San Diego EMS Protocol Exam 2025

01Sec

Section 1 of 5

Drug Dosages — Adult & Pediatric

35 questions covering every drug in P-115 and P-117 — adult doses, pediatric doses, max limits, and route-specific rules.

True / False

The adult dose of Acetaminophen IV is 1,000 mg administered over 15 minutes.

True

False

Protocol ReferenceP-115 Acetaminophen: Adult = 1,000 mg IV over 15 min. Pediatric = per drug chart (15 mg/kg, max 1 gm) in 100 mL NS over 15 min. Contraindicated in <2 years.

Multiple Choice

What is the pediatric dose and max for Acetaminophen IV per P-117?

10 mg/kg IV, max 500 mg

15 mg/kg IV, max 1 gm — contraindicated <2 years

20 mg/kg IV, max 1 gm

1,000 mg IV for all pediatric patients ≥10 kg

Protocol ReferenceP-117 Drug Chart: Acetaminophen IV = 15 mg/kg, max single dose 1 gm, in 100 mL NS over 15 min. Contraindicated in patients <2 years of age.

Multiple Choice

What is the correct adult dose sequence for Adenosine in SVT?

6 mg rapid IV/IO + 20 mL NS flush; if no conversion: 12 mg rapid IV/IO + flush, MR x1

12 mg rapid IV/IO + flush; then 6 mg if no conversion

6 mg IV over 2 min, repeat 12 mg at 5 min

3 mg rapid IV/IO, then 6 mg, then 12 mg

Protocol ReferenceP-115 Adenosine: 6 mg rapid IV/IO + 20 mL NS rapid flush. If no conversion: 12 mg rapid IV/IO + 20 mL NS flush, MR x1. Peds: per drug chart (0.1 mg/kg 1st dose, 0.2 mg/kg 2nd/3rd), max 6 mg/12 mg, MR x2.

Multiple Choice

The adult dose of Albuterol for respiratory distress is:

2.5 mg in 3 mL NS via nebulizer, MR

5 mg via nebulizer, MR x1

6 mL via nebulizer (albuterol/levalbuterol), MR

2 puffs MDI, MR q5 min

Protocol ReferenceP-115 Albuterol/Levalbuterol: Adult = 6 mL via nebulizer, MR. For hyperkalemia/crush: continuous nebulization. Pediatric = per drug chart (albuterol 5 mg fixed, levalbuterol age-based). Levalbuterol contraindicated <6 years.

Multiple Choice

For persistent VF/pulseless VT after 3 defibrillation attempts, what is the correct adult Amiodarone dose?

150 mg in 100 mL NS over 10 min IV/IO, MR x1

300 mg IV/IO, MR 150 mg q3-5 min (max total 450 mg)

300 mg IV/IO, MR 300 mg x1

200 mg IV/IO, MR 100 mg q5 min

Protocol ReferenceP-115 Amiodarone: VF/pVT = 300 mg IV/IO, MR 150 mg q3-5 min (max 450 mg). Stable VT = 150 mg in 100 mL NS over 10 min IV/IO, MR x1. Peds VF/pVT = 5 mg/kg IV/IO, max 150 mg per drug chart.

True / False

The adult paramedic dose of Aspirin for suspected ACS is 324 mg chewable PO (not 325 mg).

True

False

Protocol ReferenceP-115 Aspirin: Paramedic dose = 324 mg chewable PO. EMTs may assist patient self-medicate own prescribed aspirin up to 325 mg. Not indicated in pediatrics.

Multiple Choice

For adult symptomatic organophosphate poisoning, what is the correct initial Atropine dose and repeat strategy?

1 mg IV/IO, MR q3-5 min to max 3 mg

2 mg IV/IO; if SLUDGE/BBB continue, double prior dose q3-5 min

5 mg IV/IO, MR 5 mg q5 min until dry

0.5 mg IV/IO, MR q5 min titrate to HR

Protocol ReferenceP-115 Atropine: Unstable bradycardia = 1 mg IV/IO, MR q3-5 min, max 3 mg. Organophosphate = start 2 mg IV/IO, then double prior dose q3-5 min for continued SLUDGE/BBB signs. Peds bradycardia: per drug chart (0.02 mg/kg, max 0.5 mg/2 mg) after 3 epi doses.

Multiple Choice

What is the adult dose of Calcium Chloride for suspected hyperkalemia with widened QRS?

500 mg IV/IO

2 gm IV/IO over 10 min

1 gm IV/IO

0.5 gm IO, MR x2

Protocol ReferenceP-115 Calcium Chloride: Adult = 1 gm IV/IO for hyperkalemia (widened QRS, PEA), calcium channel blocker OD, or crush injury (over 30 sec). Peds = 20 mg/kg IV/IO, max 500 mg, MR x1 in 5 min for continued ECG findings.

Multiple Choice

Which statement about Dextrose dosing is correct per P-115/P-117?

Adults receive D10; pediatric patients receive D25

Adults receive 25 gm IV (D50 formulation); peds receive D10 per drug chart (0.5 gm/kg, max 25 gm)

Both adults and peds receive D10 per weight

Adults receive 50 gm IV; peds receive D25 per chart

Protocol ReferenceP-115/P-117 Dextrose: Adult = 25 gm IV if BS <60 mg/dL, MR if remains symptomatic. Peds = D10 per drug chart (0.5 gm/kg, max 25 gm) if BS <60 mg/dL (<45 mg/dL for neonates), MR if remains symptomatic.

Q10

Multiple Choice

What is the adult dose of Diphenhydramine for allergic reaction or extrapyramidal reaction?

25 mg IV/IM

50 mg IV/IM (slow)

100 mg IV/IM

1 mg/kg IV, max 50 mg

Protocol ReferenceP-115 Diphenhydramine: Adult = 50 mg IV/IM (administer slow IV). Peds = per drug chart (1 mg/kg, max 50 mg) IV/IM.

Q11

Multiple Choice

What is the adult Epinephrine 1:1,000 IM dose for anaphylaxis?

0.3 mg IM, MR x1 q5 min

0.5 mg IM, MR x2 q5 min

1 mg IM, MR x1 q10 min

0.1 mg/kg IM, max 0.5 mg

Protocol ReferenceP-115 Epi 1:1,000: Adult = 0.5 mg IM, MR x2 q5 min. Peds IM = 0.01 mg/kg, max 0.3 mg, MR x2 q5 min. Peds nebulized = 2.5–5 mg (1:1,000 + 3 mL NS), MR x1.

