PARA 306 Test 4 Review
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1
What defibrillation technique is authorized instead of DSED at Essex-Windsor EMS?
Vector change defibrillation\
2
What does a defibrillation shock accomplish physiologically?
Depolarizes myocardial cells to interrupt disorganized electrical activity\
3
Why is early defibrillation critical in ventricular fibrillation?
It can terminate VF before prolonged ischemia reduces successful resuscitation\
4
Why are chest compressions necessary during cardiac arrest?
They generate artificial blood flow to the heart and brain\
5
What does coronary perfusion pressure influence during CPR?
The likelihood of successful myocardial reperfusion and ROSC\
6
Why is complete chest recoil important?
It permits venous return and cardiac refilling\
7
Why are prolonged compression interruptions harmful?
They reduce coronary and cerebral perfusion\
8
What does an organized ECG rhythm without a palpable pulse indicate?
Pulseless electrical activity\
9
Is PEA a shockable rhythm?
No\
10
Is asystole a shockable rhythm?
No\
11
Is pulseless ventricular tachycardia shockable?
Yes\
12
Is ventricular fibrillation shockable?
Yes\
13
A patient has wide-complex tachycardia at 180 bpm with a palpable pulse. Should the Medical Cardiac Arrest defibrillation pathway be used?
No, the patient has a pulse\
14
A patient has chaotic ECG activity without identifiable QRS complexes. What rhythm is most likely?
Ventricular fibrillation\
15
A patient has an organized rhythm at 70 bpm but no pulse. What is the rhythm classification?
Pulseless electrical activity\
16
What must be ruled out before interpreting a flat ECG tracing as asystole?
Disconnected leads, low gain and fine VF\
17
Why should CPR continue while a manual defibrillator charges?
To minimize the peri-shock pause\
18
Why must manual rhythm interpretation be performed hands-off?
Movement and compressions produce ECG artifact\
19
What should be documented after a non-shockable manual rhythm interpretation?
An event or snapshot marker\
20
Why must previous fire service shocks be counted?
They affect shock escalation and VCD eligibility\
21
A patient received two fire AED shocks before paramedics arrived. What number is the next shock?
Third\
22
What energy should an authorized PCP select for a third overall Zoll shock?
200 J\
23
What energy should an authorized PCP select for a third overall LIFEPAK 15 shock?
360 J\
24
A 6-year-old has an unknown weight. What is the estimated weight?
22 kg\
25
A 6-year-old weighs an estimated 22 kg. What is the first manual shock dose?
44 J\
26
A 6-year-old weighs 22 kg. What is the subsequent manual shock dose?
88 J\
27
A 3-year-old has an unknown weight. What is the estimated weight?
16 kg\
28
What is the first shock dose for a 16 kg child?
32 J\
29
What is the subsequent shock dose for a 16 kg child?
64 J\
30
A 7-year-old weighs an estimated 24 kg. What is the first shock dose?
48 J\
31
A 7-year-old weighs 24 kg. What is the subsequent shock dose?
96 J\
32
A 9-year-old is in VF. Which manual energy guidance applies?
RBHP/manufacturer recommendations\
33
A 17-year-old remains in VF after three consecutive shocks. Is VCD indicated?
No, VCD requires age 18 or older\
34
An adult remains in VF after three consecutive standard shocks. What technique should an Essex-Windsor PCP prepare?
Vector change defibrillation\
35
What pad orientation is used for VCD?
Anterior-posterior\
36
How many consecutive standard shocks must precede VCD?
Three\
37
A patient receives two shocks, converts to PEA, then returns to VF. Does the previous sequence qualify for VCD?
No, three consecutive shockable analyses are required\
38
Do public access defibrillator shocks count toward the three shocks required for VCD?
No\
39
Do fire service AED shocks count toward VCD eligibility?
Yes\
40
A patient receives three consecutive shocks from fire and paramedics. What is the next intervention if VF persists?
VCD\
41
How many VCD shocks are delivered before transport in the on-scene refractory VF pathway?
Three\
42
How many total consecutive shocks precede transport in the on-scene VCD pathway?
Six\
43
When should transport preparation begin during the VCD sequence?
After shock five\
44
Should transport be delayed to obtain additional defibrillation equipment?
