NREMT-B Prep

From Amateur Medicine's "Crush the NREMT-B Exam With This FREE Study Guide"

Baseline Vitals

HR: 60-99 bpm
BP: sys 100-139; dys <100 mmHg
RR: 12-20
SPO2: 94-100%
Temp: 96.8-98.9 degrees Fahrenheit
BGL: 70-120

Tachycardia

HR 100-149

Fast heart rate

Bradycardia

HR <60

Slow heart rate

SPO2 considerations

If COPD → normal SPO2 is 88-92%

If carbon monoxide poisoning → SPO2 will present normally (94-100%) but still NOT perfusing well

EMT-B Medications

1. Aspirin

2. Nitroglycerin

3. Albuterol

4. Atravent

5. Epinephrine (auto-inject)

6. Narcan/Nalaxone

7. Oral Glucose

8. Activated Charcoal

9. Tylenol (acetaminophen)

Aspirin

Chest pain

Dose 324 mg

Nitroglycerin

Chest pain

Contraindications: sys BP <90, used s*xual enhancers in past 24 hours (stendra, viagra (sildenafil), Cialis, Levitra

Albuterol and Atravent

Breathing problems (wheezing, asthma)

Dose Albuterol: 2.5 mg per 3 mLs

Dose Atravent: 0.5 mg per 3 mLs

Administer via Nebulizer at 6-8 Lpm O2

Epinephrine (auto-injector)

Anaphylaxis

Dose: 0.3 mg for adult, 0.15 mg for pediatric

Urticaria: hives

Narcan/Nalaxone

Opioid overdose

Pinpoint/constricted pupils

Administer via MAD (intranasal)

Oral Glucose

Hypoglycemia (low blood sugar <70 BGL)

Contraindications: not A&O x4, pt can’t protect own airway

Activated Charcoal

Poison/drug overdose

Contraindications: not A&O x4, pt can’t protect own airway

Tylenol (acetaminophen)

Elevated fever

Contraindications: not A&O x4, pt can’t protect own airway

Oxygen devices

1. Nasal cannula

2. Nonrebreather mask

3. Nebulizer

4. Bag valve mask

Nasal Cannula

2-6 Lpm O2

Pt sating 88-93%

RR normal, conscious, A&O x4 (adequate breathing)

Nonrebreather mask

10-15 Lpm O2

Pt sating 70-87%

RR normal, conscious, A&O x4 (adequate breathing)

Nebulizer

6-8 Lpm O2

Meds: albuterol or atravent

Wheezing, bronchoconstriction, asthma

Bag valve mask (BVM)

15 Lpm O2

Pt sating less than 93%

INadequate breathing (too slow <10 or too fast >30, inadequate chest rise)

Open airway maneuvers

Head tilt, chin lift: no trauma

Jaw thrust: trauma suspected

Airway adjuncts

oropharyngeal airway (OPA) - through mouth

nasopharyngeal airway (NPA) - though nose

Air contains ____% of oxygen

21

A normal capillary refill time is…

2 seconds or less

Shows good perfusion

Cardiac output formula

CO = stroke volume x heart rate

CO = SV x HR

(total volume of blood pumped by the heart per minute)

Minute volume

MV = Tidal volume x Respiratory rate

MV = TV x RR

(total volume of air moving in or out of a person's lungs in one minute)

If there is facial trauma, what airway adjunct is CONTRAINDICATED?

Nasopharyngeal airway (NPA)

How long can you suction the airway?

Adults - 15 secs max

Pediatric - 10 secs max

If pt has snoring respirations, what is likely in the way?

Tongue

What is paradoxical motion of chest called?

Flail chest

(when one side of chest rises/falls, the other one doesn’t)

If there is diminished/no sound of breathing on one side of chest during auscultation, there is likely…

Pneumothorax

(Can become lifethreatening → tension pneumothorax. A sign is distended neck veins and tracheal deviation)

Pt has cherry red skin, dizziness, light-headed…

Carbon monoxide poisoning

(SPO2 may show normal, but not good perfusion)

Pediatric respiratory problems

1. Croup

2. Epiglottitis

Croup

VIRAL infection, seal-like bark/cough

Epiglottis

BACTERIAL infection, drooling, tripod-position

Pt is diabetic and has deep, rapid respirations. These are called…

Kussmaul respirations

(to blow off CO2 and raise blood pH levels; diabetic ketoacidosis (DKA))

(Pt has hyperglycemia aka high blood sugar)

If a pt goes into cardiac arrest during transport…

Pull over immediately and start CPR

Immediately after AED shocks pt, you should…

Resume compressions

3 meds for chest pain:

1. Aspirin

2. Nitroglycerin

3. Oxygen

Types of heart failure

Left-sided heart failure: pulmonary edema (fluid in lungs)

Right-sided heart failure: pedal edema (fluid in lower extremities)

Sympathetic nervous system

Fight or flight, raises BP, slows digestion

Parasympathetic nervous system

Rest and digest, lowers BP, increases digestion

Opioids can activate the ______ nervous system

Parasympathetic

Heartbeat sounds (S1-S4… but what are S1 and S2)

S1: “lub” sound, atrioventricular valve close

S2: “dub” sound, semilunar valve close

What is the correct depth of compressions?

Adult: 2-3 inches

Child/Infant: 1/3 depth of chest

What is the correct rate of compressions?

100-120 bpm

What is the correct ratio of compressions:ventilations?

If alone: 30:2

If with partner (2-rescuer) and infant/neonate: 15:2

If pt has pacemaker or defibrillator, where should you place AED?

A few inches away, but in general area of regular placement

If pt has medication patch, what should you do before you place AED?

Take the patch off

If pt was in water, what should you do before you place AED?