Q12

Multiple Choice

What is the adult dose of Epinephrine 1:10,000 for cardiac arrest?

0.5 mg IV/IO q3-5 min

1 mg IV/IO q3-5 min

2 mg IV/IO q5-10 min

0.01 mg/kg IV/IO q3-5 min

Protocol ReferenceP-115 Epi 1:10,000: Adult cardiac arrest = 1 mg IV/IO q3-5 min. VF/pVT: begin after 2nd defibrillation. Hypothermia arrest: 1 mg x1 only. Peds: 0.01 mg/kg IV/IO (max 1 mg) q3-5 min per drug chart.

Q13

True / False

Push-Dose Epinephrine 1:100,000 is dosed at 1 mL IV/IO in adults, repeated q3 min and titrated to SBP ≥90 mmHg.

True

False

Protocol ReferenceP-115 Epi 1:100,000 (push-dose): Adult = 1 mL IV/IO MR q3 min, titrate to SBP ≥90 mmHg. Mixed by adding 1 mL of 1:10,000 epi to 9 mL NS → 10 mcg/mL. Peds = per drug chart (0.001 mg/kg, max 0.01 mg), titrate to adequate perfusion.

Q14

Multiple Choice

What is the adult maximum total IV dose of Fentanyl per P-115, and the maximum single IN dose?

Max 100 mcg IV total; 25 mcg IN per dose

Max 200 mcg IV total; 50 mcg IN per dose (MR x2 at 15 min)

Max 300 mcg IV total; 100 mcg IN per dose

Max 150 mcg IV total; 50 mcg IN per dose MR x1

Protocol ReferenceP-115 Fentanyl: Adult IV = up to 100 mcg, MR 50 mcg q5 min x2 (max 200 mcg). IN = up to 50 mcg q15 min x2 (3rd dose 50 mcg also allowed). Peds <10 kg: IV 1 mcg/kg (max 10 mcg), IN 1 mcg/kg (max 10 mcg). Peds ≥10 kg: IV 1 mcg/kg (max 100 mcg), IN 1.5 mcg/kg (max 50 mcg).

Q15

Multiple Choice

For adult beta blocker overdose with cardiac effects, what is the correct Glucagon IV dose and max?

1 mL IM, MR x1 in 10 min

2 mg IV, MR 2 mg q10 min, max 6 mg

1–5 mg IV, MR 5–10 min, max 10 mg total

0.5 mg IV push, MR q5 min max 3 mg

Protocol ReferenceP-115 Glucagon: Hypoglycemia adult = 1 mL IM. Beta blocker OD = 1–5 mg IV, MR q5-10 min, max 10 mg total. Peds = per drug chart IM (0.05 mg/kg, max 1 mg).

Q16

True / False

Ipratropium Bromide is added to the FIRST dose of albuterol/levalbuterol only, not repeat doses.

True

False

Protocol ReferenceP-115 Ipratropium: Adult = 2.5 mL 0.02% via nebulizer ADDED to first dose of albuterol/levalbuterol only. Peds = per drug chart (0.5 mg/2.5 mL), also combined with first albuterol dose only.

Q17

Multiple Choice

What is the adult sub-dissociative dose of Ketamine IV, and what is the maximum total IV dose allowed?

0.5 mg/kg IV over 10 min; max 50 mg total

0.3 mg/kg in 100 mL NS over 10 min (max 30 mg per dose); max 60 mg total IV

1 mg/kg IV push; max 100 mg total

0.1 mg/kg IV over 5 min; max 10 mg total

Protocol ReferenceP-115 Ketamine (sub-dissociative): IV = 0.3 mg/kg in 100 mL NS over 10 min, max 30 mg per dose, MR x1 at 15 min. IN = 0.5 mg/kg (50 mg/mL), max 50 mg per dose, MR x1 at 15 min. Do NOT exceed 60 mg IV or 100 mg IN total. Not indicated in peds.

Q18

Multiple Choice

For adult stable VT or persistent VF/pVT, what is the correct Lidocaine IV/IO dose and max?

1 mg/kg IV/IO, MR 0.5 mg/kg q5 min, max 3 mg/kg

1.5 mg/kg IV/IO, MR 0.5 mg/kg q5 min, max 3 mg/kg

2 mg/kg IV/IO, MR 1 mg/kg q5 min, max 4 mg/kg

300 mg IV/IO, MR 150 mg q5 min

Protocol ReferenceP-115 Lidocaine: Adult dysrhythmia = 1.5 mg/kg IV/IO, MR 0.5 mg/kg q5 min, max 3 mg/kg. Conscious adult IO procedure = 40 mg IO slow. Peds VF/pVT per drug chart (1 mg/kg, max not applicable — use drug chart).

Q19

Multiple Choice

For an adult seizure patient weighing ≥40 kg without IV access, what is the correct Midazolam IM dose?

5 mg IM

10 mg IM

0.2 mg/kg IM, max 5 mg

2.5 mg IM, MR x1

Protocol ReferenceP-115 Midazolam Seizure: ≥40 kg = 10 mg IM. <40 kg = 0.2 mg/kg IM. If IV access: 0.2 mg/kg IV/IO max 5 mg, MR x1 in 10 min, max 10 mg total. Behavioral adult: 5 mg IM/IN/IV, MR x1 in 5-10 min. Pre-cardioversion: 1–5 mg IV/IO.

Q20

Multiple Choice

For an adult who is unable to tolerate CPAP, what is the correct Midazolam dose?

5 mg IM/IN/IV, MR x1

2–5 mg IV/IO, MR x1 in 5-10 min

0.5–1 mg IM/IN/IV

1–5 mg IV/IO (pre-cardioversion dose)

Protocol ReferenceP-115 Midazolam indications: Unable to tolerate CPAP = 0.5–1 mg IM/IN/IV. Intubated with agitation = 2–5 mg IM/IN/IV/IO, MR x1 in 5-10 min. Behavioral = 5 mg IM/IN/IV, MR x1 in 5-10 min. Pre-cardioversion/pacing = 1–5 mg IV/IO.

Q21

Multiple Choice

What is the adult IV dosing strategy for Morphine per P-115?

