10 free AEMT practice questions: Protocol Application and Deviation

Perform needle decompression on the right side: Needle decompression is the right treatment for a tension pneumothorax. Only a Paramedic can perform it. An AEMT cannot, no matter how clearly the patient needs it.

Wait on scene for a paramedic unit to respond: Waiting for a paramedic unit makes sense only when the paramedic can reach the patient faster than you can reach the hospital. The hospital is eight minutes away. Waiting on scene spends this patient's time on help that is not faster.

Place a supraglottic airway before moving: A supraglottic airway is the AEMT's advanced airway, and it helps when the upper airway is the problem. This patient's problem is pressure in the chest. A supraglottic airway does nothing for that pressure.

Insert below the deformity on the same leg: Going below the deformity keeps the needle away from the part of the leg that looks injured. Fluid given below the break still has to travel through the broken bone to reach the circulation. That's the same reason you do not start an IV below a fracture.

Insert above the deformity on the same leg: Going above the break puts the needle closer to the heart than the injury. The rule covers the whole bone, not just the part that looks hurt. You cannot see from the outside how far the break runs inside the bone. A fractured tibia is the wrong tibia at either end.

Insert into the left distal tibia: The distal tibia, just above the medial malleolus, is a real IO site. In this patient, the distal tibia is part of the same broken bone. The fracture rules out every site on the left tibia.

Give it, since the protocol authorizes aspirin for chest pain: The protocol does say chest pain, and the heading gets you to the right page. This patient still has to meet the indication written under the heading. Chest wall pain does not meet it.

Give it, since aspirin carries little risk in a healthy patient: Aspirin is low risk in a healthy young patient. Low risk is not an indication. Giving a medication outside what the protocol allows is acting outside the protocol, no matter how safe the medication is.

Withhold it until the pain has lasted longer than thirty minutes: Some protocols do use how long the pain has lasted as a rule. Waiting does not turn chest wall pain into ischemic pain. No amount of time makes this patient eligible for aspirin.

Apply the device at the lowest pressure the protocol lists: Lowering the pressure would make sense if the pressure setting were the problem. The problem here is the patient's airway and mental status, not the number on the dial. No setting makes CPAP safe for a patient who vomited and stopped following commands.

Suction the airway and then apply the device as planned: Suctioning first is right, and the airway does need to be cleared. A patient who vomited and stopped following commands is still not going to hold a seal or protect the airway after suctioning. CPAP still does not fit.

Apply the mask and hold a seal manually through the vomiting: The patient is hypoxic at 87%, and the mask is already out. Holding a seal over active vomiting pushes stomach contents into the lungs. Preventing that aspiration is the reason the contraindication exists.

That the order matched a standing order already in place: Matching the order to a standing order sounds like it makes the record stronger. If a standing order already covered this medication, you would not have needed a verbal order at all. Writing that down records the wrong thing.

The radio channel and the time the channel cleared: Times do belong in a report. The radio channel and the time the channel cleared do not say who authorized the medication or what was authorized. Those two facts are what a reviewer needs.

That the order was received en route rather than on scene: Where you were when the order came in can matter for the timeline. Being en route or on scene does not tell anyone which physician gave the order or what the order said. The two pieces the report has to have are still missing.

Give the bronchodilator and watch what the wheezing does: Giving a treatment and watching the response is a fair way to work in a real asthma or COPD flare. Here the wait takes time away from the treatment that would help. The bronchodilator can also push up a heart rate of 104 in a patient whose heart is the problem.

Give the bronchodilator, since the wheezing is audible: The wheezing is real, and you can hear the wheezing at the mouth. Fluid in the alveoli makes the same sound, and the bronchodilator cannot reach fluid. Hearing a wheeze is not enough by itself to give the bronchodilator.

Withhold the bronchodilator and every remaining protocol step: Withholding the bronchodilator is right. Stopping every other step takes away care this patient still needs. Oxygen, sitting upright, and the rest of the pulmonary edema care all still apply.

Administer nitroglycerin as indicated by the chest pain protocol, since the protocol does not specifically mention tadalafil: The protocol not naming tadalafil does not make nitroglycerin safe. PDE5 inhibitor use is a contraindication to nitroglycerin whether the protocol page lists it or not. Tadalafil taken 12 hours ago is well inside the 48 hour window. Nitroglycerin now risks the same severe hypotension.

Withhold both aspirin and nitroglycerin until medical control has cleared every part of the treatment plan: Holding everything until medical control clears it sounds safe, but aspirin has no interaction with PDE5 inhibitors. The blood pressure is 138/84, and nothing in this patient contraindicates aspirin. The risk only applies to nitroglycerin, so aspirin should not be held.

Administer nitroglycerin at half the usual dose in order to reduce the risk of hypotension from the interaction: A smaller dose makes sense for a drug whose risk goes up with the dose. This interaction does not work that way. Any amount of nitroglycerin can cause the same drop in blood pressure with tadalafil on board. No dose is safe inside the 48 hour window. Withhold the nitroglycerin and let medical control direct the pain management.

Give the medication as ordered, since the physician has authorized it: A physician's order covers the information the physician had at the time. The order fit until the patient described throat swelling with this same drug. Giving a drug you now know is contraindicated makes you the source of the harm.

Give the medication and monitor closely for an allergic reaction: Close monitoring is how you handle a drug the patient has never reacted to. This patient already had airway swelling from this exact drug. That history is a contraindication, not a risk to watch for. Watching closely does not make the drug any safer to give.

Withhold the medication and document that the order was declined: Withholding the drug does protect the patient. The physician still does not learn why the order was not carried out. The physician may repeat the order, or order something else, still missing the reaction history. Report the reaction so the physician can decide with the full information.

Remove the restraints, since the patient is now cooperative: Taking restraints off en route is right when the restraints themselves are putting the patient at risk. This patient has warm hands and feet with strong radial pulses, so the restraints are not causing harm. A promise to hold still is not a reason to remove them. The behavior that got the patient restrained can come back in seconds in a moving ambulance.

Remove the wrist restraints and leave the ankle restraints in place: Taking off only the wrist restraints is still taking restraints off. Freeing the wrists frees the arms, and the arms are the limbs most able to hurt the crew. A patient's promise to cooperate is not one of the reasons to remove restraints during transport.

Discontinue the circulation checks now that the patient is calm: Circulation checks are not only for a patient who is fighting the restraints. You check circulation, breathing, and the airway the whole time a patient is restrained. A quiet patient can develop a problem from the restraints without complaining about it.

The name of the protocol and a statement that its criteria were met: Naming the protocol and saying its criteria were met only records your conclusion. Someone reading the report months later has nothing to check that statement against. The findings are what prove the criteria were met, and this report leaves them out.

The roommate's account of the patient's health before the event: The roommate's account is useful history. History did not meet the protocol criteria, and a roommate can be wrong. The decision rested on the lividity and rigor mortis you saw yourself, and those findings are what the report has to show.

A copy of the service's protocol attached to the report: Attaching the protocol shows what the criteria are. A copy of the protocol says nothing about whether this patient met them. Only the findings you write down show the patient met the criteria.