EMS NREMT EXAM

Based off PocketPrep Questions

myocardial-infarction

caused by decreased or complete cessation of blood flow to a portion of the myocardium. Heart attack

hypotensive

Hypotension, or low blood pressure (typically below 90/60 mmHg), occurs when blood flow to organs is inadequate, causing dizziness, fainting, or fatigue.

pulmonary edema

Fluid buildup in the alveoli/interstitial lung tissue, most often from left-sided heart failure after an MI. On the exam think severe dyspnea, crackles, pink frothy sputum, and low SpO₂—giving the patient signs of respiratory distress.

Cardiogenic Shock

The heart lacks sufficient power to maintain adequate cardiac output, usually resulting from acute myocardial infarction. Cool, clammy skin, a weak, irregular pulse, tachycardia; tachypnea; shallow breathing; dyspnea (shortness of breath); nausea; hypotension

ROSC

Return of spontaneous circulation

Hematuria

Blood in the urine, seen as pink/red urine or detected on testing, indicating bleeding in the urinary tract (kidneys, ureters, bladder, urethra). It is not a GI-bleed finding, so it points to a non-gastrointestinal source of bleeding.

Coffee--Ground emesis

Vomiting that looks like wet coffee grounds due to blood that has been in the stomach long enough to be partially digested by gastric acid. This is a classic sign of upper gastrointestinal bleeding that may be slower or less brisk than bright-red hematemesis.

Melena

Dark, tarry, foul-smelling stools caused by digested blood, most commonly from an upper GI bleed (esophagus, stomach, duodenum). It usually indicates bleeding that has been present long enough to be chemically altered during digestion.

Hematemesis

Vomiting blood, often bright red when bleeding is active and significant, indicating an upper GI source (e.g., ulcers, varices). It suggests more rapid bleeding than coffee-ground emesis and can quickly lead to shock.

Hemorrhagic Shock

A type of hypovolemic shock caused by significant blood loss, leading to decreased circulating volume, reduced preload, and inadequate tissue perfusion. In trauma, assume hemorrhagic shock until proven otherwise because internal bleeding may be hidden but rapidly fatal.

Tachycardia

An abnormally fast heart rate (often >100 bpm in adults) that commonly occurs as the body tries to maintain cardiac output during low blood volume. A very fast, weak/thready pulse suggests poor stroke volume and worsening shock.

tachypnea

An abnormally fast respiratory rate (often >20/min in adults), commonly seen in shock due to stress, hypoxia, and metabolic acidosis. Rapid breathing can be an early sign that the body is trying to compensate for poor oxygen delivery.

Compensatory mechanisms

Physiologic responses that try to maintain perfusion during shock, including increased heart rate, peripheral vasoconstriction (cool, pale skin), and increased respiratory rate. When these mechanisms can no longer maintain blood pressure and perfusion, shock becomes decompensated.

Decompensated Shock

The stage where compensatory mechanisms fail and blood pressure drops, indicating inadequate organ perfusion. Findings often include hypotension, severe tachycardia, altered mental status, cool/clammy skin, and rapid respirations.

Tissue perfusion

Delivery of oxygenated blood to organs and tissues; when perfusion drops, cells switch to anaerobic metabolism and produce lactic acid. Signs of poor perfusion include altered mental status, cool/pale/clammy skin, weak pulses, and hypotension.

Compensated Distributive shock

Early distributive shock (e.g., sepsis, anaphylaxis, neurogenic) where blood pressure may still be maintained despite abnormal vasodilation and maldistribution of blood flow. Skin is often warm/flushed early (except neurogenic), helping differentiate it from hemorrhagic shock which is typically cool and pale.

Compensated cardiogenic shock

Early shock from pump failure (e.g., MI) where the heart cannot effectively move blood but blood pressure may be temporarily maintained by vasoconstriction. Often associated with signs of cardiac dysfunction such as chest pain, pulmonary edema/crackles, JVD, and cool clammy skin.

Cyanosis

Bluish discoloration of skin or mucous membranes caused by inadequate oxygenation or poor circulation. It is a late and serious sign in shock and respiratory failure—check lips and nail beds.

hypovolemic shock

A shock state caused by too little circulating blood volume, most often from bleeding or severe fluid loss. On the NREMT, look for cool/clammy skin, tachycardia, narrow pulse pressure, hypotension, anxiety/AMS, and treat with bleeding control, oxygen/ventilation support, and rapid transport.

neurogenic shock

A type of distributive shock from spinal cord injury (usually cervical/upper thoracic) causing loss of sympathetic tone and vasodilation. Classic NREMT clue: hypotension with bradycardia and warm, dry skin (unlike the cool/clammy tachycardic presentation of hypovolemia).

psychogenic shock

A brief fainting episode (vasovagal syncope) triggered by pain, fear, or emotional stress, leading to temporary decreased cerebral perfusion. It usually improves quickly when the patient is supine and does not typically cause ongoing hypotension with signs of blood loss.

aortic disruption

A life-threatening tear/rupture of the aorta (often from high-energy deceleration) causing massive internal bleeding and rapid shock. Common exam clues include severe chest/back pain, signs of thoracic trauma, and quick deterioration.

pulsatile mass

A rhythmic, throbbing abdominal lump suggesting an abdominal aortic aneurysm or major vascular injury. In shock with abdominal pain or trauma, it’s a red flag for catastrophic internal bleeding and rapid transport.

