarone", "explanation": "Epinephrine is the primary medication for asystole or pulseless electrical activity. Amiodarone is indicated for ventricular fibrillation or pulseless ventricular tachycardia, not asystole or PEA." }, { "question": "What is the maximum total dose of naloxone that can be administered for suspected opioid overdose according to the protocol?", "choices": ["2 mg", "4 mg", "6 mg", "8 mg"], "correctAnswer": "6 mg", "explanation": "The protocol allows for naloxone administration up to 6 mg intravenously/intraosseously for opioid overdose, excluding previous intranasal doses." }, { "question": "Which of the following is NOT listed as a reversible cause of cardiac arrest in the protocol?", "choices": ["Hypoxemia", "Hypothermia", "Hyperkalemia", "Hypertension"], "correctAnswer": "Hypertension", "explanation": "The protocol lists hypoxemia, hypothermia, and hyperkalemia as reversible causes of cardiac arrest, but hypertension is not mentioned." }, { "question": "What is the minimum duration of EMS resuscitation efforts required before consulting OLMC for cessation of resuscitation?", "choices": ["10 minutes", "15 minutes", "20 minutes", "30 minutes"], "correctAnswer": "20 minutes", "explanation": "The protocol specifies that OLMC should be consulted for cessation of resuscitation efforts after a minimum of 20 minutes of EMS resuscitation attempts without any response." } ] }

```json { "questions": [ { "question": "What is the first step in the BLS protocol for a medical cardiac arrest?", "choices": [ "Secure airway and establish vascular access", "Immediately initiate rhythm assessment when AED/defibrillator available", "Establish Compression Performance Resuscitation procedure and Pit Crew Model", "Administer epinephrine intravenously" ], "correctAnswer": "Establish Compression Performance Resuscitation procedure and Pit Crew Model", "explanation": "The first step in the BLS protocol is to establish the Compression Performance Resuscitation procedure and Pit Crew Model, as outlined in the protocol." }, { "question": "Which medication is recommended for asystole or pulseless electrical activity?", "choices": [ "Amiodarone 300 mg", "Epinephrine 1 mg", "Magnesium sulfate 2 grams", "Naloxone 2 mg" ], "correctAnswer": "Epinephrine 1 mg", "explanation": "For asystole or pulseless electrical activity, the protocol recommends administering 1 mg of epinephrine every 3-5 minutes, with a maximum of 3 doses." }, { "question": "What should be done if a patient remains in ventricular fibrillation despite antiarrhythmic drug therapy and at least three defibrillation attempts?", "choices": [ "Continue administering epinephrine", "Perform vector change defibrillation", "Administer magnesium sulfate", "Contact Online Medical Control Physician" ], "correctAnswer": "Perform vector change defibrillation", "explanation": "If ventricular fibrillation persists despite antiarrhythmic drug therapy and at least three defibrillation attempts, the protocol advises performing vector change defibrillation." }, { "question": "Which of the following is NOT listed as a reversible cause of cardiac arrest in the protocol?", "choices": [ "Hypoxia", "Hypovolemia", "Hyperglycemia", "Hypothermia" ], "correctAnswer": "Hyperglycemia", "explanation": "The protocol lists several reversible causes of cardiac arrest, including hypoxia, hypovolemia, and hypothermia, but hyperglycemia is not mentioned." }, { "question": "When should transport generally be deferred in the case of a medical cardiac arrest?", "choices": [ "Immediately upon arrival", "After ROSC is achieved", "After administering naloxone", "After consulting Online Medical Control Physician" ], "correctAnswer": "After ROSC is achieved", "explanation": "The protocol states that transport should generally be deferred until after Return of Spontaneous Circulation (ROSC) is achieved, unless scene factors dictate otherwise." } ] } ```

