NREMT EMT-B Critical Topics: Cardiac, Respiratory, Endocrine & Triage

Beck's Triad

Muffled heart sounds, HTN (widened pulse pressure), JVD (jugular vein distension)

Cushing's Triad

Bradycardia, hypotension, irregular respirations

Virchow's Triad

Stasis (slow blood flow), vessel wall injury, hypercoagulability

Charcot's Triad

Fever/chills, jaundice, RUQ pain

Waddell's Triad

Ped struck by car, late signs include femur fracture, absent breath sounds, thoracic/abdominal injury

Tension Pneumothorax

Absent breath sounds, JVD, tracheal deviation (late), hypotension

Unstable Angina

Chest pain at rest or worsening pattern, no enzyme elevation, not fully blocked

NSTEMI

Partial blockage, troponin rises, no ST elevation, subendocardial injury

STEMI

Complete blockage, ST elevation on ECG, full transmural infarct, time critical

Classic Symptoms of ACS

Crushing chest pain, radiates to left arm/jaw/back, diaphoresis, N/V, SOB, anxiety/doom

Atypical Symptoms in Women, Elderly, Diabetics

Fatigue, epigastric pain, no chest pain, jaw pain only, indigestion feeling

VFib / PVT

No pulse, no output, chaotic rhythm; shock + CPR immediately

PEA

Organized rhythm, no pulse; CPR only, no shock

Asystole

Flatline; CPR only, do NOT shock

CHF / Pulmonary Edema

SOB, crackles in lungs, JVD, pitting edema, pink frothy sputum, orthopnea

Cardiogenic Shock

Heart can't pump; hypotension + JVD + wet lungs; pale, cool, diaphoretic

Cardiac Tamponade

Beck's Triad, pulsus paradoxus (>10mmHg SBP drop on inspiration)

Hypertensive Crisis

SBP >180; HA, visual changes, altered MS, nosebleed; position of comfort + O₂

H's & T's — PEA Causes

Hypovolemia, hypoxia, H⁺ (acidosis), hypo/hyperkalemia, hypothermia, tamponade, tension pneumo, toxins, thrombosis (PE/MI), trauma

Asthma

Bronchospasm; wheezing, prolonged expiration, accessory muscle use

COPD Exacerbation

Barrel chest, pursed-lip breathing, chronic hypercapnia; low-flow O₂

Pulmonary Embolism

Sudden SOB, pleuritic chest pain, tachycardia, hypoxia; risk: Virchow's triad

Spontaneous Pneumothorax

Sudden unilateral chest pain + SOB; decreased breath sounds on affected side

Epiglottitis

Drooling, 'hot potato' voice, tripod position, stridor; DO NOT examine throat

Croup

Peds; seal-bark cough, stridor (inspiratory), low-grade fever; viral

Anaphylaxis

Bronchospasm + urticaria + hypotension; stridor = airway swelling; Epi IM first

Wheezing

Bronchospasm (asthma, COPD, anaphylaxis)

Crackles/Rales

Fluid (CHF, pneumonia, pulmonary edema)

Stridor

Upper airway obstruction (epiglottitis, croup, FB)

Absent Breath Sounds

Pneumothorax, misplaced tube, effusion

Hypoglycemia

<70 mg/dL; altered MS, diaphoresis, pale, shaky, tachycardia, combative; Tx: oral glucose if conscious

Hyperglycemia

>200 mg/dL; gradual onset, polydipsia, polyuria, polyphagia; fruity breath (ketones)

DKA

Type 1 diabetes; severe hyperglycemia, N/V, abdominal pain, Kussmaul breathing, fruity breath, dehydration

HHS/HHNS

Type 2 diabetes; extreme hyperglycemia, severe dehydration, no ketoacidosis; very altered MS

Hypothyroidism

Myxedema coma (severe); cold intolerance, bradycardia, constipation, fatigue, weight gain, hoarse voice

Thyroid Storm

Hyperthyroidism extreme; high fever, tachycardia, hypertension, AMS, diaphoresis; life-threatening

Adrenal Crisis

Addison's disease; hypotension, weakness, N/V, abdominal pain, hyponatremia, hyperkalemia

START Triage (Adults)

RPM: Red — Immediate, Yellow — Delayed, Green — Minor, Black — Expectant

JumpSTART (Peds <8 Yrs)

Key differences in triage for pediatric patients

Salt Triage (Newer Method)

Sort Walk → Wave → Still → then individual assessment.

