Need urgent answers - Failed Protocols Exam!

[EMT Brendan]

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.

 

[DesertMedic66]

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.

 

[JPINFV]

Massachusetts EMS protocol:

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

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).

 

[DesertMedic66]

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

 

[VFlutter]

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?

 

[firetender]

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.

 

[EMT Brendan]

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.

 

[EMT Brendan]

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

 

[JPINFV]

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.....

 

[EMT Brendan]

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.

 

[Sandog]

Your best bet.

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

 

[mike1390]

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

 

[EMT Brendan]

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.

 

[NYMedic828]

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.

 

[Tigger]

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.

 

[Medic Tim]

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.

 

[EMT Brendan]

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.

 

[EMT Brendan]

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.

 

[JPINFV]

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.

 

[NYMedic828]

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.