NREMT Study Guide

Typical Adult Blood Pressure

120/80 (100-139/<100)

Hypertensive

High Blood Pressure

Hypotensive

Low Blood Pressure

Typical Adult Heart Rate

60-99 bpm

Tachycardia

Fast heart rate

Bradycardia

Slow Heart Rate

Typical Adult SPO2

94-100% perfusing at the normal range

Typical Adult Respiratory Rate

12-20 breaths per minute

Typical Adult Temperature

96.8-98.9 degrees Fahrenheit

Hypothermic Temperature

About 95 degrees or less

Typical Adult Finger Stick Blood Glucose

70-120 units (any blood sugar below 70 units is bad and needs to be addressed immediately.)

What are some Medications an EMT-B can Administer

1.) Asprin - utilized for chest pain (administer up to 324mg for patients experiencing chest pain make sure not allergic to sallycylics)

2.)  Nitroglycerin - utilized for chest pain but there are contraindications (systolic blood pressure below 100 aka hypotension and also ed medications in the last 24hrs)

3.) Albuterol - airway (asthma) wheezing ( 2.5mg per 3ml) administered via nebulizer set at 6-8L/min

4.) Attrovent - airway (asthma) (0.5mg per 3ml) administered via nebulizer set at 6-8L/min

5.) Epinephrine only as an auto injector (0.3mg for adult and 0.15 for child) (epi 1-1000 mix)

6.) Narcan/Naloxon - intranasally (man device) used for an opioid overdose (pupils will be constricted) when taking an upper eyes are dilated and cant really do much for them but opioid overdoes will be constricted. 

7.) Oral Glucose - used for hypoglycemia less than 70 units (contraindications - patient needs to be A/Ox4) 

8.) Activated Charcoal - patent airway and A/O x4 used for overdose on pills or bottle of asprin kinda of a timelimit, this will coat the medication from further absorption. 

9.) Tylenol/Aceteminophen - used for elevated fever at a temp of 101-102 via mouth

What Oxygen Devices can you use?

1.) Nasal Canula at 2-6 LPM O2 (use when 93-80% and conscious and normal RR A/Ox4)

2.) Non-Rebreather Mask at 10-15 LPM O2 (70-80% A/O x4 and normal RR)

3.) Nebulizer at 6-8 LPM O2 (Used with albuterol and attrovent for asthma or wheezing or bronchconstriction)

4.) Bag Valve mask at 15 LPM O2 (someone who cant control their own airway usually unconscious low RR (<12) 93% or lower

The Head tilt-chin method vs. the Jaw-Thrust method, why do we use either one?

The head tilt-chin method is utilized for patients who did not have trauma.

The jaw-thrust method is for patients who DID HAVE TRAUMA.

If you find an unconscious patient on the floor unless it was a witnessed controlled slow descent, you MUST assume that it was traumatic, and that along with C-spine precautions you need to utilize a jaw-thrust method!

Air has approximately how much oxygen?

21% oxygen

Capillary Refill

squeeze a fingernail and let it go the time it takes to turn back to its normal color is the capillary refills, you want it to be <2 seconds. Greater than 2 seconds is a sign of inadequate perfusion and not good!

CO = SV x HR

Formula for Cardiac Output = Stroke Volume x Heart Rate.

Minute Volume = Tidal volume x Respiratory Rate

Just know this.

What are two vital signs that we can assess to check someone’s airway?

1.)  SPO2 94 – 100%

2.) Respiratory Rate 12 - 20 breaths per minute

When should you use a nasal cannula?

88 – 93% SPO2, normal respiratory rate *** However if someone’s unconscious I will never put one on a patient.

When should you use a non-rebreather mask?

87% or lower SPO2, normal respiratory rate *** However if someone’s unconscious I will never put one on a patient

When should you use a bag valve mask?

