FINAL EMT STUDY

Assessment Flow

Scene safety → general impression → mental status → airway → breathing → circulation → major bleeding → transport decision → secondary assessment → treatment/reassessment. This is the core order EMTs follow on almost every patient.

NREMT Priority Question

The NREMT commonly asks “What should the EMT do NEXT?” The correct answer is usually the first life threat or highest priority problem.

Scene Size-Up

Initial evaluation of the scene before patient contact to identify hazards, number of patients, MOI/NOI, and need for resources.

BSI/PPE

Body Substance Isolation/Personal Protective Equipment used to protect EMTs from blood, body fluids, disease, and hazards. Includes gloves, masks, eye protection, and gowns.

Scene Safety

Checking for dangers before entering a scene. Never enter an unsafe scene.

Unsafe Scene

Common hazards include weapons, fire, violence, electrical hazards, hazmat, and traffic.

Hazmat

Hazardous materials that may harm responders or patients.

Hazmat Clues

Multiple sick patients, strange odors, dead animals, chemical containers, or unusual smoke.

Hazmat EMT Role

Recognize the hazard, avoid entering, isolate the area, and call hazmat teams.

MOI (Mechanism of Injury)

How trauma happened; helps predict hidden injuries. Examples: rollover MVC, falls, stabbings, motorcycle crashes.

High-Risk MOI

Trauma mechanisms associated with severe hidden injuries such as ejection from vehicle, pedestrian struck, or rollover crash.

NOI (Nature of Illness)

The patient’s medical complaint or sickness, such as chest pain or difficulty breathing.

Additional Resources

Calling for ALS, fire, police, hazmat, or air medical when needed.

Spinal Precautions

Protecting the spine when trauma, neuro deficits, neck/back pain, altered mental status, or major MOI are present.

General Impression

Your first visual assessment of the patient. Determines whether the patient appears stable or critically ill.

Signs of a Sick Patient

Pale skin, sweating, cyanosis, severe distress, altered mental status, or obvious respiratory difficulty.

Mental Status

The patient’s level of awareness and ability to respond appropriately.

AVPU

Mental status scale: Alert, responds to Verbal stimuli, responds to Pain, Unresponsive.

Altered Mental Status

Abnormal thinking or responsiveness caused by hypoxia, shock, stroke, hypoglycemia, head injury, overdose, or illness.

Hypoxia

Low oxygen reaching body tissues. Can cause confusion, cyanosis, altered mental status, and respiratory distress.

Glasgow Coma Scale (GCS)

A neurological scale used to measure level of consciousness based on eye opening, verbal response, and motor response. Total score ranges from 3–15.

GCS Eye Opening Scale

4 = spontaneous, 3 = to speech, 2 = to pain, 1 = none.

GCS Verbal Response Scale

5 = oriented, 4 = confused, 3 = inappropriate words, 2 = incomprehensible sounds, 1 = none.

GCS Motor Response Scale

6 = obeys commands, 5 = localizes pain, 4 = withdraws from pain, 3 = abnormal flexion, 2 = abnormal extension, 1 = none.

Normal GCS

15; patient is fully alert and oriented.

Severe Brain Injury

GCS less than 8; often indicates major brain injury and airway concern.

Airway

The passage air travels through into the lungs.

Airway Assessment

Check whether the airway is open, clear, and protected from obstruction.

Airway Obstruction

Blockage of airflow caused by the tongue, vomit, blood, swelling, or foreign objects.

Suctioning

Removing blood, vomit, or secretions from the airway to prevent aspiration and improve breathing.

Adult Suction Limit

Suction adults for no longer than 15 seconds at a time.

Airway Adjunct

Device used to help maintain an open airway.

OPA (Oropharyngeal Airway)

Airway device used in unresponsive patients without a gag reflex to prevent the tongue from blocking the airway.

OPA Contraindication

Do NOT use if the patient has a gag reflex because it can cause vomiting.

NPA (Nasopharyngeal Airway)

Soft airway device inserted through the nose for semi-conscious patients with a gag reflex.

NPA Contraindication

Do NOT use if skull fracture is suspected.

Signs of Skull Fracture

Raccoon eyes, Battle signs, CSF leaking from nose or ears.

Battle Signs

Bruising behind the ears indicating possible skull fracture.

Raccoon Eyes

Bruising around the eyes indicating possible skull fracture.

CSF (Cerebrospinal Fluid)

Clear fluid around the brain/spinal cord leaking from ears or nose after skull fracture.

Breathing

Process of moving air in and out of the lungs.

Breathing Assessment

Evaluate respiratory rate, depth, effort, and adequacy.

Respiratory Rate

Number of breaths per minute.

Respiratory Depth

How deep or shallow breaths are.

Respiratory Effort

How hard the patient is working to breathe.

Adequate Breathing

Breathing that provides enough oxygen and chest rise to support the body.