No\
45
What should happen if a patient converts from VF to PEA during VCD?
Stop defibrillating and proceed with transport\
46
What should happen if VF returns after a temporary conversion to PEA during VCD?
Resume VCD when shockable\
47
Why is anterior-posterior pad placement used for VCD?
It changes the electrical vector through the myocardium\
48
What is the recommended action with the original pads when changing vectors using one defibrillator?
Remove the original pads before applying anterior-posterior pads\
49
Why should the original pads be removed during single-device VCD?
To prevent reconnecting the wrong pad set\
50
Can authorized manual rhythm interpretation occur in a moving ambulance?
Yes, when safe and reliable\
51
Can an SAED analyze a rhythm in a moving ambulance?
No\
52
An adult arrests for the first time during transport. What should the crew do first?
Stop safely and perform at least one rhythm analysis\
53
An en-route arrest remains in VF after three standard shocks. How many additional VCD shocks are performed before transport resumes?
One\
54
How many total shocks are used for refractory VF during an en-route arrest?
Four\
55
An en-route patient converts from VF to PEA after three shocks. What happens next?
Resume transport without further shocks\
56
Why does the en-route VCD pathway use fewer shocks than the on-scene pathway?
To avoid delaying definitive hospital care\
57
A patient re-arrests after ROSC during transport. What should the crew do?
Stop safely, perform one rhythm interpretation, treat appropriately and resume transport\
58
What is the SWORBHP maximum on-scene resuscitation time for selected non-TOR patients?
20 minutes\
59
What is the minimum number of rhythm analyses during the extended non-TOR approach?
Four\
60
What factors may support earlier transport in a non-TOR patient?
Young age, paramedic-witnessed arrest, ACP availability or non-agonal PEA\
61
What should a PCP do when uncertain about early transport versus continued resuscitation?
Patch to the Base Hospital Physician\
62
Why must the decision to remain on scene or transport early be documented?
To explain the clinical reasoning and regional directive compliance\
63
A patient received one AED shock before paramedic arrival. Can Medical TOR be considered?
No\
64
A patient has persistent PEA and does not meet TOR criteria. What is the expected disposition?
Transport\
65
Why is hemorrhage control especially important in traumatic cardiac arrest?
Blood loss prevents adequate cardiac filling\
66
Why may chest compressions be less effective in profound traumatic hypovolemia?
There is insufficient circulating volume to generate perfusion\
67
What condition may prevent venous return during traumatic arrest?
Tension pneumothorax\
68
What cardiac condition can mechanically obstruct filling after penetrating trauma?
Cardiac tamponade\
69
What is the preferred trauma destination identified in the Test 4 review?
Windsor Regional Hospital – Ouellette Campus\
70
A trauma patient has asystole and no signs of life. What decision may require a BHP patch?
Trauma termination of resuscitation\
71
Why must trauma TOR criteria be evaluated separately from medical TOR criteria?
They have different conditions and contraindications\
72
What should a PCP prioritize when traumatic arrest is caused by major external bleeding?
Immediate hemorrhage control\
73
Why should transport not be unnecessarily delayed in traumatic cardiac arrest?
Definitive treatment of reversible traumatic causes may require hospital intervention\
74
What is the primary physiological problem in most newborns requiring resuscitation?
Inadequate ventilation during transition to extrauterine life\
75
What happens to pulmonary vascular resistance after effective newborn ventilation?
It decreases\
76
What is the primary intervention for a newborn with inadequate respiratory effort?
Positive-pressure ventilation\
77
Why is newborn ventilation prioritized before chest compressions?
Most newborn bradycardia is caused by hypoxia\
78
What heart rate indicates the need for newborn chest compressions after effective PPV?
Below 60 bpm\
79
What heart rate indicates successful improvement in newborn resuscitation?
At least 100 bpm\
80
What is the initial oxygen concentration for newborn PPV?
21%\
81
What oxygen concentration is used when newborn chest compressions begin?
100%\
82
What is the purpose of MR SOPA?
To correct ineffective newborn positive-pressure ventilation\
83
What does the M in MR SOPA represent?
Mask seal\
84
What does the R in MR SOPA represent?