```json { "initialDispatch": "EMS is dispatched to a 55-year-old male reported to be unconscious and not breathing at a public park. Caller states the patient collapsed while jogging. Bystanders are performing CPR. Dispatch notes indicate the patient has a known history of heart disease.", "sceneDescription": "On arrival, EMS finds the patient lying on the ground in a grassy area near a jogging trail. Bystanders confirm the patient collapsed approximately 5 minutes ago. The patient is unresponsive, pulseless, and not breathing. A bystander is performing chest compressions while another is preparing an AED. The scene is safe, but it is hot and sunny, with limited shade.", "patientCondition": "The patient is in full cardiac arrest. No pulse is detected via carotid or femoral arteries. No spontaneous respirations are observed. Skin is pale and cool to the touch. Pupils are fixed and dilated. The AED is applied, and the first shock is delivered prior to EMS arrival. Initial rhythm analysis shows ventricular fibrillation (VF).", "possibleComplications": [ "Hypoxic brain injury due to prolonged downtime", "Refractory ventricular fibrillation requiring multiple defibrillation attempts", "Acidosis from prolonged CPR", "Physical exhaustion of CPR providers in a non-clinical setting" ], "timeConstraints": { "criticalActions": [ "Immediate continuation of high-quality CPR", "Rapid defibrillation if indicated", "Advanced airway management and oxygenation", "Intravenous or intraosseous access for medication administration" ], "timeLimit": "First 10 minutes are critical for achieving ROSC (Return of Spontaneous Circulation)" }, "environmentalFactors": [ "High ambient temperature increasing risk of heat exhaustion for providers", "Potentially uneven ground affecting CPR quality", "Limited access to advanced equipment in a remote location" ], "resourceNeeds": [ "Additional EMS personnel for CPR rotation and advanced interventions", "AED with backup battery and pads", "Advanced airway equipment (e.g., endotracheal tube, supraglottic airway)", "IV/IO access kits and cardiac medications (e.g., epinephrine, amiodarone)" ] } ```

```json { "initialDispatch": "Dispatch reports a 58-year-old male collapsed at a local gym. Bystanders report the patient was on the treadmill when he suddenly fell unconscious. No known history of cardiac issues. CPR is in progress by a gym staff member. Time of collapse was approximately 5 minutes ago.", "sceneDescription": "Upon arrival, the patient is found on the floor of the gym near the treadmill. Bystanders are performing chest compressions. The gym is well-lit and accessible, with ample space for EMS to work. The patient is unresponsive, pulseless, and not breathing. An automated external defibrillator (AED) is nearby but has not been used yet.", "patientCondition": "The patient is in cardiac arrest. No pulse or spontaneous breathing is detected. Skin is pale and cool to the touch. Pupils are fixed and dilated. No obvious signs of trauma or external injuries. Bystanders report no prior complaints of chest pain or shortness of breath before the collapse.", "possibleComplications": [ "Ventricular fibrillation or pulseless ventricular tachycardia requiring immediate defibrillation", "Hypoxic brain injury due to prolonged lack of oxygen", "Pulmonary edema or aspiration if resuscitation efforts are prolonged", "Reperfusion injury if ROSC (Return of Spontaneous Circulation) is achieved" ], "timeConstraints": { "criticalActions": [ "Initiate high-quality CPR immediately", "Apply AED and analyze rhythm", "Administer epinephrine and other advanced cardiac life support (ACLS) medications as per protocol", "Secure advanced airway and provide oxygenation" ], "timeLimit": "10 minutes to achieve ROSC to minimize risk of irreversible brain damage" }, "environmentalFactors": [ "Crowded gym environment with potential distractions", "Limited privacy for patient care", "Potential for equipment interference (e.g., treadmill, weights)" ], "resourceNeeds": [ "AED or manual defibrillator", "Advanced airway equipment (e.g., endotracheal tube, supraglottic airway)", "IV access and ACLS medications (e.g., epinephrine, amiodarone)", "Backboard for potential transport" ] } ```