Pediatrics Special Considerations

Larger head → airway compromise. Sniffing position. Normal HR higher. Decompensate fast then crash. Use length-based tape (Broselow). Silent chest = ominous in asthma.

Geriatrics Special Considerations

May not show typical pain (MI without chest pain). On multiple meds (polypharmacy). Atypical presentations. Skin tears easily. Baseline confusion may mask worsening.

Obstetric Special Considerations

Supine hypotension syndrome → tilt left. Normal: HR ↑, BP ↓ slightly. Placenta previa = painless bleeding. Abruptio = painful. Eclampsia = HTN + seizure.

Bariatric Special Considerations

Airway management difficult. May need extra O₂. Position sitting upright. Equipment limitations. Requires extra crew. Reverse Trendelenburg for respiratory distress.

Tracheostomy Patients

Suction stoma first. Ventilate through stoma. Stoma obstruction → clear or replace. Don't cover stoma.

DNR / POLST

Must be present and signed. If no valid DNR → start resuscitation. Comfort care measures still provided. Know your state protocols.

Behavioral / Psych Considerations

Rule out medical cause first (hypoglycemia, head injury, drugs). Restrain only if danger. Document behavior objectively. Never leave alone.

Abuse / Neglect Indicators

Peds: injury pattern inconsistent with story. Elderly: poor hygiene, malnourished, fear of caregiver. Mandated reporter.

Oxygen (O₂)

Indicated for hypoxia, respiratory distress, any serious illness. NRB 15L for serious → NC 2-6L for COPD pts cautiously.

Oral Glucose (gel)

Indicated for hypoglycemia in alert patient who can swallow. 15-45g. Check BGL, confirm MS first. Don't give if unconscious.

Activated Charcoal

Indicated for certain poisonings/ingestions (with medical direction). 1g/kg. Do NOT use if: caustic, petroleum, unconscious, or for acetaminophen (controversial).

Aspirin (ASA) 324mg

Indicated for suspected ACS/MI — anti-platelet. 4 x 81mg baby ASA, chewed. Contraindicated: true allergy, active GI bleed, already took dose.

Epinephrine Auto-Injector

Indicated for anaphylaxis. 0.3mg IM (adult) / 0.15mg (pedi). Outer thigh. May repeat in 5-15 min with orders.

Albuterol (MDI)

Indicated for bronchospasm — asthma, COPD. 2 puffs. Must be prescribed to patient. Spacer if available. Reassess breath sounds.

Nitroglycerin (SL)

Indicated for chest pain (ACS, angina). 0.4mg SL q5min × 3. Contraindicated: SBP <100, took ED med (Viagra/Cialis/Levitra) in last 24-48h, RVI.

Naloxone (Narcan)

Indicated for opioid overdose reversal. 2mg IN. Repeat q2-3min. Watch for re-narcotization. May cause withdrawal/combativeness.

Nerve Agents (Organophosphates)

Think: pesticides on steroids. ACh excess → everything overactivated. GA/GB/GD/VX: Tabun, Sarin, Soman, VX.

Signs of Nerve Agent Exposure (SLUDGEM)

Salivation, Lacrimation, Urination, Defecation, GI Distress, Emesis, Miosis.

Antidote for Nerve Agents

Atropine: Anticholinergic — dries up secretions, reverses bronchospasm, increases HR. Repeated high doses needed. Pralidoxime (2-PAM): Reactivates cholinesterase.

Dirty Bomb

Conventional explosion + radiological dispersal. Blast injury first priority. Decon, PPE, limit exposure time, distance, shielding.

ARS (Radiation Sickness)

N/V early, latent period, then bone marrow suppression. Dose-dependent. Decon before treating.