93% SPO2 or lower with a low respiratory rate (also shallow respirations let’s say at around 30 breaths per minute), this is generally for unconscious patients unless they are semi conscious with a low respiratory rate (<12 breaths per minute) ((In the national this is usually 8 breaths per minute))

When should you use a nebulizer?

This is generally indicated for wheezing patients, you are looking for someone who has asthma and is currently (but not limited to) an asthma attack

When someone has a facial trauma with a suspected basilar skull fracture what airway device is contraindicated?

NPA (nasal)

When suctioning how long can you suction an adult or a child?

Adult: 15 seconds max

Pediatric: 10 seconds max

If someone has snoring respirations what can you suspect is in the way?

The Tongue

What does paradoxical motion mean of the chest?

This is when one side of the chest rises/falls, while the other doesn’t. Flail segment or flail chest

If you auscultate somebody’s lung sounds and note that there is only air moving from one side of the chest (or at least diminished lungs sounds on one side of the chest), what should you consider?

A pneumothorax

Pneumothoral

refers to the presence of air in the pleural space, which can lead to lung collapse.

If someone has cherry red skin and is at home with dizziness/lightheadedness, what respiratory issue should you be possibly concerned about?

Carbon Monoxide Poisoning!

Croup

It’s caused by a VIRAL infection!!!

Noted by a seal / bark like cough

in children

Epiglottis

It’s caused by a BACTERIAL infection!!!

Noted by drooling!! As well as signs / symptoms such as a sore throat, a fever, and a tripod position.

It’s extremely important to keep these patients in a position of comfort, be extremely careful moving or agitating these patients in any way because you can cause their Epiglottis to close up.

in children

Tripod position

A position assumed by patients with respiratory distress, where they sit upright and lean forward with hands on their knees to help with breathing.

Think respiratory distress!! Usually when someone is sitting down leaning forward struggling breathing. When you see this on your national alarms should be saying hey respiratory respiratory respiratory, or at least slightly think of it.

If you see a patient with very deep and rapid respirations that are diabetic, what are these respirations called?

Kussmaul respirations

Kussmaul Respirations

a type of hyperventilation characterized by deep, rapid breathing often associated with metabolic acidosis, particularly in diabetic patients.

In HYPERGLYCEMIC patients

Tracing a drop of blood throughout the body

Deoxygenated blood

Know how to trace a drop of blood from start to finish:

Blood enters the RT atrium

Goes through the Tricuspid Valve

Enters the RT Ventricle

Goes through the Pulmonary Artery

Goes to the lungs for Gas Exchange

Oxygenated blood

Goes through the Pulmonary Vein

Goes to the LT atrium

Goes through the Bicuspid/Mitral Valve

Enters the LT ventricle

Travels through the Aorta through Arteries and Arterioles

Then heads to Capillaries and Oxygenates Tissues while receiving CO2

Deoxygenated Blood

Travels through Venules and Veins

Goes to Superior and Inferior Vena Cava back to the RT atrium

Pulmonary artery

the vessel that carries deoxygenated blood from the right ventricle of the heart to the lungs for gas exchange.

Pulmonary vien

the vessel that transports oxygenated blood from the lungs to the left atrium of the heart.

Artery

a blood vessel that carries blood away from the heart to tissues and organs.

Vein

a blood vessel that carries blood toward the heart.

If you are transporting a patient and they go into cardiac arrest, what do you do first?

Tell your partner to pull of FIRST then CPR

If the AED shocks the patient, what do you immediately do next?

Immediately start with compressions again

What are EMT-B medications you can consider for a chest pain call, of course without any allergies to the medication or contraindications?

1.) Aspirin

2.) Nitroglycerin (no ed drugs must have greater than 100 systole)

3.) Oxygen

Congestive heart failure

where fluid builds up in the lungs may be caused by left-sided heart failure.

Pedal Edema

where fluid builds up to the lower extremities and may be caused by right sided heart failure.

Sympathetic Nervous System

Causes the fight or flight system, it’s generally when the body increases its heart rate and decreases intestinal activity.

