# Need urgent answers - Failed Protocols Exam!



## EMT Brendan (Sep 15, 2012)

Hey everyone im Brendan, an EMT for Fallon Ambulance out of Massachusetts.

Im going through a OEMS protocol test and i failed the first time (two tries). If i fail again, i lose my job. Here are the difficulties im having

First off, if anyone could answer every medication we carry as BLS and their max dosages and contraindications? Also, when do we contact med control? Im not looking for street stuff, im looking for book stuff. I know that a lot of the times, what happens in the book is NOWHERE near the actual "real-life" scenarios.

I know there's ASA (aspirin) in 81 mg oral tablet form (usually 162-324mg), which we can administer up to a max dosage of 324 mg. Usage is to alleviate or help with chest pain. Aspirin is contraindicative in pt's with asthma, allergies to NSAID's and/or on a blood thinner medication.

Then there is epinephrine. Patients over the age of 8 receive a 0.3mg adult epi, pt's under 8 receive a 0.15 pedi epi. When a pt is under 66lbs or 33kg, medical control should be contacted prior to use. Usage is for severe anaphalaxis, which is presented by severe respiratory difficulty (labored breathing), low or bradycardic heartrate, hives, swelling of the throat. If a pt does not show signs of anaphalaxis or distress, do not administer an epipen at that time and assess vitals every 5mins.

Oral Glucose gel is administered for pt's with diabetes and hypoglycemia. the normal blood sugar level is 80-120, with a mental status changing level anywhere from 50 and lower. EMT's should administer 1 dose, or 1 tube of oral glucose to a responsive and alert pt. Unresponsive, or unconcious pts cannot swallow and therefore oral glucose would be counter-productive because of the chance of aspiration.

Oxygen is an easy one. Usually administered to most pts even if just for a sense of comfort (the pt thinks you are doing something for them). Counterindicative in pts with COPD. Most commonly administer via NRB (15 lpm) or Cannula (2-6 lpm).

Nitroglycerin is used in pts with hypertension. Administered, up to three doses 5 minutes apart, in 0.4mg sublingual tablets -or- two 0.4mg sprays for liquid nitro. counterindicative in a pt with hypotension.

Activated charcoal is used in pt with an oral poisoning or medication overdose. ALWAYS contact medical control prior to use. Administered in powder form. counterindicative in comatose pts or when a corrosive substance has been consumed.


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## DesertMedic66 (Sep 15, 2012)

Nitro is used for ACS "chest pain". Not for hypertension. Can only be used at the BLS level if it is the patients own nitro (it won't be carried on a BLS rig). 

For allergic reactions the patient will be tachycardic.


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## JPINFV (Sep 15, 2012)

Massachusetts EMS protocol:

http://www.mass.gov/eohhs/provider/...t/public-health-oems-treatment-protocols.html



EMT Brendan said:


> I know there's ASA (aspirin) in 81 mg oral tablet form (usually 162-324mg), which we can administer up to a max dosage of 324 mg. Usage is to alleviate or help with chest pain. Aspirin is contraindicative in pt's with asthma, allergies to NSAID's and/or on a blood thinner medication.



ASA is used in patients with chest pain not for the pain, but as an anti-platelet agent to slow down clotting in a patient with acute coronary syndrome. Also in asthma, unless there's been a prior sensitivity it is more of a caution than anything else. 




> Oral Glucose gel is administered for pt's with diabetes and hypoglycemia. the normal blood sugar level is 80-120, with a mental status changing level anywhere from 50 and lower. EMT's should administer 1 dose, or 1 tube of oral glucose to a responsive and alert pt. Unresponsive, or unconcious pts cannot swallow and therefore oral glucose would be counter-productive because of the chance of aspiration.


Just realize that 50 is by no means a hard limit. 



> Oxygen is an easy one. Usually administered to most pts even if just for a sense of comfort (the pt thinks you are doing something for them). Counterindicative in pts with COPD. Most commonly administer via NRB (15 lpm) or Cannula (2-6 lpm).


It's definitely not contraindicated in patients with COPD, in fact end stage COPD will be on full time supplemental oxygen (normally in the 2-4 L/min via NC). At most, it should be a caution, and not a contraindication (absolute or relative). 