```json { "initialDispatch": "Dispatch received for a 65-year-old male reported to be unconscious and unresponsive at a local gym. Caller states the patient was on the treadmill when he suddenly collapsed. CPR is being performed by a bystander. Dispatched as a Code Blue - Cardiac Arrest. ETA approximately 6 minutes.", "sceneDescription": "Upon arrival, the scene is chaotic with multiple bystanders present. The patient is lying on the floor near the treadmill. A gym employee is performing chest compressions. The patient has no visible signs of life. The gym is well-lit and accessible for EMS equipment. No immediate hazards are present.", "patientCondition": "Patient is unresponsive, pulseless, and apneic. Skin is pale and cool to the touch. Pupils are fixed and dilated. No obvious signs of trauma. Bystanders report no history of chest pain or other symptoms prior to the collapse. Patient has a history of hypertension and hyperlipidemia.", "possibleComplications": [ "Ventricular fibrillation (V-fib) or ventricular tachycardia (V-tach) as the initial rhythm", "Pulseless electrical activity (PEA) or asystole on initial rhythm check", "Hypoxic brain injury due to prolonged downtime", "Difficulty in achieving ROSC (Return of Spontaneous Circulation)", "Post-resuscitation syndrome including hemodynamic instability" ], "timeConstraints": { "criticalActions": [ "Initiate high-quality CPR immediately", "Apply AED and analyze rhythm; deliver shock if indicated", "Establish advanced airway and ensure adequate ventilation", "Administer epinephrine and other medications per protocol", "Monitor and treat reversible causes (e.g., hypoxia, hypovolemia, hyperkalemia)" ], "timeLimit": "10 minutes until irreversible brain damage or death" }, "environmentalFactors": [ "Potential for over-crowding and emotional distress among bystanders", "Limited space around the patient due to gym equipment", "Noise and distractions from other gym patrons" ], "resourceNeeds": [ "Advanced life support (ALS) equipment including defibrillator, airway management tools, and medications", "Additional EMS personnel to assist with CPR, airway management, and medication administration", "Rapid transport to a cardiac arrest center or hospital with advanced capabilities" ] } ```

```json { "initialDispatch": "EMS dispatched to a 58-year-old male reported to have collapsed at a local gym. Caller states the patient was on the treadmill when he suddenly fell to the ground and is unresponsive. CPR is reportedly in progress by bystanders.", "sceneDescription": "Upon arrival, the scene is safe and controlled. The patient is lying supine on the gym floor surrounded by gym staff. Two bystanders are performing CPR as instructed by the 911 dispatcher. The patient is attached to an automated external defibrillator (AED) that has advised a shock. The gym is moderately crowded, but staff have cleared a space around the patient.", "patientCondition": "The patient is unresponsive with no palpable carotid pulse and no spontaneous breathing. Skin is pale and diaphoretic. Pupils are fixed and dilated. Cardiac monitor upon EMS arrival shows ventricular fibrillation (V-fib).", "possibleComplications": [ "Return of spontaneous circulation (ROSC) not achieved", "Hypoxic brain injury", "Multiple organ failure", "Refractory arrhythmias" ], "timeConstraints": { "criticalActions": [ "Immediate defibrillation", "Continued high-quality CPR", "Administration of epinephrine and amiodarone as per ACLS protocol" ], "timeLimit": "Every minute without defibrillation reduces the chance of survival by 7-10%, with critical need for action within the first 5 minutes" }, "environmentalFactors": [ "Noisy and distracting environment due to gym activities", "Crowd control needed to ensure patient privacy and uninterrupted CPR" ], "resourceNeeds": [ "Advanced Cardiac Life Support (ACLS) trained personnel", "Additional EMS units for manpower support", "Backboard and stretcher for patient transport", "Hospital pre-alert to ensure Cardiac Cath Lab prep if ROSC achieved" ] } ```

```json { "initialDispatch": "Dispatch reports a 58-year-old male experiencing sudden collapse and unresponsiveness at a local gym. Bystanders report he was exercising on a treadmill when he suddenly fell to the ground. CPR is currently being performed by a gym staff member who is certified. Dispatch advises urgent response due to suspected cardiac arrest.", "sceneDescription": "Upon arrival, the gym is crowded with patrons. The patient is on the floor near a treadmill. A staff member is performing chest compressions, and a defibrillator is present but not yet applied. The scene is chaotic with several bystanders attempting to assist. The AED is accessible but not yet in use.", "patientCondition": "Patient is unresponsive, apneic, and pulseless. Skin is pale and diaphoretic. No signs of trauma are evident. Bystanders report no prior medical history of significance, but the patient had mentioned feeling unusually fatigued and short of breath earlier in the day.", "possibleComplications": [ "Ventricular