Reposition the airway\
85
What does the S in MR SOPA represent?
Suction the airway\
86
What does the O in MR SOPA represent?
Open the mouth\
87
What does the P in MR SOPA represent?
Increase ventilation pressure\
88
What does the A in MR SOPA represent?
Alternate airway\
89
Why is right-hand pulse oximetry used in newborn resuscitation?
It measures preductal oxygen saturation\
90
What should be reassessed after 30 seconds of effective newborn PPV?
Heart rate\
91
Why can excessive newborn ventilation pressure be dangerous?
It may cause pneumothorax\
92
What is the immediate significance of ROSC?
Spontaneous circulation has returned\
93
Why is hypotension common following ROSC?
Post-arrest myocardial dysfunction and reperfusion injury\
94
Why must oxygen be titrated after ROSC?
Both hypoxemia and hyperoxia can worsen injury\
95
Why should a 12-lead ECG be obtained after ROSC?
To assess for acute coronary ischemia\
96
What is the post-ROSC saline bolus volume for a 70 kg adult?
700 mL\
97
What is the post-ROSC saline bolus volume for a 90 kg adult?
900 mL\
98
What is the maximum post-ROSC saline bolus for a 120 kg adult?
1,000 mL\
99
What is the post-ROSC saline bolus for a 20 kg child?
200 mL\
100
A 4-year-old weighs an estimated 18 kg. What is the post-ROSC saline bolus?
180 mL\
101
How frequently must a 4-year-old receiving post-ROSC saline be reassessed?
Every 100 mL\
102
How frequently must a 15-year-old receiving post-ROSC saline be reassessed?
Every 250 mL\
103
What finding would make a post-ROSC fluid bolus inappropriate?
Pulmonary edema\
104
Why must lung sounds be reassessed during post-ROSC fluid administration?
To identify developing pulmonary edema\
105
What is the primary role of waveform capnography after SGA insertion?
Confirm and continuously monitor airway placement\
106
What does an absent capnography waveform after airway insertion require?
Immediate assessment of the patient, airway and equipment\
107
Why may capnography remain low despite correct SGA placement during cardiac arrest?
Very low pulmonary perfusion\
108
Why is continuous waveform capnography superior to a single colour change?
It provides breath-by-breath ventilation and perfusion trends\
109
What does an abrupt EtCO₂ increase during CPR suggest?
ROSC\
110
What does a persistently low EtCO₂ during CPR suggest?
Poor pulmonary blood flow or inadequate ventilation sampling\
111
A patient has EtCO₂ of 8 mmHg during CPR. What should be reassessed?
Compression quality, ventilation and airway equipment\
112
A patient has EtCO₂ of 12 mmHg followed by a sudden rise to 42 mmHg. What should be suspected?
ROSC\
113
A patient has SpO₂ of 99% while receiving oxygen but is breathing four times per minute. Is ventilation adequate?
No\
114
Which monitor directly evaluates exhaled CO₂?
Capnography\
115
Which monitor estimates arterial oxygen saturation?
Pulse oximetry\
116
Why may SpO₂ remain high during apnea in a patient receiving supplemental oxygen?
Stored oxygen delays desaturation\
117
What capnography pattern suggests bronchospasm?
Shark-fin waveform\
118
What capnography pattern suggests CO₂ rebreathing?
A baseline that does not return to zero\
119
What capnography pattern suggests hypoventilation?
Slow respiratory rate with elevated EtCO₂\
120
What capnography pattern suggests hyperventilation?
Rapid respiratory rate with decreased EtCO₂\
121
What does a sudden loss of waveform capnography suggest?
Apnea, airway dislodgement, obstruction, disconnection or loss of circulation\
122
What does a curare cleft indicate?
Spontaneous breathing effort during assisted ventilation\
123
Why is a falling EtCO₂ concerning when ventilation has not changed?
It may indicate deteriorating perfusion\
124
Why can massive pulmonary embolism cause low EtCO₂?
Pulmonary blood flow decreases and dead space increases\
125
Why can an asthmatic patient's rising EtCO₂ indicate deterioration?
Respiratory muscle fatigue and inadequate ventilation\
126
Why is a normal EtCO₂ not always reassuring in severe asthma?