5 mg IV, MR 5 mg q10 min, max 20 mg

0.1 mg/kg IV; MR half initial dose at 5 min; MR half initial dose at additional 5 min

2 mg IV q5 min, max 10 mg

0.05 mg/kg IV, MR 0.05 mg/kg q10 min, max 0.2 mg/kg

Protocol ReferenceP-115 Morphine: Adult IV = up to 0.1 mg/kg IV, MR half initial dose at 5 min, MR half initial dose at additional 5 min. Adult IM = up to 0.1 mg/kg IM, MR half initial dose at 15 min, MR half again at additional 15 min. Peds = per drug chart (0.1 mg/kg, max 4 mg) IV/IM.

Q22

Multiple Choice

What is the adult dose of Naloxone for opioid overdose with respiratory depression?

0.4 mg IV, titrate to effect, max 2 mg

2 mg IN/IM/IV MR, OR 4 mg via nasal spray preloaded device

4 mg IN/IM/IV, MR x2

1 mg IM, MR 1 mg x1 at 5 min

Protocol ReferenceP-115 Naloxone: Adult = 2 mg IN/IM/IV MR, OR 4 mg nasal spray preloaded device. NOT authorized in cardiac arrest. If patient refuses transport: additional 2 mg IM or 4 mg nasal spray. Peds = per drug chart IN/IV/IM, MR.

Q23

Multiple Choice

For adult CHF with SBP ≥150 mmHg, what is the correct Nitroglycerin SL dose?

0.4 mg SL, MR q3-5 min

0.8 mg SL, MR q3-5 min

1.2 mg SL, single dose

0.4 mg SL x2 simultaneously

Protocol ReferenceP-115 Nitroglycerin: Cardiac chest pain SBP ≥100 = 0.4 mg SL MR q3-5 min. CHF SBP ≥100 but <150 = 0.4 mg SL MR q3-5 min. CHF SBP ≥150 = 0.8 mg SL MR q3-5 min. Contraindicated if ED/PH meds within 48 hr or suspected intracranial bleed. Not for peds.

Q24

Multiple Choice

What is the adult dose of Ondansetron for nausea/vomiting, and what is the pediatric age cutoff for contraindication?

4 mg IV/IM/ODT, MR x1 in 10 min; contraindicated <1 month

8 mg IV/IM/ODT, MR x1; contraindicated <2 years

4 mg IV/IM/ODT, MR x1 in 10 min; contraindicated <6 months

2 mg IV/IM, MR x2; no pediatric restriction

Protocol ReferenceP-115 Ondansetron: Adult = 4 mg IV/IM/ODT, MR x1 in 10 min. Contraindicated in <6 months or known long QT syndrome. Peds per drug chart: <6 mo = contraindicated; 6 mo–3 yr = 2 mg; >3 yr = 4 mg IM/IV/ODT.

Q25

Multiple Choice

What is the adult dose of Sodium Bicarbonate and what are its primary EMS indications?

50 mEq IV/IO; used for respiratory acidosis and STEMI

1 mEq/kg IV/IO; used for hyperkalemia, TCA OD, and crush injuries

2 mEq/kg IV/IO; used for metabolic alkalosis correction

1 gm IV/IO; used for cardiac arrest only

Protocol ReferenceP-115 Sodium Bicarbonate: Adult = 1 mEq/kg IV/IO. Indications: hyperkalemia, TCA overdose, crush injuries. Peds = per drug chart (1 mEq/kg, max 50 mEq) IV/IO. Do NOT mix with calcium chloride — flush line between.

Q26

Multiple Choice

What is the adult dose of Tranexamic Acid (TXA) and what is the critical time contraindication?

2 gm IV over 10 min; contraindicated if injury >6 hours

1 gm/10 mL in 50–100 mL NS over 10 min; contraindicated if injury/delivery >3 hours prior

500 mg IV over 5 min; no time contraindication

1 gm IV push; contraindicated if injury >1 hour

Protocol ReferenceP-115 TXA: 1 gm/10 mL IV/IO in 50–100 mL NS over 10 min. Contraindicated if mechanism/delivery >3 hrs prior, isolated severe head injury, thromboembolic event within 24 hrs, or potential need for reimplantation. Not indicated in peds.

Q27

Multiple Choice

What is the initial adult dose of Buprenorphine-Naloxone (Suboxone) for opioid withdrawal, and what is the max total dose?

8 mg/2 mg SL; max 16 mg/4 mg total

16 mg/4 mg SL; repeat 8 mg/2 mg for continued symptoms; max 24 mg/6 mg total

4 mg/1 mg SL; MR x2 at 10 min; max 12 mg/3 mg

2 mg/0.5 mg SL; titrate to symptom relief, no maximum

Protocol ReferenceP-115 Buprenorphine-Naloxone: Initial = 16 mg/4 mg SL (BHO). For continued symptoms, repeat 8 mg/2 mg SL, max 24 mg/6 mg total. Contraindicated <16 years, methadone use within 10 days, AMS, or severe illness. Only authorized at agencies in the Buprenorphine Pilot Program.

Q28

True / False

The pediatric first dose of Adenosine is 0.1 mg/kg (max 6 mg), and the second/third dose is 0.2 mg/kg (max 12 mg), MR x2.

True

False

Protocol ReferenceP-117 Peds Drug Chart: Adenosine 1st dose = 0.1 mg/kg rapid IV/IO + 20 mL NS flush, max 6 mg. 2nd/3rd dose = 0.2 mg/kg rapid IV/IO + flush, max 12 mg. MR x2.

Q29

Multiple Choice

What is the pediatric Epinephrine 1:10,000 dose for cardiac arrest per P-117?

0.1 mg/kg IV/IO q3-5 min, max 1 mg

0.01 mg/kg IV/IO q3-5 min, max 1 mg

0.001 mg/kg IV/IO, MR q3 min

1 mg flat dose for all peds patients in arrest

Protocol ReferenceP-117 Peds Drug Chart: Epi 1:10,000 cardiac arrest/newborn HR <60 = 0.01 mg/kg IV/IO q3-5 min, max 1 mg. VF/pVT: begin after 2nd defibrillation. Hypothermia: 0.01 mg/kg x1 only. Unstable bradycardia: 0.01 mg/kg, MR x2 q3-5 min, MR BHO.

Q30

Multiple Choice

For a pediatric patient ≥10 kg, what is the Fentanyl IV initial dose and max per P-117?