fibrillation or ventricular tachycardia as the initial rhythm", "Hypoxic brain injury due to prolonged downtime", "Aspiration pneumonia from potential airway compromise", "Myocardial infarction as the underlying cause", "Electrolyte imbalances from intense exercise" ], "timeConstraints": { "criticalActions": [ "Immediate initiation of high-quality CPR", "Defibrillation within 2 minutes of arrival if indicated", "Advanced airway management to ensure oxygenation" ], "timeLimit": "5 minutes to start critical interventions to maximize the chance of survival and minimize brain damage" }, "environmentalFactors": [ "High level of noise and distractions from gym patrons", "Possible interference with radio signals due to gym equipment", "Need to manage the scene to ensure bystanders do not impede care" ], "resourceNeeds": [ "AED or manual defibrillator", "Advanced airway equipment (e.g., supraglottic airway device, endotracheal intubation kit)", "Intravenous access for medication administration", "Backboard for possible movement if resuscitation is successful", "Additional EMS personnel for scene management and assistance with interventions" ] } ```

```json { "initialDescription": "Dispatch receives a 911 call from a frantic family member reporting that a 55-year-old male suddenly collapsed while watching TV. The caller states the patient is unresponsive, not breathing, and has no pulse. BLS unit is dispatched Code 3 to the scene.", "sceneDetails": "Upon arrival, EMS finds the patient lying supine on the living room floor. Family members are performing chest compressions as instructed by the 911 dispatcher. The scene is safe, and the patient appears to have no obvious signs of trauma. A bystander reports the patient has a history of heart disease and hypertension.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. A quick assessment confirms cardiac arrest. The BLS team immediately takes over chest compressions and places the AED. The AED analyzes and advises a shock for ventricular fibrillation. A shock is delivered, and CPR is resumed. The patient remains in cardiac arrest after the first shock, and CPR continues as per protocol.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch received a 911 call for a 54-year-old male complaining of chest pain and shortness of breath. The caller, the patient's wife, reported that he suddenly collapsed and became unresponsive while walking to the kitchen. She is currently performing chest compressions as directed by the 911 dispatcher. No AED is available on scene.", "sceneDetails": "Upon arrival, the patient is found supine on the kitchen floor. The wife is actively performing chest compressions. The scene is safe, and no obvious signs of trauma or hazardous conditions are present. The patient has no known allergies, and the wife denies any recent illnesses or medications other than his prescribed blood pressure medication.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. The wife reports he was conscious and alert until the sudden collapse. No agonal breathing is noted. Skin is pale and cool to the touch. No external signs of trauma or injury are observed.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch reports a 58-year-old male collapsed at a local gym. Caller states the patient was jogging on a treadmill when he suddenly fell forward and is unresponsive. No known medical history provided. AED is available on scene. BLS unit dispatched immediately.", "sceneDetails": "Upon arrival, the patient is found lying supine on the floor next to the treadmill. No signs of trauma observed. Gym staff initiated CPR immediately after collapse, and AED pads have been applied. AED has advised a shock, but no shock has been delivered yet. Scene is safe and controlled.", "patientPresentation": "Patient is unresponsive, pulseless, and not breathing. Skin is pale and diaphoretic. AED analysis shows ventricular fibrillation. CPR is ongoing with chest compressions. No bystander medications administered prior to arrival.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch receives a call for a 65-year-old male at a local gym who collapsed while on the treadmill. Bystanders report that the patient was unresponsive and not breathing. No CPR has been initiated yet. The AED is on scene but has not been used.", "sceneDetails": "Upon arrival, EMS finds the patient lying on the floor next to the treadmill. Bystanders are present and confirm the patient has been unresponsive for approximately 3 minutes. There are no obvious signs of trauma. The gym staff has placed an AED nearby but has not applied it.