It may indicate loss of compensatory hyperventilation\
127
Why can excessive BVM ventilation worsen cardiac arrest outcomes?
It increases intrathoracic pressure and decreases venous return\
128
Why is a reliable pleth waveform necessary before interpreting SpO₂?
Poor signal quality can produce inaccurate saturation readings\
129
What does a pleth pulse rate lower than the ECG rate suggest?
Some electrical beats are not producing effective peripheral pulses\
130
What can cause a falsely low SpO₂ reading in shock?
Poor peripheral perfusion\
131
Why can carbon monoxide poisoning produce SpO₂ of 100%?
The oximeter cannot reliably distinguish carboxyhemoglobin from oxyhemoglobin\
132
Why does severe anemia reduce oxygen delivery despite normal SpO₂?
Reduced hemoglobin concentration lowers oxygen content\
133
What are the three main determinants of oxygen delivery?
Oxygen saturation, hemoglobin concentration and cardiac output\
134
What is the general BLS PCS oxygen saturation target?
92–96%\
135
What is the COPD oxygen saturation target for patients meeting the specified conditions?
88–92%\
136
What oxygen treatment is required for suspected CO poisoning regardless of SpO₂?
High-concentration oxygen\
137
What should be assessed when SpO₂ and the patient's clinical presentation disagree?
Pleth quality, perfusion, respiratory status and EtCO₂\
138
What must be documented with every SpO₂ measurement?
Oxygen device and flow rate\
139
What is the PCP IM EPINEPHrine dose for suspected anaphylactic cardiac arrest?
0.01 mg/kg\
140
What is the maximum PCP IM EPINEPHrine dose during anaphylactic cardiac arrest?
0.5 mg\
141
What is the concentration of EPINEPHrine used for PCP anaphylactic cardiac arrest?
1 mg/mL\
142
How many PCP IM EPINEPHrine doses are permitted during anaphylactic arrest?
One\
143
What is the EPINEPHrine dose for a 30 kg patient at 0.01 mg/kg?
0.3 mg\
144
What volume of 1 mg/mL EPINEPHrine provides 0.3 mg?
0.3 mL\
145
What is the calculated EPINEPHrine dose for a 40 kg patient?
0.4 mg\
146
What volume of 1 mg/mL EPINEPHrine provides 0.4 mg?
0.4 mL\
147
What is the maximum EPINEPHrine dose for a 70 kg patient?
0.5 mg\
148
What volume of 1 mg/mL EPINEPHrine provides 0.5 mg?
0.5 mL\
149
What is the main alpha-1 effect of EPINEPHrine?
Peripheral vasoconstriction\
150
What is the main beta-1 effect of EPINEPHrine?
Increased heart rate and myocardial contractility\
151
What is the main beta-2 effect of EPINEPHrine?
Bronchodilation\
152
Why is EPINEPHrine not routinely administered by PCPs in every cardiac arrest?
PCP administration is limited to suspected anaphylactic arrest\
153
What was the main clinical question investigated in the DOSE VF trial?
Whether alternative defibrillation strategies improve refractory VF outcomes\
154
What percentage survived to hospital discharge with VCD in the DOSE VF trial?
21.7%\
155
What percentage survived to hospital discharge with standard defibrillation in the DOSE VF trial?
13.3%\
156
What is the main clinical purpose of vector change defibrillation?
To alter the electrical pathway through the myocardium\
157
What is the correct response when a cardiac arrest treatment decision is unclear under regional direction?
Consult the Base Hospital Physician\
158
What is the most important consideration when reviewing a documented cardiac arrest timeline?
Whether every intervention meets the directive's timing and conditions\
159
What should be checked when reviewing a defibrillation record?
Rhythm, shock count, energy, timing and authorization\
160
What should be checked when reviewing medication administration?
Indication, concentration, dose, route, maximum and contraindications\
161
What should be checked when reviewing a pediatric resuscitation calculation?
Estimated weight, dose per kilogram and maximum dose\
162
What should be checked before making a termination-of-resuscitation decision?
Every applicable TOR condition and contraindication\
163
What is the main purpose of a Base Hospital patch during a complex arrest?
Obtain physician direction when required or when clinical decisions are uncertain
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