The dynamic cardiology station will present a scenario similar to the ACLS “megacode.” The candidate will be evaluated on their ability to manage a cardiac arrest situation. This will include delivery of electrical therapy and verbalizing all interpretations and treatments after being given a scenario.
The candidate should expect to use an actual functioning cardiac monitor defibrillator, or a realistic simulator cardiac monitor defibrillator simulator device.
Expect to spend up to eight minutes responding with the appropriate verbal treatments (algorithms) to four types of rhythms. There is no rational order to the cardiac rhythm changes: they are random and don’t have to make sense in a real life patient, so be ready to respond to any rhythm at any time. It’s high speed ACLS algorithms.
The dynamic cardiology scenario is testing your ability to electronically intervene with the monitor – using cardioversion, defibrillation, or pacing. You will need to verbalize medication interventions given along with other treatments like intubations, chest compressions, etc (which can be delegated to a partner). Some rhythms you might run into during testing are V-tach, V-fib, PEA, and third degree heart block.
According to the skill sheet the candidate will need to take PPE precautions, check patient responsiveness and check ABC’s. This includes checking if patient is responsive, breathing and checking for a pulse if the patient is unresponsive. Next the candidate will need to verbalize initiating CPR if appropriate, and attach the ECG monitor or paddles for a “quick look.”
The next steps on the NREMT paramedic skill sheet repeat with the candidate correctly interpreting rhythms, managing rhythms, noting changes in rhythms, and checking the patient condition – including pulse and blood pressure when appropriate.
The last step on the paramedic skill sheet indicates that the candidate should order high percentages of supplemental oxygen at the proper times throughout the scenario.
CRITICAL CRITERIA – Dynamic Cardiology
_____ Failure to deliver first shock in a timely manner
_____ Failure to verify rhythm before delivering each shock
_____ Failure to ensure the safety of self and others [verbalize “All clear” and observe]
_____ Inability to deliver DC shock [does not use machine properly]
_____ Failure to demonstrate acceptable shock sequence
_____ Failure to order initiation or resumption of CPR when appropriate
_____ Failure to order correct management of airway [ET when appropriate]
_____ Failure to order administration of appropriate oxygen at proper time
_____ Failure to diagnose or treat 2 or more rhythms correctly
_____ Order administration of an inappropriate drug or lethal dosage
_____ Failure to correctly diagnose or adequately treat v-fib, v-tach, or asystole
_____ Failure to manage the patient as a competent EMT
_____ Exhibits unacceptable affect with patient or other personnel
_____ Uses or orders a dangerous or inappropriate intervention
The Critical Criteria are significant for this station and failing one of these will lead to a fail for the Dynamic Cardiology Scenario test.
A candidate should be familiar with the Critical Criteria so they can avoid making a fatal error during the paramedic test.
At the static cardiology station there will be 4 cardiac rhythms that need to be completed in 6 minutes. Each rhythm will stay the same once it is handed to the candidate. The candidate will be given four prepared ECG tracings with brief patient description information attached. The candidate has to verbalize the interpretation of the rhythm and vocalize all associated treatments.
There are a total of 12 points available at this station, with 3 points available for each rhythm. One point is available for interpreting the rhythm correctly; however, if the candidate identifies the wrong cardiac rhythm from the ECG tracing they will get zero points for that rhythm scenario.
The other two points available for each rhythm tracing will be awarded based on how well the candidate verbalizes their handling of the scenario.
Quick Tip: Follow ACLS algorithms if they differ from local protocols.
Once you are given a cardiac rhythm strip and a brief description of the patient, read the description and identify the cardiac rhythm before continuing to your treatment plan algorithm.
An example of a possible patient description is:
48 y/o male complains of n/v. Blood Pressure 88/54 Resp 18 SaO2= 94% ETCO2=38
Remember to start with verbalizing scene safety and personal protection equipment for each ECG tracing. Being able to communicate effectively is also important in this station because all of your interventions will be verbal, not physical.
Here is an example of a possible scenario and candidate response from the Static Cardiology paramedic test:
65 y/o Male – Unresponsive – no respirations – no pulse –
Candidate Response: Cardiac Rhythm is Ventricular Fibrillation. “First I determine scene is safe and apply personal protection equipment. I request additional resources. I check airway, breathing, apply oxygen and suction if needed. Have partner begin CPR while defibrillator pads are applied. Defibrillate at 360 joules as soon as possible, followed by high quality CPR. Obtain IV or IO access and administer normal saline solution at a wide open rate. Give 1mg of Epinephrine (1:10,000) every 3-5 minutes. Continue high quality CPR, alternating compressions with a rhythm check every few minutes. Give 300 mg of amiodarone in a 20cc syringe. Have partner establish an advanced airway and attach waveform capnography. Ventilate patient with one breath every 6 seconds and at ten minutes we will consider reversible causes. We can also give a second dose of 150 mg of Amiodarone. At this time we will contact medical command for orders. Next.”
This is a fairly long example of what the candidate may need to verbalize during the Static Cardiology Paramedic Scenario. Time is an issue so speak quickly and clearly and when you are done with a rhythm, turn it upside down on the table and say “next.”
A candidate should keep in mind the following as a guideline for success while at this paramedic testing station.
Safety –> BSI -> PPE -> ABC’s -> VOMIT mnemonic (Vitals, Oxygen, Monitor, IV, Transport)
Oral Station A & B
The National Registry paramedic exam requires candidates to pass two Oral Station tests. These paramedic Oral Stations test the candidate’s ability to manage a call from top to bottom, beginning to end.
The candidate will usually be sitting at a table or desk and will be allowed to take notes while the instructor informs you about the medical call information.
If for some reason, you find yourself at an Oral Station without anything to take notes, ask for a pen and paper. They should provide it, and taking notes greatly increases the chances of passing each station.
The National Registry paramedic candidate will be given two separate cases and will be evaluated on their ability to verbally manage all aspects of an out-of-hospital call.
The paramedic candidate has 15 minutes to verbally complete each case (Oral A and Oral B) and will be evaluated in the following categories:
• Scene Management
• Patient Assessment
• Patient Management
• Interpersonal Relations
• Integrations (verbal report, field impression, and transport decision)
Just to clarify both of the Oral Stations only require oral skills and do not require any hands on or physical patient treatments. However, this doesn’t mean the candidate will sit down and be interrogated by the instructor and prompted to give correct answers.
The Oral Stations are more of a verbal back and forth between the instructor and candidate. If the candidate can get an understanding of how the Oral stations work before testing, they may be more comfortable with the process and be able to ask better questions during the test.
Before getting into how to talk your way through a call, lets talk about what kind of medical situations to expect. National Registry paramedic candidates need to be ready for any kind of call at both Oral Station A and B.
Often the scenarios will be pediatric, toxicology, elderly, environmental or illness related. Keep in mind, you may need to do some assessing to figure out the true cause of a patients signs and symptoms.
Just like in real life, patients may have an underlying issue that triggers other more obvious problems.
On Scene – Oral Station
The call scenario will start with the instructor verbally giving the candidate Background and Dispatch information. This will be limited information about the medical responder information, patient problem, setting, and distance from medical facilities. Take notes and pay special attention to what kind of unit you are responding on.
Some tests will state “You are a paramedic on a transporting paramedic unit.” which is great and no further action is needed. However, some exams will state you are on a Fire Apparatus or a BLS Unit – in these cases, you have to call for an Ambulance or ALS Unit during the scenario.
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