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. No agonal gasps are observed. Skin is pale and cool to the touch. Bystanders confirm the patient had no known medical history but was taking a potassium supplement for occasional muscle cramps.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch reports a 58-year-old male bystander who collapsed in a grocery store parking lot. The caller states the patient is unresponsive, not breathing normally, and has no pulse. Bystanders are currently performing CPR. No other medical history is known.", "sceneDetails": "Upon arrival, find the patient lying on the ground in the parking lot with two bystanders performing CPR effectively. The patient has no signs of life. A nearby AED is present but has not been used yet. The scene is safe, and store employees are assisting in crowd control.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. Bystanders report the patient collapsed suddenly without any warning. No obvious signs of trauma or injury are observed. The patient's skin is pale and cool to the touch. Agonal gasps are noted intermittently.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatcher reports a 67-year-old male collapsed at a local grocery store. Bystanders state the patient suddenly grabbed his chest and fell to the ground. They initiated CPR and called 911. No AED was available on scene. Dispatcher confirms CPR is in progress.", "sceneDetails": "Upon arrival, patient is found lying supine on the floor of the grocery store. Bystanders are performing chest compressions. No AED or other medical equipment is visible. Patient is unresponsive, apneic, and pulseless. Family members are present and confirm the patient has a history of coronary artery disease and hypertension.", "patientPresentation": "Patient is unresponsive with no palpable pulse or spontaneous breathing. Skin is pale and cool to the touch. Bystanders report agonal gasps were present before CPR was initiated. No obvious signs of trauma or external injury. Pupils are fixed and dilated.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch reports a 58-year-old male collapsed at the park while jogging. Bystanders initiated CPR and used an AED which advised a shock. EMS is dispatched with a BLS unit arriving on scene within 5 minutes.", "sceneDetails": "On arrival, the patient is found lying on the ground in a shaded area of the park. Bystanders are performing chest compressions and have placed the AED pads. The AED is turned on and indicates a shockable rhythm. The scene is safe with no immediate threats.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. The AED is applied and indicates ventricular fibrillation. Bystanders report the patient collapsed suddenly without warning and they immediately began CPR. No obvious signs of trauma or drug use are observed.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch reports a 58-year-old male experiencing chest pain and difficulty breathing. Caller states the patient suddenly collapsed and is unresponsive. No bystander CPR or AED use reported prior to EMS arrival.", "sceneDetails": "Upon arrival, the patient is found lying supine on the living room floor. No obvious signs of trauma or hazardous conditions. Family members are present and state the patient has a history of hypertension and diabetes.", "patientPresentation": "Patient is unresponsive, apneic, and pulseless. Skin is pale and cool to the touch. No agonal respirations noted. Immediate BLS assessment confirms cardiac arrest.", "protocolName": "CARDIAC_ARREST" } ```

{ "initialDescription": "Dispatch reports a 58-year-old male found unconscious in a local grocery store. Bystanders state the patient collapsed while shopping and is not breathing. No known history or medications. CPR in progress by store staff. AED pads applied, but no shock advised yet. Caller states patient has no pulse.", "sceneDetails": "Upon arrival, find a male patient lying supine on the floor of the produce section. Bystanders performing chest compressions with an AED attached. Store manager states patient was talking normally before suddenly collapsing approximately 5 minutes ago. No obvious signs of trauma. Store security has cleared the area and is managing crowd control.", "patientPresentation": "Adult male, approximately 58 years old, unresponsive to painful stimuli. No spontaneous respirations observed. Skin pale and diaphoretic. Pads of monitor/AED in place on patient's chest. Bystander CPR continuing with good depth and rate. No carotid pulse palpable.", "protocolName": "CARDIAC_ARREST" }