0.5 mcg/kg IV, max 25 mcg

2 mcg/kg IV, max 200 mcg

1 mcg/kg IV, max 100 mcg; MR half initial dose

1.5 mcg/kg IV, max 50 mcg

Protocol ReferenceP-117 Fentanyl Peds ≥10 kg: IV = 1 mcg/kg (max 100 mcg), MR at half initial IV dose. IN = 1.5 mcg/kg (max 50 mcg), MR at initial IN dose. Peds <10 kg: IV = 1 mcg/kg (max 10 mcg), IN = 1 mcg/kg (max 10 mcg), MR BHO.

Q31

Multiple Choice

For a pediatric seizure patient, the IM Midazolam dose per P-117 is 0.2 mg/kg with a max of:

5 mg

10 mg

2.5 mg

1 mg

Protocol ReferenceP-117 Midazolam Peds: Seizure IM = 0.2 mg/kg, max 5 mg. Seizure IV/IO slow = 0.1 mg/kg, max 5 mg, MR x1 in 10 min. Behavioral IM/IN/IV = per drug chart, MR x1 in 10 min. Pre-cardioversion = per drug chart IV/IO.

Q32

Multiple Choice

The pediatric Atropine dose for unstable bradycardia per P-117 is 0.02 mg/kg. What is the maximum single dose?

1 mg, MR x1

0.5 mg, MR x1 in 5 min (bradycardia); 2 mg for organophosphate

0.1 mg, no repeat

0.25 mg, MR x2

Protocol ReferenceP-117 Atropine Peds: Bradycardia = 0.02 mg/kg IV/IO, max 0.5 mg, MR x1 in 5 min (given after 3 epinephrine doses). Organophosphate = 0.02 mg/kg IV/IO, max 2 mg, then double prior dose q3-5 min for continued SLUDGE/BBB.

Q33

True / False

The adult dose of Activated Charcoal is 50 gm PO, and the pediatric dose is 1 gm/kg PO with a max of 50 gm.

True

False

Protocol ReferenceP-117 Activated Charcoal: Adult = 50 gm PO. Peds = 1 gm/kg PO, max 50 gm. Note: P-117 also lists a pediatric half-dose column at 0.5 gm/kg, max 25 gm for certain situations.

Q34

Multiple Choice

What is the pediatric Normal Saline fluid bolus dose per P-117 and the maximum single bolus?

10 mL/kg IV/IO, max 250 mL

20 mL/kg IV/IO, max 500 mL

30 mL/kg IV/IO, max 1,000 mL

5 mL/kg IV/IO, max 100 mL

Protocol ReferenceP-117 Normal Saline Bolus: Peds = 20 mL/kg IV/IO, max single bolus 500 mL.

Q35

Multiple Choice

Which correctly describes pediatric Ondansetron dosing by age group per P-117?

All peds: 4 mg IM/IV/ODT regardless of age

<6 mo: contraindicated; 6 mo–3 yr: 2 mg; >3 yr: 4 mg IM/IV/ODT

<1 yr: 1 mg; 1–5 yr: 2 mg; >5 yr: 4 mg

<2 yr: contraindicated; ≥2 yr: 4 mg

Protocol ReferenceP-117 Ondansetron Peds: <6 months = contraindicated. 6 months–3 years = 2 mg IM/IV/ODT. >3 years = 4 mg IM/IV/ODT. Adult = 4 mg IV/IM/ODT, MR x1 in 10 min.

02Sec

Section 2 of 5

Indications & Contraindications

Identify correct indications and absolute contraindications for each medication.

Q36

Select All That Apply

Which of the following are contraindications for Nitroglycerin per P-115?

Select all that apply, then submit.

Use of erectile dysfunction medications (e.g., sildenafil, tadalafil) within last 48 hours

Suspected intracranial bleed

Systolic BP <100 mmHg (for cardiac chest pain indication)

Pulmonary hypertension medications within last 48 hours

Patient age over 65 years

Protocol ReferenceP-115 NTG Contraindications: (1) Erectile dysfunction or pulmonary hypertension medications within last 48 hours; (2) Suspected intracranial bleed. SBP <100 is a conditional caveat, not a listed contraindication — it triggers dosing guidance. Age is not a contraindication.

Q37

Multiple Choice

Ketamine (sub-dissociative) is contraindicated in which of the following patients?

A 25-year-old with a femur fracture, GCS 15, not pregnant

A 30-year-old in active labor with contraction pain

A 20-year-old with a pain score of 7 from a shoulder dislocation

A 16-year-old with back pain, GCS 15

Protocol ReferenceP-115 Ketamine Contraindications: Sedation, dissociative dose ranges, and pregnancy with pain from active labor. Also note: not indicated for pediatrics. Standing order requirements: ≥15 y/o, GCS 15, not pregnant, no alcohol/drug intoxication.

Q38

True / False

Adenosine is contraindicated in patients with second- or third-degree AV block without a pacemaker.

True

False

Protocol ReferenceP-115 Adenosine Contraindications: Second- or third-degree AV block (without pacemaker) and sick sinus syndrome.

Q39

Select All That Apply

Which of the following are indications for Albuterol / Levalbuterol per P-115?

Select all that apply.

Respiratory distress (non-cardiac)

Anaphylaxis with respiratory involvement

Suspected hyperkalemia

Specific crush injuries

Burns with bronchospasm

Croup

Protocol ReferenceP-115 Albuterol Indications: Respiratory distress (non-cardiac, anaphylaxis, and burns), suspected hyperkalemia, and specific crush injuries. Croup = INCORRECT; protocol states albuterol is ineffective in croup and should be avoided.

Q40

Multiple Choice

Which of the following is a contraindication to Buprenorphine-Naloxone (Suboxone)?

Patient is 17 years old

Any methadone use within the last 10 days

COWS score of 10

History of opioid use disorder

Protocol ReferenceP-115 / S-145 Buprenorphine-Naloxone Contraindications: Methadone use within last 10 days, lack of withdrawal signs/symptoms, severe medical illness (sepsis, respiratory distress), altered mental status, <16 years of age. Age 17 = ok; COWS ≥8 is required for treatment.

Q41

True / False

Tranexamic Acid (TXA) is contraindicated in patients who experienced trauma more than 3 hours prior to EMS care.

True

False

Protocol ReferenceP-115 TXA Contraindications: Isolated severe head injury, thromboembolic event within 24 hours (stroke, MI, DVT, PE), potential need for reimplantation, and mechanism of injury or delivery MORE than 3 hours prior to EMS care.