> Nitroglycerin is used in pts with hypertension. Administered, up to three doses 5 minutes apart, in 0.4mg sublingual tablets -or- two 0.4mg sprays for liquid nitro. counterindicative in a pt with hypotension.


Nitroglycerin is used in patients with chest pain (ACS), not hypertension (well, IV forms of nitro can be used like nitroprusside, but not SL nitro) since decreasing blood pressure in a hypertensive urgency or emergency needs to be strictly controlled. Dropping a patient from 200/100 to 100/50 is a good way to cause significant complications. Make sure to know what Mass EMS considers "hypotensive" as some places use SBP of 90, some use 100.

It's also contraindicated in patients taking phosphodiesterase 5 inhibitors. Generically, these are the -afil drugs (sildenafil, tadalafil, etc) and are most often used for erectile dysfunction, but can also be used for pulmonary hypertension under a different brand name (i.e. Revatio is Viagra for pulmonary hypertension. Both are the same generic drug, sildenafil).


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## DesertMedic66 (Sep 15, 2012)

It's also in your protocols as an EMT to administer Narcan for ODs via IN.


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## VFlutter (Sep 15, 2012)

EMT Brendan said:


> Hey everyone im Brendan, an EMT for Fallon Ambulance out of Massachusetts.
> 
> 
> First off, if anyone could answer every medication we carry as BLS and their max dosages and contraindications? Also, when do we contact med control? Im not looking for street stuff, im looking for book stuff.



Seriously? Were you not given a protocol book or any information? Is there a certain book they told you to reference?


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## firetender (Sep 15, 2012)

How urgent is this, EMT Brendan?

And what books were you given?

If you want book answers then consult your books. I am confused, please help me out.


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## EMT Brendan (Sep 15, 2012)

yes there was a book, The Mass OEMS Standing Orders book. I know i could easily find this info in the book, but what i typed above was off my head. I was trying to receive corrective answers off my memory which is something that helps me memorize things better, rather than just repeating the medications appendix in the protocol booklet.....

In my opinion, the test i took was very opinion based. Yes, it was based on Standing orders, but a lot of them the instructor was like "ill take either a or b for this one, or i dont like this question and how its worded, so i wont grade it." The frustrating part is that he wrote the test :huh: .... I got my license in Feb 2011 and havent done jack with it due to a application error resulting in me never being hired until now. The problem with me is for one, im a hands on learner, not a book learner. two, out of all the studying i DID manage to do for this test, i studied the wrong things as nothing similar appeared on the protocol exam. I really need to get into this position.... especially as how i left my previous job after they gave me an offer letter not knowing i still technically wasnt hired.


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## EMT Brendan (Sep 15, 2012)

firetender said:


> How urgent is this, EMT Brendan?
> 
> And what books were you given?
> 
> If you want book answers then consult your books. I am confused, please help me out.



I retake the protocol test Monday at noon.... i failed my first yesterday. We had orientation all week. Everything was all OK. I remembered pretty much everything. The only thing i needed to work out was just the medications and their uses/dosages.... which i now know.

If you fail the exam twice, you are discharged


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## JPINFV (Sep 15, 2012)

EMT Brendan said:


> yes there was a book, The Mass OEMS Standing Orders book. I know i could easily find this info in the book, but what i typed above was off my head. I was trying to receive corrective answers off my memory which is something that helps me memorize things better, rather than just repeating the medications appendix in the protocol booklet.....


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## EMT Brendan (Sep 15, 2012)

lol, believe me i have been sleeping with index cards, my protocol/standing orders binder, and EMT-B course book for the last week. I just seem to draw blanks on stuff.

But i remember better if i get "corrective action" from someone else.


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## Sandog (Sep 15, 2012)

JPINFV said:


>



Your best bet. 

Add as much detail as you need. Have a friend quiz you. know em backwards and forwards.


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## mike1390 (Sep 15, 2012)

Potentially losing your job is not enough "corrective action"?


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## EMT Brendan (Sep 15, 2012)

not what i meant. they dont correct you when you fail... they just say you failed, heres the retest date. if you fail again, you will be discharged. thats not correcting, just consequencing.


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## NYMedic828 (Sep 15, 2012)

I don't mean to come off as well, mean, but I don't want someone treating my family members let alone administering medications who essentially does not know anything about their job or what they are doing.

Sorry, but you REALLY need to step up your game.

Good luck on your test.