Inadequate Breathing

Breathing too slow, too fast, shallow, weak, or ineffective; requires ventilatory support.

Signs of Inadequate Breathing

Cyanosis, shallow respirations, poor chest rise, accessory muscle use, altered mental status, low SpO2.

Accessory Muscle Use

Use of neck/chest muscles to breathe, showing respiratory distress.

Cyanosis

Bluish discoloration of skin/lips caused by low oxygen levels.

SpO2

Pulse oximeter reading that measures oxygen saturation in the blood.

Normal SpO2

Usually 95% or higher.

Respiratory Distress

Patient is struggling to breathe but still compensating.

Respiratory Failure

Patient can no longer breathe adequately and is tiring out; requires BVM ventilation.

Signs of Respiratory Failure

Silent chest, weak effort, decreased LOC, exhaustion, severe cyanosis.

Nasal Cannula

Low-flow oxygen device used for mild respiratory distress.

Nonrebreather Mask

High-concentration oxygen mask used for serious distress when breathing is still adequate.

BVM (Bag-Valve Mask)

Manual ventilation device used when breathing is inadequate or absent.

Most Important Breathing Rule

If breathing is inadequate, ventilate with BVM — oxygen alone is not enough.

Wheezing

High-pitched sound caused by narrowing of the lower airways, commonly in asthma or COPD.

Stridor

High-pitched upper airway sound caused by severe airway obstruction; medical emergency.

Crackles

Popping lung sounds caused by fluid in the lungs, often from CHF or pulmonary edema.

COPD

Chronic obstructive pulmonary disease causing long-term breathing difficulty and poor airflow.

Asthma

Lower airway disease causing bronchoconstriction and wheezing.

Bronchoconstriction

Tightening of airway muscles that narrows the airways.

Tripod Position

Patient leaning forward with arms supporting body to improve breathing.

Barrel Chest

Rounded chest shape commonly seen in COPD patients.

Pulmonary Edema

Fluid builds up in the lungs, making it hard to breathe. Often caused by the heart not pumping correctly.

CHF (Congestive Heart Failure)

A condition where the heart is too weak or stiff to pump blood effectively, causing fluid buildup in the lungs, legs, or body.

Circulation

Movement of blood through the body to deliver oxygen and nutrients.

Circulation Assessment

Check pulse, skin color/temperature, and bleeding.

Perfusion

Delivery of oxygen-rich blood to tissues.

Shock

State of poor perfusion where organs/tissues do not receive enough oxygen.

Signs of Shock

Pale cool clammy skin, tachycardia, weak pulse, anxiety, altered mental status.

Tachycardia

Fast heart rate, commonly seen in shock.

Hypotension

Low blood pressure; often a late sign of shock.

Hypovolemic Shock

Shock caused by blood or fluid loss.

Cardiogenic Shock

Shock caused by the heart failing to pump effectively.

Septic Shock

Shock caused by severe infection leading to vasodilation and poor perfusion.

Anaphylactic Shock

Shock caused by severe allergic reaction and airway swelling.

Neurogenic Shock

Shock caused by spinal cord injury disrupting nervous system control of blood vessels.

Shock Treatment

Oxygen, keep warm, control bleeding, and rapid transport.

Major Bleeding

Life-threatening blood loss requiring immediate treatment.

Direct Pressure

First treatment for bleeding by pressing directly on the wound.

Tourniquet

Device applied above severe extremity bleeding to stop blood flow.

Hemostatic Dressing

Special dressing that helps blood clot faster.

Transport Decision

Determining whether the patient needs rapid transport or can remain on scene longer.

Load and Go

Rapid transport for unstable or critical patients.

Patients Requiring Rapid Transport

Stroke, STEMI, respiratory failure, shock, severe trauma, unresponsive patients.

STEMI

Heart attack caused by a completely blocked coronary artery, shown on a 12-lead ECG by ST elevation. Part of the heart muscle is not getting oxygen and begins dying quickly. Emergency treatment is needed fast to reopen the artery.

Secondary Assessment

Detailed exam and history after immediate life threats are managed.

SAMPLE History

Signs/symptoms, allergies, medications, past history, last oral intake, events leading up.

OPQRST

Pain assessment tool: onset, provocation/palliation, quality, radiation, severity, time.

Normal Adult Respiratory Rate

12–20 breaths per minute.

Normal Adult Pulse

60–100 beats per minute.

Normal Adult Blood Pressure

Approximately 120/80 mmHg.

Pediatric Respiratory Distress Signs

Nasal flaring, retractions, grunting.

Retractions

Skin pulling inward around ribs/neck during breathing; sign of respiratory distress.

Grunting

Noise made during breathing in children trying to keep air in the lungs.

Myocardial Infarction (MI)

Heart attack caused by blocked blood flow to the heart muscle.