Signs of poor perfusion

Signs of poor perfusion indicate inadequate blood flow to tissues and may include altered mental status, pale/cool/clammy skin, delayed capillary refill, weak pulses, or hypotension (late). In pediatrics, these signs help decide whether to begin compressions when the pulse is very slow.

Snoring Respirations

Snoring respirations are noisy, rattling breaths that indicate partial airway obstruction, often caused by the tongue relaxing and blocking the airway in unresponsive patients.

stridor

Stridor is a high-pitched, harsh sound heard during inhalation, caused by an upper airway obstruction like swelling or a lodged object, and is different from the snoring sound caused by the tongue.

pharynx

The pharynx is the part of the throat behind the mouth and nasal cavity that serves as a passageway for air and food and is a common site for airway obstruction, especially by the tongue in unconscious patients.

apneic

Not breathing at all (no normal respirations). In a pulseless patient, apnea confirms cardiac arrest and the priority is continuous high-quality compressions with appropriate ventilations once available.

ischemia

Insufficient oxygen delivery to tissue due to inadequate blood flow. In the heart, ischemia causes chest pressure/pain and can be reversible (angina) or progress to infarction (AMI) if prolonged.

angina pectoris

Chest discomfort caused by temporary (reversible) decreased oxygen supply to the heart muscle, usually from narrowed coronary arteries. It is ischemia without permanent muscle death and often improves with rest and/or nitroglycerin within minutes.

transient myocardial ischemia

A brief period of reduced oxygen to the heart muscle that resolves before cells die. This is the mechanism of angina—symptoms often improve with rest and may respond to nitroglycerin.

diaphoresis

Abnormal sweating, often cool and clammy, caused by sympathetic nervous system activation during stress/pain. It is a classic associated sign of acute coronary syndrome, including AMI.

percutaneous coronary intervention

A hospital procedure (cardiac cath) where a catheter is used to open a blocked coronary artery, often with balloon angioplasty and stent placement. It is a definitive way to rapidly reperfuse the myocardium and is time-critical in STEMI.

infarction progression

The time-dependent spread of cell death in the affected area as ischemia continues, generally from the innermost (subendocardial) layers outward. Without reperfusion, most of the threatened myocardium becomes nonviable by about 4–6 hours.

Trending

comparing multiple sets of vital signs over time to identify patterns or changes in a patient’s condition

Jaundice

Yellowing of the skin and/or sclera caused by excess bilirubin in the blood. On the EMT exam, it commonly points toward liver disease (e.g., hepatitis), bile duct obstruction, or hemolysis, and should prompt assessment for abdominal pain, nausea, and systemic illness.

malaise

A vague, generalized feeling of being unwell, weak, or fatigued. It’s common with systemic illness like infection or inflammation (including viral hepatitis) and is a key “nonspecific” symptom in many medical complaints.

bilirubin processing

Bilirubin is produced from the breakdown of red blood cells and is normally processed by the liver and excreted in bile. If the liver is inflamed/damaged (e.g., hepatitis) or bile flow is blocked, bilirubin builds up and causes jaundice.

Epigastric pain

Epigastric pain is pain in the upper middle abdomen (between the ribs), often associated with stomach, pancreas, or cardiac causes. Pancreatitis typically causes severe epigastric pain and may be associated with nausea/vomiting.

Chronic Renal Failure

Chronic renal failure is long-term, progressive loss of kidney function leading to fluid/electrolyte and waste buildup. It can cause fatigue, nausea, and edema, but it does not typically cause RUQ pain with jaundice, making it less likely here.

Compartment syndrome

A limb-threatening condition where swelling or bleeding raises pressure inside a closed muscle compartment (often after fractures or a tight cast), reducing blood flow and compressing nerves. Key exam findings include severe pain out of proportion (often worse with passive stretch), tense/firm compartment, and paresthesia; pulses can be present early, so don’t rule it out based on pulses alone.

paresthesia

An abnormal sensation such as numbness, tingling, or “pins and needles,” usually from nerve irritation or compression. In compartment syndrome it’s an early warning sign that nerves are being compromised by rising compartment pressure.

flaccid muscle tone

Decreased or absent muscle resistance to movement (limp/weak muscle), usually indicating significant nerve or spinal cord dysfunction. It is not a typical early finding of compartment syndrome, where the compartment and muscles are more often tight/tense; flaccidity would suggest later/advanced nerve injury.

rhonchi

Low-pitched, coarse “snoring” or “gurgling” lung sounds caused by mucus/secretions in larger lower airways (bronchi). They may improve or clear after coughing, which is a key exam clue.