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## Tigger (Sep 15, 2012)

EMT Brendan said:


> Hey everyone im Brendan, an EMT for Fallon Ambulance out of Massachusetts.
> 
> Im going through a OEMS protocol test and i failed the first time (two tries). If i fail again, i lose my job. Here are the difficulties im having
> 
> First off, if anyone could answer every medication we carry as BLS and their max dosages and contraindications? Also, when do we contact med control? Im not looking for street stuff, im looking for book stuff. I know that a lot of the times, what happens in the book is NOWHERE near the actual "real-life" scenarios.



It's an OEMS protocol test. Study the OEMS protocols by whatever means you find helpful, but don't use any other source. There is no "street stuff" and "book stuff" when it comes to medications. Deviation from BLS medication standing orders is bad news. Do not listen to those that say otherwise. 

Med control for charcoal and repeat doses of the patient's own Nitro or albuterol inhaler.


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## Medic Tim (Sep 15, 2012)

If you didn't get any feedback how do you know your only problem area is meds.

As others have said use the reference material they give you. For all intent and purposes it is the only thing that matters right now.


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## EMT Brendan (Sep 15, 2012)

NYMedic828 said:


> I don't mean to come off as well, mean, but I don't want someone treating my family members let alone administering medications who essentially does not know anything about their job or what they are doing.
> 
> Sorry, but you REALLY need to step up your game.
> 
> Good luck on your test.



No i dont take that as mean, i take that as not reading my posts clearly. i DO know what i need to know, but i failed the first test and they dont tell you how you failed. The test they administer is very biased and opinion filled, therefore it is hard to gauge where i went wrong. If you were 100% perfect on all of your tests and exams, then good for you. Not all of us are good testers. Does that mean i dont know how to actually do things hands-on? Nope. Some people are really book smart, but in the field they blank, while others are really good on the field, but tell them to explain everything they know on paper and they blank.

So you may want to consider your thoughts before your write ignorant remarks like step up my game....

And btw, im glad you were able to be perfect at what you were doing when you first started.


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## EMT Brendan (Sep 15, 2012)

Medic Tim said:


> If you didn't get any feedback how do you know your only problem area is meds.
> 
> As others have said use the reference material they give you. For all intent and purposes it is the only thing that matters right now.



Because that was the only thing i kept double checking and was unsure about. Most of it was how they worded some questions.


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## JPINFV (Sep 15, 2012)

EMT Brendan said:


> No i dont take that as mean, i take that as not reading my posts clearly. i DO know what i need to know, but i failed the first test and they dont tell you how you failed. The test they administer is very biased and opinion filled, therefore it is hard to gauge where i went wrong. If you were 100% perfect on all of your tests and exams, then good for you. Not all of us are good testers. Does that mean i dont know how to actually do things hands-on? Nope. Some people are really book smart, but in the field they blank, while others are really good on the field, but tell them to explain everything they know on paper and they blank.
> 
> So you may want to consider your thoughts before your write ignorant remarks like step up my game....
> 
> And btw, im glad you were able to be perfect at what you were doing when you first started.


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## NYMedic828 (Sep 15, 2012)

EMT Brendan said:


> So you may want to consider your thoughts before your write ignorant remarks like step up my game....
> 
> And btw, im glad you were able to be perfect at what you were doing when you first started.



In the interests of not getting your thread closed, I will ignore your snippy comment above.


A protocol test is completely based on a written set of protocols and the questions are definitive and should not have room for "what if." What if, change it from a simple protocol exam to one which requires critical thinking, a trait that comes with knowledge and experience.

As much as I despise protocol based cookbook patient care, it is your only thing to fall back on in this service when you have not yet gained that further knowledge/experience. (not insulting you, it comes with time and you are new)

That said, you need to be capable of reciting that protocol book off the top of your head until you gain the understanding of why they were written to begin with and not just following what they state.

Over time, you will no longer need the protocols. (not literally) You will simply grow to just know what ASA is and what it does and when it is indicated. You won't need a book to tell you flat out.


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## EMT Brendan (Sep 15, 2012)

not snippy at all. if your advice is to step up your game to a new emt, then you shouldnt post. its not helpful. its counterproductive.


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## NYMedic828 (Sep 15, 2012)

EMT Brendan said:


> not snippy at all. if your advice is to step up your game to a new emt, then you shouldnt post. its not helpful. its counterproductive.