Parasympathetic Nervous System

Causes the heart rate to slow down, but increases digestion. Also known as Rest and Digest.

What type of drugs can cause the Parasympathetic Response System?

Opioids

what EMT-B Drug can assist with reversing this (opioid overdose)?

Narcan

How many sounds in a heart beat?

four sounds S1, S2, S3, and S4

S1

makes the “Lub” noise (when the atrioventricular valve closes)

S2

makes the “Dub” noise (When the semilunar valve closes)

What depth do you want in compressions for an adult patient? What about a child/infant?

Adult: 2 – 3 inches depth

Child/Infant: 1/3 the depth of the chest

CPR by yourself should be at what rate?

30:2 compressions to ventilations at a 100-120 compression for minute

If you are with your PARTNER and you have an INFANT, so 2 rescuers and an infant what rate can you implement?

15:2 compressions to ventilations

If you’re placing the AED on a patient and they have an implanted pacemaker or defibrillator …

place the AED pads a couple inches away from the area of the implant.

If someone’s wearing a medication patch and you need to apply an AED …

remove the patch before applying the AED

How do you apply an AED on someone who is wet?

If someone’s pulled out from a pool dry them off prior to placing the AED pads as best as possible.

When we get a pulse back during CPR what is this called?

Rosc (return of spontaneous circulation)

If we shock someone with the AED what’s the very next thing we do?

Start CPR for 2 minutes!

Ischemic Strokes

Clot causing a lack of oxygen to part of the brain causing a stroke

Transient Ischemic Attack (TIA)

Clot that dissipated by itself in less than 24 hours, reversing stroke like symptoms on its own.

Hemorrhagic Strokes

A brain bleed, while we can’t visualize what’s going on internally a huge hallmark distinguishing this from an Ischemic stroke is that the patient will generally have HIGH BLOOD PRESSURE

Strokes

are a neurological issue referring to damage of the brain either caused by a clot (Ischemic/TIA), or a bleed (Hemorrhagic).

You’re may see different signs and symptoms, like an altered mental status, dizziness, numbness to an extremity(s), but the big hall marks are paralysis or weakness to one side of the body (hemiparesis), along with weakness noted on the face.

That’s why if you suspect a stroke or note any obvious weakness it’s very very important that you complete a stroke exam!

Cincinnati stroke scale

Facial droop, Arm Drift, and Abnormalities in Speech

FAST stroke assessment

facial weakness, arm weakness, their speech, and the time it occurred

VAN assessment

Vision, Aphasia (difficulty speaking), and Neglect (lost awareness of one side of the body)

If someone is having a seizure as an EMT-B what should you do?

Request ALS and remove items from the area

Hypergylcemia

High Blood sugar

Hypoglycemia

Low Blood Sugar (deadly)

If the patient can protect their own airway, and they are A&O x 4 (!!!!) then you can consider administering what medication if they’re Hypoglycemic?

Oral glucose

What is A&O x 4?

It’s to assess if a patient is alert & oriented x 4 or generally their mental status. We need to check at minimum four different things to assess this:

1.) Person

2.) Place

3.) Time

4.) Event

If they are not A&O x 4 or if they can’t protect their own airway but they have Hypoglycemia what can we do as an EMT-B?

Request ALS Intercept!

Aspirate

Choke

4 different sections of the Abdomen

1.) RUQ (Right upper quadrant)

2.) RLQ (Right lower quadrant)

3.) LUQ (Left upper quadrant)

4.) LLQ (Left lower quadrant)

If someone has RLQ abdominal pain what should you always suspect?

Appendicitis

if someone has LUQ abdominal pain and should pain what abdominal organ should you suspect?

The Spleen

If someone says they have RLQ abdominal pain what area should you palpate first?

Palpate LUQ (the opposite side)

Why? This is because if you start at the RLQ or too close to it the patient may wince out in pain and curl up, halting further assessment of the abdomen!