Dry pt as much as possible

What is it called when pt gets pulse back during CPR?

ROSC: return of spontaneous circulation

Order of blood flow

1. Superior/inferior vena cava

2. Right atrium

3. Tricuspid valve

4. Right ventricle

5. Pulmonary artery

6. Lungs

7. Pulmonary vein

8. Left atrium

9. Bicuspid/mitral valve

10. Left ventricle

Arteries go ______ heart, Veins go _______ heart

AWAY from; TOWARDS

The only artery that carries deoxygenated blood is…

Pulmonary artery

The only vein that carries oxygenated blood is…

Pulmonary veins

3 types of strokes

1. Ischemic stroke

2. Transient ischemic attack (TIA)

3. Hemorrhagic stroke

Ischemic stroke

Clot blocks oxygen flow from part of brain

Can be treated by thrombolytic drugs if taken 3-4.5 hours from last known well

Transient ischemic attack

Clot, stroke-like symptoms go away naturally in 24 hours

Hemorrhagic stroke

Brain-bleed, causes HIGH BLOOD PRESSURE

Signs of stroke

Altered mental status, dizziness, one-sided weakness (hemiparesis), numbness to extremity(s)

Stroke scales

1. Cinncinati

2. FAST:

3. VAN:

Cinncinati scale

For stroke:

Facial droop

Arm drift

Abnormal speech

FAST assessment

For stroke:

Facial weakness

Arm weaknesses

Speech

Time of occurence

VAN assessment

For stroke:

Vision

Aphasia (difficulty speaking)

Neglect (no awareness of one side of body)

A VERY important history taking for a suspected stroke pt is…

Last known well / last seen normal

If pt has seizure…

Request ALS support
Do → record duration of seizure
X → restrain, put anything in pt’s mouth

If pt has hypoglycemia…

BGL <70, give oral glucose

What is A&O x4?

Alert and oriented

1. Person

2. Place

3. Time

4. Event

If pt is hypoglycemic but cannot protect their own airway…

Request ALS support

If pt is showing excited delirium…

Request ALS support (for sedative)

What are the quadrants of the abdomen?

RUQ - right upper qudrant

RLQ - right lower qudrant

LUQ - left upper qudrant

LLQ - left lower qudrant

If pt has RLQ pain…

Appendicitis

If pt has LUQ pain…

Spleen issue

Where should you start palpating if pt has RLQ pain?

LUQ (diagonal from pain)

If pt describes TEARING pain in abdomen that radiates to back…

Abdominal Aortic Aneurysm

(transport immediately!!!)

(also may report pulsating mass in abdomen)

If pt has STIFF NECK, fever, headache…

Meningitis (esp pediatric pts)

If pt has hepatitis C or liver failure, you’d expect pt to have…

Jaundice (yellow skin and sclera)

If pt coughs up BLOODY SPUTUM…

Tuberculosis

(HIGHLY contagious!!!! Put on an N5 mask)

Heat exhaustion vs. heat stroke

Exhaustion: still sweating

Stroke: Hot, dry skin, no sweat, AMS, lower BP

Why do we encourage people in near-drowning events to go to hospital?

Bacterial infection of lungs or pulmonary edema can be life-threatening and show up later

Snake bites

Keep arm below heart level, circle bitten area

DO NOT ice area or place a tourniquet

Tick bites

Key word: TALL GRASS

Rocky mountain spotted fever: paralysis 7-10 days after bite

Lyme disease: days to weeks after, joint pain, ring around bite

Gravida and Para

Gravida: number of times pt. has been pregnant

Para: number of times pt. has given birth

Gynecological problems

• Placenta previa

• Abruptio placenta

• Ectopic pregnancy

• Pre-eclampsia

• Eclampsia

Placenta previa

After 20 weeks of pregnancy, placenta is in an abnormal location

→ PAINLESS bright red vaginal bleeding

Abruptio placenta

Placenta detaches from uterine wall; usually from trauma

→ PAINFUL bright red vaginal bleeding

Ectopic pregnancy

Egg is fertilized in fallopian tubes

Pre-eclampsia

Pregnant pt. HIGH blood pressure, swollen limbs

→ ALS intercept

Eclampsia

Pregnant pt. is seizing or had seizure

→ ALS intercept

Meconium staining

brown/green amniotic fluid on baby’s face (fetal poop)

→ suction MOUTH first! before nose

If you are transporting a pt. has imminent delivery and they have contractions less than 2 minutes of one another…

Pull over and deliver the baby with your partner

Delivery emergencies

• Nuchal cord

• Prolapsed cord

• Limb presentation

Nuchal cord

When unbilical cord is wrapped around baby’s nech

→ try unwrapping the cord if there is enough slack,

if not then clamp cord and cut

Prolapsed cord

Cord presents first, is squeezed by baby’s head and vaginal wall

→ ONLY time you can place gloved hand into vagina and lift baby’s head

Limb presentation

Breech: buttocks or both legs; can deliver

Single limb: can NOT deliver

XABC stands for…

X - Exsanguination (severe and fatal loss of blood from the body)
A - Airway
B - Breathing
C - Circulation

If there is penetrating trauma…

Stabilize object and transport (cover both eyes if object is in eye)

do NOT take out object

Coup-countercoup brain injury

Coup: anterior (front) of brain

Countercoup: posterior (back) of brain

Greenstick fracture

One side of bone is fractured, other side is not

Also known as hairline fracture

Treat a closed femur fracture with…

A traction split

(can NOT be used for OPEN femur fractures)

If there is bright red blood squirting…

Apply direct pressure FIRST
(if bleeding does not stop, place tourniquet)

Pericardial/cardiac tamponade

Fluid build up around heart, difficult for it to beat