Failing a test based on the footing of your title and losing your livelyhood is not exactly helpful or productive either...


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## Medic Tim (Sep 15, 2012)

From what you describe you do need to step up your game. Is that not why you posted here? There are very knowledge people here who are offering good advice. Just because you didn't second guess yourself on the non medication parts does not mean you did well in/on those areas. With your current attitude I doubt people will want to help. It is no skin off our back if you are let go.


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## Handsome Robb (Sep 15, 2012)

EMT Brendan said:


> not snippy at all. if your advice is to step up your game to a new emt, then you shouldnt post. its not helpful. its counterproductive.



Don't be a tool, he provided a polite and very correct answer to you.

Protocol exams are not subjective or opinion based, there's 1 correct answer for each question and you need to know it.

So how many people does a new EMT get to make contact with and potentially affect the morbidity or outcome of their condition before we can tell that EMT to step up their game?

Like Tim said, you failed, you obviously do need to step up your game. 

Btw aspirin in chest pain of suspected cardiac origin is to inhibit platelet aggregation and slow/stop the growth of the clot, not for the pain itself.


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## Tigger (Sep 15, 2012)

EMT Brendan said:


> No i dont take that as mean, i take that as not reading my posts clearly. i DO know what i need to know, but i failed the first test and they dont tell you how you failed. The test they administer is very biased and opinion filled, therefore it is hard to gauge where i went wrong. If you were 100% perfect on all of your tests and exams, then good for you. Not all of us are good testers. Does that mean i dont know how to actually do things hands-on? Nope. Some people are really book smart, but in the field they blank, while others are really good on the field, but tell them to explain everything they know on paper and they blank.
> 
> So you may want to consider your thoughts before your write ignorant remarks like step up my game....
> 
> And btw, im glad you were able to be perfect at what you were doing when you first started.



If you know what you need to know, then why are you having to take the test again?

Good tester, bad tester, it really doesn't matter. Your competence is measured by this test, you need to pass it and it doesn't really matter if you don't think you take tests well. A failure is a failure.

If you don't know why you failed, try and get answers. If they won't tell you, and your job is on the line, study it all. Odds are though that you already know what you are weak on, you may as well start there.

I am also unsure what a protocol test could be biased towards, but hey anythings possible.


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## MrJones (Sep 15, 2012)

The thought occurs that, if I were to come to a forum as a new member and ask for advice and/or assistance in mastering my craft, it would probably be in my best interests to step gently while doing so. Snapping back at others without having gained experience in how they interact on the board and what their experience level might be - and without having gained a reputation for oneself - is counterproductive at best.

But hey, that's just me - Mr. Vegas.


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## ffemt8978 (Sep 15, 2012)

Dial back the attitude in this thread, or I will have to get involved.


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## BandageBrigade (Sep 15, 2012)

EMT Brendan said:


> Activated charcoal is used in pt with an oral poisoning or medication overdose. ALWAYS contact medical control prior to use. Administered in powder form. counterindicative in comatose pts or when a corrosive substance has been consumed.





Exactly how do you plan on administering this? Give them a straw or rolled up dollar and have the patient do a line of it? Please get some note cards and a medication guide. Not your EMT book. A index soley of medications, such as lippincotts nursing drug guide. Use the guide and write down the info about the meds you need to know.


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## NYMedic828 (Sep 15, 2012)

Side not, I have never administered charcoal in the field. They took it out where I work but still have it where I volly. I have seen it administered in the ER, which I found strange? But the girl was in total misery trying to consume it. Gagging all the way.

I wouldn't even bother trying to get someone to drink it... Let alone...snort it? I suppose I could cook it down with my partners lighter or a road flare and inject it.



Brandon, we respect your coming to this forum seeking advice. That is the first step in bettering yourself. Admitting you have a problem. 9/10 EMS providers cannot overcome this and will carry on through their career as an incompetent ill-informed care provider.

We have no beef with you, we only want to help. But, as I said the first step is giving in to needing more help than you may think you need. Furthermore, the fault isn't necessarily on you. EMS instructors are often not anywhere near what most of us on this board consider to be competent EMS providers let alone educators. A little bit of ambition and a lot of self education will go far in EMS.