Q42

Select All That Apply

Which conditions are listed as indications for Calcium Chloride per P-115?

Suspected hyperkalemia with widened QRS

Calcium channel blocker overdose

Specific crush injuries

PEA with suspected hyperkalemia

Beta blocker overdose

Protocol ReferenceP-115 Calcium Chloride Indications: Suspected hyperkalemia, calcium channel blocker overdose, and specific crush injuries. Beta blocker OD is treated with Glucagon, not CaCl2.

Q43

Multiple Choice

Ondansetron is contraindicated in which patient?

A 7-month-old infant with vomiting

A 3-year-old taking an SSRI

A 4-month-old with vomiting

An adult with known long QT syndrome

Protocol ReferenceP-115 Ondansetron Contraindications: Known or suspected long QT syndrome AND <6 months of age. A 4-month-old falls under the age contraindication. A 7-month-old is acceptable. Both the 4-month-old AND the long QT adult (answer D) are contraindicated — but the 4-month-old is the single best answer as it's the most absolute age contraindication.

Q44

True / False

Naloxone is authorized for administration in cardiac arrest if opioid overdose is suspected as the cause.

True

False

Protocol ReferenceP-115 Naloxone and S-127 PEA: Naloxone is NOT authorized in cardiac arrest. This is explicitly stated in both the medication list and the cardiac arrest protocol.

Q45

Multiple Choice

Lidocaine is contraindicated in which cardiac condition?

Atrial fibrillation with rapid ventricular response

Ventricular fibrillation

Wolff-Parkinson-White (WPW) syndrome

Second-degree Mobitz II block

Protocol ReferenceP-115 Lidocaine Contraindications: Cardiac pre-excitation syndromes — e.g., Wolff-Parkinson-White (WPW) syndrome and Lown-Ganong-Levine (LGL) syndrome.

03Sec

Section 3 of 5

Special Considerations

Critical notes, warnings, mixing instructions, and scope-of-practice considerations.

Q46

Multiple Choice

When mixing push-dose Epinephrine 1:100,000, what is the resulting concentration?

0.1 mg/mL (100 mcg/mL)

0.01 mg/mL (10 mcg/mL)

0.001 mg/mL (1 mcg/mL)

1 mg/mL (1,000 mcg/mL)

Protocol ReferenceMixing: Remove 1 mL NS from 10 mL NS syringe → Add 1 mL of epi 1:10,000 (0.1 mg/mL) to 9 mL NS = 10 mL total at 0.01 mg/mL (10 mcg/mL). Administer 1 mL IV/IO doses, titrate to SBP ≥90 mmHg, MR q3 min.

Q47

True / False

EMTs are authorized to administer Naloxone via the intranasal (IN) route only.

True

False

Protocol ReferenceP-115 Naloxone Scope: EMT = IN only. AEMT = IN/IM only. Paramedic = IN/IM/IV. EMTs may also assist family/friends to medicate with patient's prescribed naloxone in symptomatic suspected opioid OD.

Q48

Multiple Choice

Which medication must NEVER be infused with Ringer's lactate solution?

Morphine sulfate

Sodium bicarbonate

Amiodarone and Ketamine

Calcium chloride

Protocol ReferenceBoth Amiodarone (P-115) and Ketamine (P-115) explicitly state: "Do not infuse with Ringer's lactate solution."

Q49

Select All That Apply

Which of the following are important special considerations when administering Calcium Chloride?

Confirm IV patency — extravasation causes severe tissue necrosis

Avoid using small veins (feet/hands) due to extravasation risk

It precipitates with sodium bicarbonate — flush line between administrations

Calcium chloride has three times more elemental calcium than calcium gluconate

May be mixed in the same syringe as sodium bicarbonate for convenience

Protocol ReferenceP-115 CaCl2 Notes: Confirms all A-D. Option E is WRONG — they must NEVER be mixed together; flush with ≥10 mL NS between administrations or use separate IV lines.

Q50

True / False

Inadvertent IV injection of the usual IM dose of Epinephrine 1:1,000 constitutes a 10-fold overdose.

True

False

Protocol ReferenceP-115 Epi 1:1,000 Notes: "Inadvertent IV injection of usual IM formulation and dose constitutes a 10-fold overdose that can result in sudden and severe hypertension and cerebral hemorrhage." Always confirm route before injection.

Q51

Multiple Choice

Per protocol, co-administration of Ondansetron with SSRIs (e.g., fluoxetine, sertraline) may cause:

Hypoglycemia

Serotonin syndrome

Respiratory depression

Rebound bradycardia

Protocol ReferenceP-115 Ondansetron Notes: "May cause serotonin syndrome if co-administered with selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, citalopram, escitalopram, paroxetine."

Q52

True / False

When titrating Atropine in organophosphate poisoning, the endpoint should be resolution of tachycardia.

True

False

Protocol ReferenceP-115 Atropine Notes: "In organophosphate poisoning, titrate atropine to SLUDGE/BBB signs/symptoms, NOT to tachycardia." Tachycardia is an expected side effect of atropine — do not use it as the endpoint.

Q53

Multiple Choice

Before administering activated charcoal, you must ensure the patient has not ingested which type of substance?

Acetaminophen tablets

Beta blockers

Caustic agents, hydrocarbons, or liquid (e.g., alcohol) ingestions

Salicylates

Protocol ReferenceP-115 Activated Charcoal Contraindications: Caustic agents, hydrocarbons, or liquid ingestions (e.g., alcohols). Charcoal also does not effectively bind metals (iron, lithium), electrolytes (potassium, magnesium), or acids/alkalis.

04Sec

Section 4 of 5

Treatment Protocols

S-series adult and pediatric protocols — correct sequence and decision points.

Q54

Multiple Choice

Per S-122 (Adult Anaphylaxis), after administering IM epinephrine, what is the next step for respiratory involvement?

Immediate intubation

Diphenhydramine 50 mg IV/IM, then albuterol/levalbuterol 6 mL nebulizer with ipratropium on first dose

Albuterol/levalbuterol 6 mL via nebulizer MR, with ipratropium added to first dose; then diphenhydramine

Push-dose epinephrine 1:100,000 immediately

Protocol ReferenceS-122 Anaphylaxis ALS: After epi IM — Diphenhydramine 50 mg IV/IM. THEN if respiratory involvement: Albuterol/Levalbuterol 6 mL nebulizer MR + ipratropium 2.5 mL added to FIRST dose. Push-dose epi is for severe/refractory anaphylaxis.