```json { "initialDescription": "Dispatch reports a 58-year-old male who collapsed at the gym while exercising. Bystanders state the patient was on the treadmill when he suddenly fell forward and became unresponsive. Bystanders have initiated chest compressions and are using a public access AED. First arriving unit is a BLS ambulance.", "sceneDetails": "Upon arrival, the scene is secured by gym staff. The patient is lying on the floor near the treadmill with bystanders performing CPR. The AED has been applied, and one shock has been delivered. The patient remains unresponsive with no pulse or spontaneous respirations.", "patientPresentation": "The patient is unresponsive with agonal respirations, no palpable pulse, and no signs of life. The AED indicates a shockable rhythm (ventricular fibrillation). Chest compressions are ongoing, and the AED is ready to deliver another shock.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "You are dispatched to a local gym for a 56-year-old male who collapsed during a workout. Bystanders report the patient was performing sit-ups when he suddenly gasped and then became unresponsive. CPR is in progress, and an AED is on scene but not yet applied.", "sceneDetails": "Upon arrival, you find the patient lying on the gym floor with bystanders performing chest compressions. The gym staff has prepared the AED, but it has not been turned on or applied. The scene is secure, and no apparent hazards are present. Bystanders state the patient had no prior complaints of chest pain or shortness of breath before the collapse.", "patientPresentation": "The patient is unresponsive, pulseless, and not breathing. Initial rhythm check with the AED reveals ventricular fibrillation. Bystanders report the patient was down for approximately 2 minutes before CPR was initiated.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatcher reports a 65-year-old male collapsed at a local gym. Witnesses state the patient was on the treadmill when he suddenly fell to the ground, unresponsive. Bystanders are currently performing CPR. No AED has been applied yet. Dispatch notes the patient has a history of hypertension and high cholesterol.", "sceneDetails": "Upon arrival, the scene is safe and controlled. The patient is lying on the floor near the treadmill. Two bystanders are performing chest compressions, but no rescue breaths are being given. No AED has been used yet. The gym staff is present and assisting with crowd control.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. Skin is pale and cool to the touch. No obvious signs of trauma. Bystanders report the patient collapsed approximately 5 minutes prior to EMS arrival. No agonal respirations are noted. Immediate CPR and application of an AED are indicated.", "protocolName": "CARDIAC_ARREST" } ```

```json [ { "id": "step_1", "action": "Establish Compression Performance Resuscitation procedure and Pit Crew Model (Ref. CP9.1, CT3)", "provider_level": "BLS", "critical": true }, { "id": "step_2", "action": "Immediately initiate rhythm assessment when AED/defibrillator available and shock, if indicated (Ref. CP10, CP11)", "provider_level": "BLS", "critical": true }, { "id": "step_3", "action": "Continue Compression Performance Resuscitation and reassess rhythm every two (2) minutes and defibrillate when indicated", "provider_level": "BLS", "critical": true }, { "id": "step_4", "action": "Document any bystander (non-911 responder) interventions (e.g., CPR, rescue breathing, AED use) that occurred prior to arrival", "provider_level": "BLS", "critical": false }, { "id": "step_5", "action": "Document any occurrence of Return of Spontaneous Circulation (ROSC) and last known patient status at hospital, if transported", "provider_level": "BLS", "critical": false }, { "id": "step_6", "action": "Transport should generally be deferred until after ROSC unless dictated by scene factors", "provider_level": "BLS", "critical": false }, { "id": "step_7", "action": "Ensure BLS resuscitation steps are completed", "provider_level": "ALS", "critical": true }, { "id": "step_8", "action": "Secure airway and establish vascular access per Compression Performance Resuscitation procedure (Ref. CP9.1, CT3)", "provider_level": "ALS", "critical": true }, { "id": "step_9", "action": "Perform manual defibrillation as indicated for ventricular fibrillation or pulseless ventricular tachycardia", "provider_level": "ALS", "critical": true }, { "id": "step_10", "action": "Use energy settings as recommended by manufacturer (escalating 200j, 300j, 360j for Lifepak 15)", "provider_level": "ALS", "critical": true }, { "id": "step_11", "action": "If patient remains in V-fib despite antiarrhythmic drug therapy and at least three (3) defibrillation attempts, perform vector change defibrillation (Ref. CP12, CT5)", "provider_level": "ALS", "critical": true }, { "id": "step_12", "action": "Administer medications as indicated:", "provider_level": "ALS", "critical": true }, { "id": "step_13", "action": "Asystole/Pulseless Electrical Activity: 1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3 – 5 minutes. Maximum 3 doses", "provider_level": "ALS", "critical": true }, { "id": "step_14", "action": "Ventricular Fibrillation/Pulseless Ventricular Tachycardia: 1 mg EPINEPHrine (0.1 mg/mL concentration) intravenous/intraosseous every 3-5 minutes. Maximum 3 doses", "provider_level": "ALS", "critical": true }, { "id": "step_15", "action": "If refractory, administer amiodarone 300 mg intravenous/intraosseous, then 150 mg intravenous/intraosseous in 3 – 5 minutes", "provider_level": "ALS", "critical": true }, { "id": "step_16", "action": "If suspected Torsade’s de Pointes, administer magnesium sulfate 2 grams intravenous/intraosseous", "provider_level": "ALS", "critical": true }, { "id": "step_17", "action": "Monitor the progress of resuscitation using EtCO2 (Ref. CP5)", "provider_level": "ALS", "critical": true }, { "id": "step_18", "action": "Address potential reversible causes:", "provider_level": "ALS", "critical": true }, { "id": "step_19", "action": "Suspected hyperkalemia – sodium bicarbonate 8.4% (100 mEq) and calcium chloride (1 gram) intravenous/intraosseous (flush intravenous line between meds)", "provider_level": "ALS", "critical": true }, { "id": "step_20", "action": "Hypoglycemia – dextrose 10% 25 grams intravenous/intraosseous, repeat once in 3-5 min, if no effect", "provider_level": "ALS", "critical": true }, { "id": "step_21", "action": "Opioid overdose – naloxone 2 mg intravenous/intraosseous, repeat every 3-5 min. as needed up to 6 mg (excluding previous intranasal doses)", "provider_level": "ALS", "critical": true }, { "id": "step_22", "action": "Perform Leave Behind Narcan Procedure as indicated (Ref. CP29)", "provider_level": "ALS", "critical": false }, { "id": "step_23", "action": "Suspected cyanide exposure – Cyanokit intravenous/intraosseous rapid intravenous push (Ref. CT9, A5)", "provider_level": "ALS", "critical": true }, { "id": "step_24", "action": "Suspected tension pneumothorax – Perform needle thoracostomy (Ref. CP7)", "provider_level": "ALS", "critical": true }, { "id": "step_25", "action": "Consult for unusual circumstances or other specific treatment requests (e.g., lidocaine intravenous/intraosseous - First dose 1.5 mg/kg, Second dose 0.75 mg/kg (maximum combined total of 3 mg/kg), additional naloxone, etc.)", "provider_level": "OLMC", "critical": false }, { "id": "step_26", "action": "Consult for cessation of resuscitation efforts after minimum 20 minutes of EMS resuscitation attempts without ANY response (e.g., no rhythm changes, no increase in EtCO2, etc.)", "provider_level": "OLMC", "critical": false }, { "id": "step_27", "action": "Consult Online Medical Control Physician as needed or required (Ref. CS10)", "provider_level": "OLMC", "critical": false } ] ```

{ "initialDescription": "Dispatch reports a 58-year-old male collapsed at a local gym. Bystanders are performing CPR. AED on scene shows ventricular fibrillation.", "sceneDetails": "Patient found unresponsive on gym floor. Bystanders are performing chest compressions with an AED applied. No obvious trauma or medical history known.", "patientPresentation": "Patient is unresponsive, pulseless, and apneic. AED indicates ventricular fibrillation. No signs of obvious trauma or overdose.", "protocolName": "CARDIAC_ARREST" }