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## Jambi (Sep 15, 2012)

NYMedic828 said:


> EMS instructors are often not anywhere near what most of us on this board consider to be competent EMS providers let alone educators. A little bit of ambition and a lot of self education will go far in EMS.



funny. I was sitting in class teaching my EMTlings when I thought this exact thought when I had to correct some insanity flying out of the mouth of another instructor. I swear if I have to do it again i'm going to attack him with a king airway and enough cloth tape to disable an ambulance and its ricky-rescue crew...

Getting to the point...

EMT Brandon. It's bad form to come on here desperate for information then complain about how it's offered.  Would a man dying of thirst complain about the cup the water came in?

If your employer really is willing to invest money into an employee only to dispose of him or her, then it's likely a place you should think twice about working at.  That is, of course, if your perception matches the reality of the situation.


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## EMT Brendan (Sep 15, 2012)

i think maybe people may have misunderstood my intentions. to those i flipped out on, sorry, im just wound tight right now...

Im not arguing with how its offered or what advice people are giving, im just saying i didnt appreciate the advice is to step up my game and grow up. thats not what was i asking. obviously if im asking for people to give me corrective answers, im trying to step up my game, and that doesnt need to be reiterated.

I appreciate all the answers and advice, and even yours NyMedic.


Thank you all


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## MarshalFoch (Sep 15, 2012)

I took the Fallon test not too long ago, and it really just comes down to studying the OEMS protocol book they give you front and back. The BLS standing orders get incredibly repetitive so it is easy to spot the things that stand out and that is usually what they ask you. Don't forget to study the Fallon book they give you either. Some of the questions DO come from that to the surprise of people who spent all week studying the OEMS protocols.


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## NomadicMedic (Sep 15, 2012)

You don't need "corrective answers". 

You don't need to be looking for help on an EMS forum. 

You need to be studying the OEMS standing orders/protocol book. 

That is the ONLY place you will find answers for the PROTOCOL TEST.


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## EMT Brendan (Sep 16, 2012)

MarshalFoch said:


> I took the Fallon test not too long ago, and it really just comes down to studying the OEMS protocol book they give you front and back. The BLS standing orders get incredibly repetitive so it is easy to spot the things that stand out and that is usually what they ask you. Don't forget to study the Fallon book they give you either. Some of the questions DO come from that to the surprise of people who spent all week studying the OEMS protocols.



What garage are you out of... n. quincy? did you have andy as the training supervisor?


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## EMT Brendan (Sep 16, 2012)

my biggest thing is just separating the ALS from BLS in the protocol book.... i feel like im studying one page, then searching and searching until i get to another BLS protocol page. Half of them state that BLS cant do much because we dont have the materials to even diagnose the patient (a big one is EKG's)

*sigh* more reading for me i guess! lol


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## VFlutter (Sep 16, 2012)

EMT Brendan said:


> my biggest thing is just separating the ALS from BLS in the protocol book.... i feel like im studying one page, then searching and searching until i get to another BLS protocol page. Half of them state that BLS cant do much because we dont have the materials to even diagnose the patient (a big one is EKG's)
> 
> *sigh* more reading for me i guess! lol



Are you having trouble seperating ALS from BLS on a particualr situation or seperating the various pages in the book? Photocopy the pages relevant to you then just study that. Pretty much all ALS protocols start with BLS. You follow the protocol until the point where it mentions skills outside your scope. 

And ya EMTs can't do much at all. You have zero need for EKGs and you do not diagnose the patient.


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## EMT Brendan (Sep 16, 2012)

ChaseZ33 said:


> Are you having trouble seperating ALS from BLS on a particualr situation or seperating the various pages in the book? Photocopy the pages relevant to you then just study that. Pretty much all ALS protocols start with BLS. You follow the protocol until the point where it mentions skills outside your scope.
> 
> And ya EMTs can't do much at all. You have zero need for EKGs and you do not diagnose the patient.



just simply separating the ALS and BLS protocols. Yes everything could potentially lead into an ALS only situation, but for BLS a majority of them are just assess and monitor vitals as well as transport....


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## VFlutter (Sep 16, 2012)

EMT Brendan said:


> just simply separating the ALS and BLS protocols.



In that case......


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## DesertMedic66 (Sep 16, 2012)

BLS protocols are simple lets face it. Most protocols are O2, vitals, position of comfort, and call for ALS. 