Q55

True / False

Per S-127, epinephrine 1:10,000 for VF/pulseless VT should begin after the FIRST defibrillation attempt.

True

False

Protocol ReferenceS-127 VF/pVT: "Epinephrine 1:10,000 1 mg IV/IO q3-5 min — BEGIN AFTER SECOND DEFIBRILLATION." Not after the first shock.

Q56

Select All That Apply

Per S-127, which of the following criteria must ALL be met for field Termination of Resuscitation (TOR) on standing order (without BH contact)?

Persistent asystole (no other rhythms detected)

Unwitnessed arrest (by bystanders or EMS)

No bystander CPR

No AED or other defibrillation delivered

No return of pulses

≥20 minutes on-scene resuscitation time

Patient must be over 18 years old

Protocol ReferenceS-127 TOR on SO requires ALL 6 criteria: asystole only, unwitnessed, no bystander CPR, no defibrillation, no ROSC, ≥20 min on scene. Age is not listed as a criterion. Excludes: drowning, hypothermia, trauma, electrocution.

Q57

Multiple Choice

Per S-139 (Trauma), epinephrine should NOT be administered in which situation?

Non-traumatic cardiac arrest with PEA

Traumatic cardiac arrest

Anaphylaxis with hemodynamic instability

Post-ROSC with SBP <90 mmHg

Protocol ReferenceS-139 Trauma: "Do not administer epinephrine" in traumatic cardiac arrest. This applies to both adult (S-139) and pediatric (S-169) traumatic cardiac arrest protocols.

Q58

True / False

Per S-143 (Sepsis), a fluid bolus of 500 mL should be given ONLY if the patient is hypotensive (SBP <90 mmHg).

True

False

Protocol ReferenceS-143 Sepsis: Initial 500 mL fluid bolus is given "regardless of initial BP or lung sounds" if ≥2 sepsis criteria are met. Subsequent boluses require no rales OR SBP <90 mmHg (MR x2).

Q59

Multiple Choice

Per S-123 (Altered Neurologic Function), symptomatic hyperglycemia is treated with a fluid bolus IV/IO when the blood sugar is:

≥250 mg/dL

≥300 mg/dL

≥350 mg/dL or reads "high"

≥400 mg/dL

Protocol ReferenceS-123 ALS: Symptomatic hyperglycemia — 500 mL fluid bolus IV/IO if BS ≥350 mg/dL or reads "high," if no rales MR x1.

Q60

Select All That Apply

Per S-134 (Poisoning/Overdose), activated charcoal is indicated for ingestion of which substances?

Acetaminophen

Calcium channel blockers

Isopropyl alcohol

Colchicine

Paraquat

Sodium valproate

Protocol ReferenceS-134 Charcoal Indications: 1. Acetaminophen, 2. Colchicine, 3. Beta blockers, 4. Calcium channel blockers, 5. Salicylates, 6. Sodium valproate, 7. Oral anticoagulants, 8. Paraquat, 9. Amanita mushrooms, 10. Poison Control recommendation. Alcohols (isopropyl) are a CONTRAINDICATION.

Q61

Multiple Choice

Per S-133 (OB Emergencies), how long after delivery should you wait before clamping and cutting the umbilical cord?

30 seconds

60 seconds

Immediately after delivery

90 seconds

Protocol ReferenceS-133 Routine Delivery: "Wait 60 seconds after delivery, then clamp and cut cord between clamps."

Q62

True / False

Per S-127 (CPR/Arrhythmias), atropine may be omitted for unstable bradycardia in heart transplant patients and patients with 2nd-degree type II or 3rd-degree heart block.

True

False

Protocol ReferenceS-127 / P-115 Atropine: "May omit atropine in bradycardic patients unlikely to have clinical benefit (e.g., heart transplant patients, second-degree type II, or third-degree heart block)."

Q63

Multiple Choice

For ECPR eligibility per S-127, the time from cardiac arrest to arrival at an ECPR receiving center must be:

≤30 minutes

≤45 minutes

≤60 minutes

≤20 minutes

Protocol ReferenceS-127 ECPR Criteria: Time interval from cardiac arrest to arrival at ECPR receiving center ≤45 minutes. Also requires: age 18-70, witnessed arrest, CPR within 5 min, refractory VF/pVT after ≥2 shocks, mechanical compression device.

Q64

Select All That Apply

Per S-139 (Adult Trauma), which medications are indicated for crush injury requiring extrication ≥2 hours — administered immediately PRIOR to anticipated release?

1,000 mL IV fluid bolus

NaHCO3 1 mEq/kg IV/IO

CaCl2 1 gm IV/IO over 30 sec

Continuous albuterol/levalbuterol 6 mL via nebulizer

Tranexamic acid 1 gm IV/IO

Protocol ReferenceS-139 Crush Injury: Prior to release — 1,000 mL fluid bolus + NaHCO3 1 mEq/kg IV/IO + CaCl2 1 gm IV/IO over 30 sec + continuous albuterol/levalbuterol 6 mL nebulizer. TXA is not indicated for crush injuries (it's for hemorrhage/postpartum).

Q65

Multiple Choice

Per S-141 (Pain Management), which pain score requires the patient to meet all standing order requirements before ketamine can be administered?

Score ≥3

Score ≥4

Score ≥5

Score ≥7

Protocol ReferenceS-141 Pain Management: Ketamine for "moderate to severe pain (score ≥5)" with all SO requirements met: ≥15 y/o, GCS 15, not pregnant, no alcohol/drug intoxication. Acetaminophen covers 1-10; fentanyl/morphine cover 4-10.

05Sec

Section 5 of 5

Emergency Indicators

Recognizing what signs, symptoms, and findings indicate specific emergencies per San Diego EMS protocols.

Q66

Multiple Choice

Using the BE-FAST prehospital stroke scale, "E" stands for:

Extremity weakness

Eyes — blurred/double or loss of vision

Expressive aphasia

EtCO2 measurement

Protocol ReferenceS-144 BE-FAST: B=Balance (unsteadiness, ataxia), E=Eyes (blurred/double or loss of vision), F=Face (unilateral droop), A=Arms and/or legs (unilateral weakness/drift/drop), S=Speech (slurred, word-finding difficulty, absent), T=Time (accurate last known well time).

