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Region VIII EMS Systems February 2017 – CE Post-Quiz SOP White Pages 1. Which of the following is true about a POLST? A) It is a signed medical order that only dictates what actions should be taken after the patient is in cardiac arrest B) It is only valid if it is signed by the patient C) It can be signed by physicians, advanced practice nurses, some medical students and physicians assistants D) If properly executed, it negates the need for a patient to appoint a Power of Attorney for Health Care 2. True / False – In Illinois, a POLST form is not necessary to provide guidance if the patient becomes incapacitated due to cardiac arrest, if a properly executed living will is in place. 3. If multiple DNR / POLST forms are present and the patient is in cardiac arrest, EMS should: A) Honor the one signed by the patient, in the event that there are forms signed by other individuals B) Honor the form with the most recent date C) Honor the form that is printed on colored paper, in the event there are multiple forms and some are black on white D) Honor only the pink form, since that is the latest recommended color 4. Which of the following best describes Section B of the IL POLST form as revised in 2016: A) Medical Interventions – how to perform a “slow code” in the event that the patient was ambiguous about their resuscitation wishes B) CPR – what level of interventions to perform if the patient is not breathing but has a pulse C) Medically Administered Nutrition D) Medical Interventions – what to do if the patient has a pulse and/or is breathing 5. Which of the following persons CAN NOT sign section D DOCUMENTATION OF DISCUSSION, consenting to the POLST? A) Patient B) Parent of minor C) Agent under Power of Attorney D) Health care surrogate decision maker E) Patient’s primary physician 6. True / False – In Illinois, an attending physician may authorize surrogate decision makers to make decisions for patients who lack decisional capacity, even if they are not authorized as a health care agent under Power of Attorney for Health Care. Region VIII EMS Systems February 2017 – CE Post-Quiz SOP White Pages 7. True / False – In Illinois, the only legal order for non-resuscitation is the use of the recognized IL POLST form – no other written order can be accepted as an order to not resuscitate a patient. 8. Per the Adult Initial Medical Care SOP, which of the following is the target SpO2 for most patients? A) 94-98% B) 92-94% C) 100% D) > 90% 9. Which of the following is the best alternative site for pulse oximetry probe placement in the event a finger is not practicable? A) Ear lobes B) Chest wall C) Wrist D) Chin 10. Which of the following is the most common factor(s) that can effect accuracy of pulse oximetry reading? A) Motion, poor lighting B) Ambient light, moisture C) Press-on nails, coffee D) Skin pigmentation, ambient light **BLS STOP HERE** 11. EMS responds to a 15 year old with complaints of mid-sternal back pain radiating between the scapula for 1 hour. Past medical history includes Marfan syndrome, and he currently is taking a beta blocker. Vital signs are Pulse 108, BP 138/92, RR 20, SpO2 98% on room air. You suspect his pain may be caused by: A) Aortic dissection B) Acute chest syndrome C) Pericarditis D) Pleurisy Region VIII EMS Systems February 2017 – CE Post-Quiz SOP White Pages 12. Along with pain which is characterized as pleuritic and retrosternal, this sign may also be present with spontaneous pneumomediastinum: A) Odynophagia B) Gastroesophageal reflux C) Esophageal spasm D) Subcutaneous emphysema 13. Which of the following are common symptoms of exercise induced asthma? A) Rales, rhonchi B) Decreased exercise tolerance / endurance, chest tightness C) Acid reflux, coughing D) Sore throat, pedal edema 14. You are called to an extended care facility for a patient who passed out following insertion of a central venous catheter. The patient is a 55 year old male who was having a subclavian double lumen catheter placed. He is conscious but disoriented, GCS 14, vitals BP 80/50, P 128, R 20. Which of the following IS CORRECT per SOP? A) EMS can use the catheter for any IV fluid or medication, as long as someone on the crew is familiar with the device B) EMS can regulate the rate of an IV bag (such as administering a fluid bolus) that is initiated by the RN or physician at the originating facility C) EMS can use the CV catheter only for resuscitation medications, unless Medical Control approves D) Under no conditions can EMS have anything to do with a venous catheter they did not insert 15. True / False – Early notification of Medical Control is not necessary as long as the transport time is under ten minutes 16. On the above patient, you begin CPR and apply the cardiac monitor, with a finding of pulseless ventricular tachycardia. You defibrillate the patient which results in ventricular fibrillation. As CPR continues, the patient’s daughter returns and produces what appears to be a valid POLST order. Per SOP, which of the following should be your next action? A) Contact Medical Control and follow any orders received B) Once CPR is begun, it cannot be stopped. Continue resuscitation. C) CPR may be withdrawn without contacting Medical Control D) The POLST is valid only if there is a note about what to in the event CPR was begun prior to the POLST being presented. Region VIII EMS Systems February 2017 – CE Post-Quiz SOP White Pages 17. You are called to a single family residence for a bed-bound elderly male patient reported to be unresponsive. The caller and only other person there is a neighbor who “was just asked to come over and sit with him for a few minutes” while a family member went to the store. The patient has a GCS of 3, is making agonal glottic movements but has no effective respirations, has no palpable pulse. The neighbor says he knows the patient did not want CPR but does not know the location of a POLST or DNR paperwork. Which of the following is your correct action? A) Begin resuscitation B) Withhold resuscitative efforts until the family member returns to clarify C) Withhold resuscitation based on the neighbors statement D) Do CPR only and begin transport 18. True / False – A Power of Attorney for Healthcare is only valid in Illinois if a judge or attorney executes it 19. True / False – A Power of Attorney for Healthcare requires one or more successor agents be specified to back up the primary agent, in order to be valid. 20. Which of the following IS TRUE about Power of Attorney / Surrogates and their interaction with EMS? A) Healthcare decisions of the Power of Attorney or Surrogate are limited to signing a POLST form B) If more than one Power of Attorney successor listed on the form are present on the scene, the oldest person to be listed is in charge C) There are NO situations in which a surrogate can give instructions directly to the EMS providers D) The only use for Power of Attorney is to execute a living will 21. Regarding Illinois Admission Petitions, which of the following is the most likely situation under which the hospital might ask EMS to become involved? A) Documenting what someone else told them that the patient had said B) Documenting what EMS heard or saw, similar to what EMS would write in their PCR narrative C) Completing the entire petition, since nobody from the hospital was involved in the initial contact D) Completing only the portion of the petition marked FOR EMS OR AMBULANCE DRIVER USE Region VIII EMS Systems February 2017 – CE Post-Quiz SOP White Pages 22. Per SOP, which of the following IS NOT an indication for the use of atropine in the adult patient? A) Symptomatic bradycardia B) Asystole / PEA C) Muscarinic / organophosphate poisoning D) Nerve gas auto-injector 23. What portion of the autonomic nervous system does atropine have its primary action on? A) Sympathetic B) Parasympathetic C) Musculoskeletal D) Neurovascular 24. Which of the following IS NOT characteristic of sinus arrest / sinus block? A) P-waves precede most QRS complexes B) Irregular R-R interval C) Irregularly irregular D) The usual heart rate is 60-100 bpm 25. Which of the following characteristically has a short gap, usually only missing one beat, and resumes on the same cadence? A) Sinus arrest B) Sinus block