In the OEMS online protocols clearly state which protocols are for EMTs, which are for Advanced EMTs, and which are for Medics. 

If you are having problems picking the 2 out then open up a new blank document on a computer or get a blank piece of paper and write down all the BLS protocols. 

This will allow you to: 1. Write all of the BLS protocols so you know what they are and 2. After you are done writing them down study the sheets you made. That sheet will contain only BLS protocols so you can't get them confused with ALS protocols. 

Don't write the policies off the top of your head to study. If you write down a protocol you think is right but actually it's wrong, then you are studying a wrong protocol. So word for word look at the OEMS book/online protocols and copy only the BLS protocols for everything.


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## MarshalFoch (Sep 16, 2012)

EMT Brendan said:


> just simply separating the ALS and BLS protocols. Yes everything could potentially lead into an ALS only situation, but for BLS a majority of them are just assess and monitor vitals as well as transport....



The BLS standing orders will almost all have these same four components: activate ALS, transport, treat for shock if bp drops below 100mm hg systolic, and notify receiving hospital. The variations are in obvious situations, like CPR in a cardiac arrest or manage wounds in a traumatic situation.

Don't just go to the end of the situational protocols either, important stuff like when you do not have to initiate resuscitation is covered in the back appendices.


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## EMT Brendan (Sep 16, 2012)

im pretty much just reading the OEMS protocol binder i got cover to cover... stopping or slowing down on anything that i dont know or am unsure about.

But yes, it is pretty much the same for most....


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## Porta (Sep 18, 2012)

n7lxi said:


> You don't need "corrective answers".
> 
> You don't need to be looking for help on an EMS forum.
> 
> ...



This. 


I worked in Mass also and the Protocol test is very cut and dry. 

Slow down, break the book into sections, and study at a slow pace. I started with parts I knew I would have issues with, moved to portions I knew, and continued to go back to the areas I didn't feel comfortable with. I had my friends help me. Non EMS and EMS alike. I had them quiz me and re quiz me. 

I have ADD and I'm a terrible test taker all around. It's really about having healthy study habits and not freaking the eff out.


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## NYMedic828 (Sep 18, 2012)

so.... did you pass?


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## Jambi (Sep 18, 2012)

NYMedic828 said:


> so.... did you pass?



Was wondering the same...


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## EMT Brendan (Sep 19, 2012)

yessir i did. the only thing i blanked on was a unexpected delivery question. Baby is born, hr 85, respirations normal. whats the next step. i said assessment of color thinking apgar (pulse, breathing, complexion, flexion, reflex). the correct answer was begin assisted ventilations, which still makes no sense due to the baby having normal respirations. the training supervisor said that the heartrate was low, so the baby was at risk for a cardiac incident. I know ive read somewhere that there is often discrepancies about a newborn's hr and the 5 minute apgar assessment usually reveals more normal scores


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## Jambi (Sep 20, 2012)

EMT Brendan said:


> the training supervisor said that the heartrate was low, so the baby was at risk for a cardiac incident.



the word of the day here should be hypoxia, not cardiac.


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## Jambi (Sep 20, 2012)

Don't ever say I don't love you LOL


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## RackCityEMT (Sep 20, 2012)

That is pretty awesome I am definitely going to use that.


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## Martyn (Sep 20, 2012)

JPINFV said:


> It's also contraindicated in patients taking phosphodiesterase 5 inhibitors. Generically, these are the -afil drugs (sildenafil, tadalafil, etc) and are most often used for erectile dysfunction, but can also be used for pulmonary hypertension under a different brand name (i.e. Revatio is Viagra for pulmonary hypertension. Both are the same generic drug, sildenafil).


 
Earlier this year I transported a 2 year old boy (yes, 2 years old). He was on a ventilator and among his meds he was on Viagra!!! (My wife asked if he had a 'mini woody'... :blink: )


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## Martyn (Sep 20, 2012)

EMT Brendan said:


> i said assessment of color thinking apgar (pulse, breathing, complexion, flexion, reflex


 
Well done on passing.

Can't help on commenting the above though (nit picking I know) but APGAR stands for Appearance Pulse Grimace Activity Respiration not pulse, breathing, complexion, flexion, reflex which comes out as PBCFR???