Q67

Select All That Apply

Per S-143 (Sepsis), which findings (from a history of infection) indicate suspected sepsis requiring treatment?

Select ≥2 of the following criteria that trigger the sepsis protocol.

Temperature ≥100.4°F (38.0°C) or <96.8°F (36.0°C)

HR ≥90 bpm

RR ≥20 or EtCO2 <25 mmHg

Altered LOC

SBP <90 mmHg

Protocol ReferenceS-143 Sepsis: ≥2 of the following with infection history: (1) Temp ≥100.4°F or <96.8°F, (2) HR ≥90, (3) RR ≥20 or EtCO2 <25 mmHg, (4) Altered LOC, (5) SBP <90 mmHg. All 5 are valid criteria.

Q68

True / False

The SLUDGE/BBB mnemonic is used to identify signs/symptoms of organophosphate poisoning, where BBB stands for Bradycardia, Bronchorrhea, and Bronchospasm.

True

False

Protocol ReferenceS-150 ChemPack / S-134: SLUDGE = Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis. BBB = Bronchorrhea, Bronchospasm, Bradycardia.

Q69

Multiple Choice

Hypotension in a pediatric patient aged 5 years is defined as SBP less than:

70 mmHg

80 mmHg

75 mmHg (using formula: 70 + 2×5)

90 mmHg

Protocol ReferencePediatric Hypotension Formula (S-163, S-168, S-169): For 1-10 years: SBP <70 mmHg + (2 × age in years). Age 5: 70 + (2×5) = 80 mmHg. So SBP <80 mmHg = hypotensive for a 5-year-old.

Q70

Select All That Apply

Per S-100.2 (BLS/ALS Transport Criteria), which of the following require ALS transport?

ECG showing ischemia or infarct

SpO2 <94% despite NRB or PPV including CPAP

Acute change in mental status (GCS <13)

Syncope

Single dose of naloxone administered without anticipation of repeat doses

New neurologic deficit (positive BE-FAST)

Protocol ReferenceS-100.2 ALS Transport: A-D, F = ALS required. E = EXCEPTION: BLS transport allowed if single therapeutic naloxone given without anticipated repeat doses (also applies to single-dose ondansetron, glucagon, dextrose, acetaminophen).

Q71

True / False

Pediatric SVT in a child 4 years or older is defined as a heart rate ≥180 bpm.

True

False

Protocol ReferenceS-163 Pediatric SVT: Infant/child <4 years with HR ≥220 bpm OR child ≥4 years with HR ≥180 bpm. Unstable = SBP below age-based threshold + signs of inadequate perfusion.

Q72

Multiple Choice

For opioid withdrawal treatment with buprenorphine (S-145), a COWS score must be:

≥5 (mild withdrawal)

≥8

≥13 (moderate withdrawal)

≥25 (moderately severe withdrawal)

Protocol ReferenceS-145: Buprenorphine-naloxone is indicated for patients ≥16 years with COWS score ≥8. COWS scale: <5=no active withdrawal, 5-12=mild, 13-24=moderate, 25-36=moderately severe, >36=severe withdrawal.

Q73

True / False

In suspected anaphylaxis (S-122), skin signs alone (urticaria, flushing, itching) without systemic involvement should be treated with epinephrine IM.

True

False

Protocol ReferenceS-122 Allergic Reaction: Skin signs only (urticaria, erythema, pruritus) = Diphenhydramine 50 mg IV/IM. Epinephrine is reserved for ANAPHYLAXIS (respiratory, cardiovascular, GI, or angioedema involvement).

Q74

Multiple Choice

For symptomatic suspected opioid OD with respiratory depression, which parameter is NOT used to define respiratory depression per ALS protocols?

Respiratory rate <12

SpO2 <96%

EtCO2 ≥40 mmHg

GCS <13

Protocol ReferenceS-123 / S-134 ALS Opioid OD: Respiratory depression = RR<12, SpO2<96%, OR EtCO2 ≥40 mmHg. GCS <13 alone is not the listed threshold — though altered LOC may be present.

Q75

True / False

Per S-144 (Stroke), a blood glucose <60 mg/dL found during stroke assessment should be treated for hypoglycemia before transporting.

True

False

Protocol ReferenceS-144 Stroke: "Obtain blood glucose. If blood glucose <60 mg/dL, treat for hypoglycemia." Additionally per S-123 / Dextrose notes: Do NOT administer dextrose to patients with stroke unless hypoglycemia is documented.

Q76

Multiple Choice

A newborn has a heart rate of 55 bpm after 30 seconds of BVM ventilation. Per S-133/S-166, what is the correct chest compression rate?

100 compressions per minute (15:2 ratio)

120 compressions per minute (3:1 ratio)

100-120 compressions per minute

30 compressions per minute

Protocol ReferenceS-133/S-166 Neonatal Resuscitation: Newborn HR <60 → chest compressions at 120/min with a 3:1 compression-to-ventilation ratio. Check pulse q1 min. Stop compressions when HR ≥60.

Q77

Multiple Choice

For an adult in cardiac arrest with hypothermia, how many doses of epinephrine 1:10,000 are given?

1 mg q3-5 min (standard protocol)

1 mg × 1 dose only

No epinephrine until patient is rewarmed

3 mg IV/IO × 1

Protocol ReferenceS-127 / S-130 Hypothermia: Cardiac arrest with hypothermia → Epinephrine 1:10,000 1 mg IV/IO × 1 ONLY. Also: limit antiarrhythmic medications until temperature ≥86°F / ≥30°C.

Q78

True / False

Ipratropium bromide is added to EVERY dose of albuterol/levalbuterol for respiratory distress.

True

False

Protocol ReferenceP-115 Ipratropium: Added to the FIRST dose of albuterol/levalbuterol ONLY. Not repeated with subsequent nebulizer doses.

Q79

Multiple Choice

What is the adult dose of Diphenhydramine for allergic reactions?

25 mg IV/IM

50 mg IV/IM

100 mg IV/IM

1 mg/kg IV/IM

Protocol ReferenceP-115 Diphenhydramine: Adult = 50 mg IV/IM (administered slow IV). Pediatric = 1 mg/kg IV/IM per drug chart (max 50 mg).