```json { "initialDescription": "Dispatch receives a call for a 56-year-old male experiencing chest pain and sudden collapse at a local grocery store. Bystanders report witnessing the patient clutch his chest, fall to the ground, and become unresponsive. CPR has been initiated by a store employee and an AED has been applied, with one shock delivered prior to EMS arrival.", "sceneDetails": "Upon arrival, you find the patient lying supine on the floor of the grocery store. Bystanders are performing chest compressions. The AED is in use, and the patient has no palpable pulse. The scene is safe and controlled. The patient’s wife is present and states he has a history of heart disease and diabetes.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. The AED indicates ventricular fibrillation. Bystander CPR is in progress, and the patient has agonal gasps interspersed with pauses in breathing. Skin is pale and cool to the touch. No obvious signs of trauma or drug use are noted.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch reports a 67-year-old male collapsed in a grocery store. Bystanders are performing CPR. AED is on scene but has not been applied. ETA is 5 minutes. No additional information available.", "sceneDetails": "Upon arrival, you find a male patient lying on the floor of the grocery store. Bystanders are performing chest compressions. An AED is present but has not been applied. The store manager reports the patient suddenly collapsed while waiting in line and did not respond to verbal or tactile stimuli.", "patientPresentation": "Patient is unresponsive, apneic, and pulseless. Bystanders confirm they began CPR immediately after collapse. No agonal breathing observed. Skin is pale and cool to the touch.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch receives a 911 call reporting a 58-year-old male who collapsed at a local gym. Caller states the patient was on a treadmill when he suddenly fell, unresponsive. Bystanders are unsure if he is breathing.", "sceneDetails": "EMS arrives to find a male patient lying on the floor of the gym. Bystanders report they have started CPR but no AED has been used. The patient is unresponsive, not breathing, and has no palpable pulse on initial assessment.", "patientPresentation": "The patient is unresponsive, apneic, and pulseless. Initial rhythm check reveals ventricular fibrillation (V-fib). Bystander CPR was initiated but no defibrillation has been performed prior to EMS arrival.", "protocolName": "CARDIAC_ARREST" } ```

```json { "initialDescription": "Dispatch for adult male, unresponsive", "sceneDetails": "Patient found on kitchen floor", "patientPresentation": "Unresponsive, not breathing", "initialActions": [ { "id": "action_1", "text": "Confirm unresponsiveness and absence of breathing", "priority": "critical" }, { "id": "action_2", "text": "Activate EMS and request AED", "priority": "critical" }, { "id": "action_3", "text": "Begin chest compressions immediately", "priority": "critical" }, { "id": "action_4", "text": "Attach AED and follow prompts", "priority": "critical" }, { "id": "action_5", "text": "Continue CPR until ALS arrives", "priority": "critical" } ] } ```

```json { "initialDescription": "Dispatch reports cardiac arrest in a 55-year-old male.", "sceneDetails": "Patient found unresponsive on the floor.", "patientPresentation": "Unresponsive, no pulse, not breathing.", "initialActions": [ { "id": "action_1", "text": "Confirm unresponsiveness and absence of breathing.", "priority": "critical" }, { "id": "action_2", "text": "Initiate CPR immediately.", "priority": "critical" }, { "id": "action_3", "text": "Apply AED and follow prompts.", "priority": "critical" }, { "id": "action_4", "text": "Request advanced life support if available.", "priority": "critical" } ] } ```

```json { "initialDescription": "Dispatch reports unresponsive person, possible cardiac arrest", "sceneDetails": "Patient found unconscious on floor", "patientPresentation": "Unresponsive, no pulse", "initialActions": [ { "id": "action_1", "text": "Confirm unresponsiveness and check for pulse", "priority": "critical" }, { "id": "action_2", "text": "Begin chest compressions immediately", "priority": "critical" }, { "id": "action_3", "text": "Attach AED and follow prompts", "priority": "critical" }, { "id": "action_4", "text": "Provide rescue breaths if trained", "priority": "critical" }, { "id": "action_5", "text": "Monitor patient's condition continuously", "priority": "assessment" } ] } ```