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## EMT Brendan (Sep 20, 2012)

wlel mabye im dslyeixc ok? lveae me aolne


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## Medic Tim (Sep 20, 2012)




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## EMT Brendan (Sep 20, 2012)

is there someplace online to reference all the abbreviations for things when writing narratives for the PCR's?


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## Porta (Sep 20, 2012)

EMT Brendan said:


> is there someplace online to reference all the abbreviations for things when writing narratives for the PCR's?



Try not to use a lot of abbreviations. You have a lot of different people looking at it (billing, hospital staff) and they're not always going to know what TKO or NKA means.


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## NYMedic828 (Sep 20, 2012)

EMT Brendan said:


> is there someplace online to reference all the abbreviations for things when writing narratives for the PCR's?



The trick is to write with such bad handwriting that when questioned, only you can interpret it 











(kidding, don't do that.)


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## Medic Tim (Sep 20, 2012)

EMT Brendan said:


> is there someplace online to reference all the abbreviations for things when writing narratives for the PCR's?



most companies have an approved list as there are so many variations. In most all cases plain language is best.


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## VFlutter (Sep 20, 2012)

Martyn said:


> Earlier this year I transported a 2 year old boy (yes, 2 years old). He was on a ventilator and among his meds he was on Viagra!!! (My wife asked if he had a 'mini woody'... :blink: )



Viagra is used for pulmonary arterial hypertension (PAH). Usually under a different trade name or they just list it as Sildenafil.


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## medicdan (Sep 20, 2012)

EMT Brendan said:


> is there someplace online to reference all the abbreviations for things when writing narratives for the PCR's?



You (hopefully) work for a service with ePCRs. With a computer, no need for abbreviations. Just write out your words and spell check.


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## BedpanCommando (Sep 20, 2012)

EMT Brendan said:


> is there someplace online to reference all the abbreviations for things when writing narratives for the PCR's?



The best advise I can give after 24 years in the field is to use as little abbreviations as possible.


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## JPINFV (Sep 20, 2012)

ChaseZ33 said:


> Viagra is used for pulmonary arterial hypertension (PAH). Usually under a different trade name or they just list it as Sildenafil.




Revatio...


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## VFlutter (Sep 20, 2012)

JPINFV said:


> Revatio...



Thanks, I couldn't think of the name


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## EMT Brendan (Sep 20, 2012)

we have tablets to do all the paperwork. during orientation we got to review calls for training purposes and i noticed in a majority of the narratives, abbreviations were used for a lot of things.


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## Tigger (Sep 20, 2012)

EMT Brendan said:


> we have tablets to do all the paperwork. during orientation we got to review calls for training purposes and i noticed in a majority of the narratives, abbreviations were used for a lot of things.



That doesn't mean it's the right thing to do either. Type it out, it takes less time and everyone will know what you're talking about.

Think about it like this. If you have to ask for a list of abbreviations, does that mean that everyone knows what they mean?


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## EMT Brendan (Sep 20, 2012)

i see what youre saying. but what im looking for is accepted AMA abbreviations. chances are, if youre looking at my narrative, youve been doing this for a while and should know what the accepted universal abbreviations for things are.


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## Tigger (Sep 20, 2012)

EMT Brendan said:


> i see what youre saying. but what im looking for is accepted AMA abbreviations. chances are, if youre looking at my narrative, youve been doing this for a while and should know what the accepted universal abbreviations for things are.



I've been doing this for a time (not a long one by any means) and when I read others narratives I invariably come across abbreviations I have never seen and everyone thinks that their version is the correct one. Do the right thing and write it out.


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## EMT Brendan (Sep 20, 2012)

roger


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## Handsome Robb (Sep 21, 2012)

10 points if you know what CTAB means.


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## JPINFV (Sep 21, 2012)

NVRob said:


> 10 points if you know what CTAB means.



Clear to auscultation bilaterally? 

How about ACSDHF?


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## Handsome Robb (Sep 21, 2012)

JPINFV said:


> Clear to auscultation bilaterally?
> 
> How about ACSDHF?



You don't get any points since you're a med student! Only abbreviation I really use. That and "+CMS x4".

I'm not even going to venture a guess at yours.


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## NomadicMedic (Sep 21, 2012)

There are no universal abbreviations. Each service will usually publish a list of the abbreviations they'll allow on PCRs. 