When someone is having a tearing sensation in their abdomen that radiates to their back what should you consider that they’re experiencing?

An triple A (abdominal aortic aneurysm) , you need to go code 3 to your nearest trauma facility at once if someone describes a tearing sensation as described earlier! (they may also feel a pulsating mass in their abdomen, but the tearing part is the main indicator).

Triple A (abdominal aortic aneurysm)

A serious condition where the abdominal aorta weakens and bulges, potentially leading to life-threatening rupture. Symptoms often include sudden, severe abdominal or back pain, and a pulsating mass may be felt.

When a patient has a STIFF NECK, fever, headache, what should you suspect they may have?

Meningitis

If someone has hepatitis C, or some for of liver failure what should you generally be looking for?

Jaundice (yellowing of the skin or the eyes)

If somebody starts coughing up BLOODY SPUTUM what should you expect?

Tuberculosis!! If you see this back away and wear proper PPE if you haven’t already! This is very contagious!

Excited Delirium

When a patient becomes agitated, hostile, with a frenzied bizarre behavior. These patients are diaphoretic and can potentially be FATAL!! These patients may hurt you, others, and themselves!!

When a patient becomes agitated, hostile, with a frenzied bizarre behavior. These patients are diaphoretic and can potentially be FATAL!! These patients may hurt you, others, and themselves!! If a patient presents this way what can you as an EMT-B do?

Request ALS

Heat Exhaustion

The patient is still able to sweat with the body trying to cool itself off.

Heat Stroke

The patient is no longer able to sweat!! An altered mental status may occur as well along with hypotension.

If you pull somebody out of a body of water / pool that was near-drowning but now they’re “okay” and don’t want to go to the hospital what should you do?

Highly highly encourage them to go!! The bacteria infection that could be developing in their lungs can be extremely dangerous! Secondary drowning can also occur where individuals develop pulmonary edema (fluid in the lungs), and they can die that way later on.

For snake bites

If they are bitten in the arm keep the patients arm at a lower level then their heart, DON’T place ice on the bite, DON’T use a tourniquet to stop the spread of venom, circle the area effected of course this depends on the type of snake but it’s still important to do.

rocky mountain spotted fever

Causing nausea, vomiting, headache, weakness, and paralysis 7 – 10 days after the tick bite)

Lyme Disease

days to weeks after the bite causing joint pain and a ring around the bite

Gravida

How many times a patient has been pregnant

Parity (Para)

How many times a patient has given birth

Placenta Previa

Described after 20 weeks of pregnancy where the placenta is formed in an abnormal location. The patient will present with PAINLESS BRIGHT RED VAGINAL BLEEDING

Abruptio Placenta

When the placenta separates itself from the uterine wall, usually found in traumas. You would be looking for PAINFUL ABDOMEN WITH VAGINAL BLEEDING

Ectopic Pregnancy

When the fertilized egg implants on the fallopian tubes.

This condition can lead to serious complications, including rupture and internal bleeding, requiring immediate medical attention.

Pre–eclampsia

When a female has hypertension (will vary the range to consider at Pre-eclampsia depending on local protocols), you may see swelling of the limbs, and is pregnant, can potentially lead to Eclampsia! Request ALS Intercept if you have a patient with this as they can administer a medication to help with this.

Eclampsia

A severe complication of pregnancy characterized by seizures or convulsions due to the progression of pre-eclampsia. It requires immediate medical intervention and monitoring.

Same symptoms as Pre-eclampsia but the patient is seizing or had a seizure! This is extremely dangerous! Request ALS Intercept if you have a patient with this as they can administer a medication to help with this.

What is Meconium Staining?

It’s amniotic fluid that is greenish or brownish yellow as a result of fetal defecation that can appear over a newborns face.

It’s amniotic fluid that is greenish or brownish yellow as a result of fetal defecation that can appear over a newborns face. If this is the case, do you suction their mouth or their nose first?

Mouth