Q80

True / False

Levalbuterol may be substituted for albuterol in patients ≥6 years of age and can be combined with ipratropium bromide.

True

False

Protocol ReferenceP-115 Albuterol/Levalbuterol Notes: "Levalbuterol may be substituted for albuterol and can be combined with ipratropium bromide. This substitution option applies to patients ≥6 years of age."

Q81

Multiple Choice

Burn center criteria in San Diego County require contacting UCSD Base Hospital for patients with burns involving:

Adults: >10% partial-thickness BSA; Children: >5% full-thickness BSA

Adults: >20% partial-thickness or >5% full-thickness BSA; Children: >10% partial or >5% full-thickness

Electrical injury ≥500 volts

Any full-thickness burn

Protocol ReferenceS-124 (Adults): >20% partial-thickness or >5% full-thickness burns. S-170 (Peds): >10% BSA partial-thickness or >5% BSA full-thickness. Both also include suspected respiratory involvement, circumferential/face/hands/feet/perineum burns, and electrical ≥1,000 volts.

Q82

Multiple Choice

For stable VT in an adult, which two antidysrhythmics are listed as options per S-127?

Adenosine and Amiodarone

Amiodarone and Lidocaine

Lidocaine and Magnesium

Amiodarone and Procainamide

Protocol ReferenceS-127 Stable VT: Amiodarone 150 mg in 100 mL NS over 10 min IV/IO MR x1 OR Lidocaine 1.5 mg/kg IV/IO MR at 0.5 mg/kg q5 min to max 3 mg/kg. Synchronized cardioversion for unstable VT.

Q83

True / False

Per S-130 (Environmental Exposure), defibrillation attempts may be unsuccessful in hypothermic patients until temperature reaches at least 86°F (30°C).

True

False

Protocol ReferenceS-130 Environmental: "Defibrillation attempts may be unsuccessful during rewarming until temperature ≥86°F / ≥30°C." Continue rewarming efforts; limit epi to 1 dose and withhold antiarrhythmics until temp ≥30°C.

Q84

Multiple Choice

For suspected beta blocker overdose with cardiac effects (bradycardia with hypotension), what medication is indicated per S-134?

Calcium chloride 1 gm IV/IO

Glucagon 1-5 mg IV, MR 5-10 min, total up to 10 mg

Sodium bicarbonate 1 mEq/kg IV/IO

Atropine 1 mg IV/IO MR to 3 mg max

Protocol ReferenceS-134 Beta Blocker OD: Glucagon 1-5 mg IV, MR 5-10 min, for a total of 10 mg. Calcium channel blocker OD (SBP <90 mmHg) = CaCl2 1 gm IV/IO. TCA OD with cardiac effects = NaHCO3 1 mEq/kg.

Q85

True / False

Per S-133, if estimated postpartum blood loss is ≥500 mL and delivery was within 3 hours, tranexamic acid 1 gm IV/IO should be administered.

True

False

Protocol ReferenceS-133 Postpartum Hemorrhage: "If estimated blood loss ≥500 mL and within 3 hours of delivery, tranexamic acid 1 gm/10 mL IV/IO, in 50-100 mL NS, over 10 min."

Q86

Multiple Choice

Per S-131 (Hemodialysis Patient), when accessing a dialysis catheter (Vascath), you must FIRST:

Flush with 10 mL NS before use

Aspirate 5 mL prior to infusion (catheter contains concentrated heparin)

Infuse 20 mL NS to verify patency

Obtain BH order before accessing

Protocol ReferenceS-131 / S-135: "Dialysis catheter (Vascath) contains concentrated dose of heparin, which must be ASPIRATED prior to infusion." Aspirate 5 mL first to prevent heparin bolus causing systemic anticoagulation.

Q87

True / False

For pediatric unstable bradycardia per S-163, atropine is the FIRST drug given after BVM ventilation fails to increase HR.

True

False

Protocol ReferenceS-163 Pediatric Unstable Bradycardia: If no HR increase after 30 sec BVM → CPR + Epinephrine 1:10,000 per drug chart IV/IO MR x2 q3-5 min. ATROPINE comes AFTER 3 doses of epinephrine (per drug chart, MR x1 in 5 min). Unlike adults, epi comes before atropine in peds.

Q88

Multiple Choice

Per S-144, what is the recommended head-of-bed position for stroke patients?

Flat (0° elevation)

15° elevation (flat if SBP <120 mmHg and tolerated)

30° elevation

45° elevation (high Fowler's)

Protocol ReferenceS-144 Stroke: "Keep head of bed (HOB) at 15° elevation. If SBP <120 mmHg and patient tolerates, place HOB flat." Avoid lowering below 15° unless hypotensive.

Q89

Multiple Choice

For behavioral emergencies (S-142), when midazolam is given to a severely agitated patient with suspected alcohol intoxication, what precaution applies?

Midazolam is absolutely contraindicated in alcohol intoxication

Consider a lower dose or avoiding use due to risk of respiratory depression

Double the standard dose to overcome alcohol tolerance

Switch to fentanyl instead

Protocol ReferenceS-142 / P-115 Midazolam: "Administration in patients with alcohol intoxication can cause respiratory depression. Consider a lower dose or avoiding use." Not absolutely contraindicated — clinical judgment required.

Q90

Select All That Apply

Which of the following are correct about the EtCO2 goal after ROSC per S-127?

Target EtCO2 = 40 mmHg with ventilation

If EtCO2 rises rapidly during CPR, pause and check for pulse

For EtCO2 >0 mmHg, a PAA or ET may be placed without interrupting compressions

For trauma, EtCO2 goal is 35-45 mmHg

Protocol ReferenceS-127 ROSC: Goal EtCO2 = 40 mmHg. During CPR: rapid rise = check pulse; EtCO2 >0 allows airway placement without interruption. S-139/S-169 Trauma: Maintain EtCO2 35-45 mmHg.

Q91

Multiple Choice

Acetaminophen IV is contraindicated in pediatric patients under which age?

6 months

1 year

2 years

5 years

Protocol ReferenceP-115 / P-117 Acetaminophen IV: Contraindicated in patients <2 years of age. P-117 Pediatric Drug Chart: Grey column (newborn–6 months) = "DO NOT ADMINISTER." Red/subsequent columns (≥2 years) = 15 mg/kg, max 1 gm.

06Sec

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San Diego County EMS Protocol Exam 2025–2026

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