We have a 2 page list and I only use a handful. BKA, UTI, IDDM, HTN, COPD and NTG. That's about it. Everything else I write out.


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## NomadicMedic (Sep 21, 2012)

ACSDHF. 

attempted couch surfing, dumped head first.


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## JPINFV (Sep 21, 2012)

Since we're on a new page...

Acute on chronic systolic diastolic heart failure.

Ok, here's another one... SAD. It can be related to BP (and here is where we show the dangers of acronyms, granted context counts).


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## Porta (Sep 21, 2012)

JPINFV said:


> Since we're on a new page...
> 
> Acute on chronic systolic diastolic heart failure.
> 
> Ok, here's another one... SAD. It can be related to BP (and here is where we show the dangers of acronyms, granted context counts).



Sick And Disgusting.


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## EMT Brendan (Sep 21, 2012)

symptomatic abdominal distension


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## medicdan (Sep 21, 2012)

Seasonal Affective Disorder?


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## MrJones (Sep 21, 2012)

Sorry *** Doctor?


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## VFlutter (Sep 21, 2012)

JPINFV said:


> Since we're on a new page...
> 
> Acute on chronic systolic diastolic heart failure.
> 
> Ok, here's another one... SAD. It can be related to BP (and here is where we show the dangers of acronyms, granted context counts).



Small Airway Disease, sinoaortic denervation, an emotion?


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## JPINFV (Sep 21, 2012)

ChaseZ33 said:


> an emotion?



Close... it's a mood disorder + something else. BP is related.


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## MrJones (Sep 21, 2012)

Social Anxiety Disorder.


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## EMT Brendan (Sep 21, 2012)

great job everyone on their use of google =p. point noted


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## VFlutter (Sep 21, 2012)

EMT Brendan said:


> great job everyone on their use of google =p. point noted



I actually didn't use google. Good try though


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## JPINFV (Sep 21, 2012)

SAD= schizoaffective disorder, which is schizophrenia combined with depression or bipolar disorder (BP). ...and yes, I've been in non-EMS situations where those were used in that maner. Similarly, "PCR" has multiple uses.


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## VFlutter (Sep 22, 2012)

JPINFV said:


> SAD= schizoaffective disorder, which is schizophrenia combined with depression or bipolar disorder (BP). ...and yes, I've been in non-EMS situations where those were used in that maner. Similarly, "PCR" has multiple uses.



Good example, I was trying to figure out something related to blood pressure


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## emtevan (Sep 22, 2012)

emt brandan,ive been at fallon for a long time and been an emt there for almost 4 yrs.any questions let me know.Also,as a basic ive helped and saved people and at fallon ive delivered a baby in the ambulance with my partner 2 months ago,have done diabetic emergencies,epi pen,cardiac arrests,OD,cva's,mva's.Massachusetts basics can do enough stuff to help pts till they get to the ER.Dont use abbreviations just write everything out they like it better tht way and so doesnt the ER's we go to.


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## msaver (Sep 25, 2012)

firefite said:


> Nitro is used for ACS "chest pain". Not for hypertension. Can only be used at the BLS level if it is the patients own nitro (it won't be carried on a BLS rig).
> 
> For allergic reactions the patient will be tachycardic.



The part about the NITRO is not necessarily true. Where I am from we carry nitro in our stat box and we can administer with permission from med control


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## Medic Tim (Sep 25, 2012)

msaver said:


> The part about the NITRO is not necessarily true. Where I am from we carry nitro in our stat box and we can administer with permission from med control



They are speaking about MA.


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## Milla3P (Oct 5, 2012)

EMT Brendan said:


> Then there is epinephrine... Usage is for... low or bradycardic heartrate...



I know I'm late to the party.... But: What?!


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## 18G (Oct 11, 2012)

Milla3P said:


> I know I'm late to the party.... But: What?!



Why the ?! An epinephrine drip is considered equivalent to pacing for brady rhythms in adults and epinephrine is used for brady rhythms in pediatric patients, not atropine in peds.


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## Tigger (Oct 11, 2012)

18G said:


> Why the ?! An epinephrine drip is considered equivalent to pacing for brady rhythms in adults and epinephrine is used for brady rhythms in pediatric patients, not atropine in peds.



The OP was speaking from a basic's perspective in Massachusetts. Hopefully he is not giving an EpiPen for a patient who is only bradycardic, that would be wrong.


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