Chronic obstructive pulmonary disease

Progressive lower-airway and alveolar disease (e.g., chronic bronchitis/emphysema) causing airflow limitation and air trapping. Patients may have wheezing/rhonchi, prolonged expiration, and decreased breath sounds.

postictal phase

The recovery period after the seizure ends, often marked by confusion, drowsiness, headache, slow or labored breathing, and decreased responsiveness. It can last minutes to hours, and longer seizures often mean a longer postictal phase.

metabolic acidosis

A condition where body fluids become too acidic due to excess acid production or poor clearance; after a prolonged seizure, lactic acid buildup from intense muscle activity can contribute. The patient may breathe more deeply/rapidly later to compensate, but initially respirations can be irregular or slow.

prodromal phase

The period before a seizure when some patients have early warning symptoms such as mood changes, irritability, anxiety, or feeling “off.” It can occur minutes to hours before the seizure and is not the active convulsion.

avulsion injury

tearing away of soft tissue so that it is either completely detatched or remains partially attatched as a flap

amputation injury

A complete or near-complete separation of a body part (often a finger, hand, or limb), unlike an avulsion flap that remains attached. Control bleeding (often needs a tourniquet) and preserve the amputated part properly for transport.

evisceration

Protrusion of internal organs (usually abdominal) through an open wound. Do not push organs back in; cover with moist sterile dressing and an occlusive layer, keep warm, and transport promptly.

subluxation

A partial dislocation where joint surfaces are misaligned but not completely separated. It causes pain, deformity, and limited motion; EMT care is to immobilize in the position found and check distal circulation, sensation, and movement.

generalized tonic-clonic seizure

A type of seizure that involves the entire brain and body, starting with a stiffening phase (tonic) followed by rhythmic jerking of all limbs (clonic), during which the patient is unconscious, cannot follow commands, loses protective reflexes, and is at high risk for injury and airway compromise—making safety and airway management your top priorities as an EMT.

Common encountered venomous snakes in NA

rattlesnakes, cottonmouths, copperheads, coral snakes

bariatric patient

A patient whose body weight/size exceeds standard equipment limits, making lifting, moving, and packaging more difficult and higher risk. On the NREMT, bariatric patients often require extra personnel, specialized equipment, and careful planning to prevent patient falls and provider injury.

vasodilator

A vasodilator is a medication or substance that widens (dilates) blood vessels, which lowers blood pressure and increases blood flow; nitroglycerin is a common vasodilator used to treat chest pain (angina) in cardiac patients.

bradycardia

Bradycardia is an abnormally slow heart rate, which in children often occurs as a late sign of severe hypoxia or respiratory failure. It is a critical finding that requires immediate intervention.

Signs of compensated shock

weak central pulses, vasoconstriction, decreasing pulse strength and perfusion.

cardiac tamponade

a life-threatening condition where fluid builds up around the heart and compresses it, preventing it from filling and pumping effectively.

Beck’s triad

a group of three clinical signs—hypotension, muffled heart sounds, and jugular venous distention (JVD)—that indicate cardiac tamponade, a life-threatening condition.

larynx

The larynx, or voice box, is located in the upper part of the neck and is responsible for producing sound and protecting the airway during swallowing. Injury to the larynx can compromise breathing and speech.

vertebral arteries

The vertebral arteries are major blood vessels that run through the neck alongside the spinal column, supplying blood to the brain. Injury to these arteries can cause serious bleeding or stroke.

Common signs of lacerated liver

upper right abdominal quadrant pain, intermittent pain from abdomen to right shoulder. rigid and distended abdomen.

distended abdomen

A distended abdomen is one that appears swollen or enlarged, often due to internal bleeding, fluid accumulation, or organ injury, and is a sign of serious abdominal pathology.

phrenic nerve

The phrenic nerve originates from the cervical spine (C3-C5) and controls the diaphragm; irritation of this nerve, such as from blood or injury in the abdomen, can cause referred pain to the shoulder.

Mallory-Weiss tear

A Mallory–Weiss tear is a longitudinal (lengthwise) tear in the mucosal lining of the lower esophagus or upper stomach, usually caused by forceful vomiting or retching. a non–full-thickness tear at the gastroesophageal junction that leads to bleeding.

dyspnea

Dyspnea is the medical term for difficulty or labored breathing, often described as shortness of breath. It is a common symptom in patients experiencing cardiac compromise and can signal that the heart is not pumping effectively.

prolapsed umbilical cord

A prolapsed umbilical cord occurs when the umbilical cord slips through the cervix and into the vagina ahead of the baby during labor, putting the cord at risk of being compressed and cutting off oxygen to the fetus; it is a true emergency requiring immediate intervention.

knee-chest position

The knee-chest position involves placing the patient face down with their knees drawn up to their chest and buttocks elevated, using gravity to help relieve pressure on a prolapsed umbilical cord.

trendelenburg position

The Trendelenburg position is when the patient lies flat on their back with the pelvis elevated higher than the head, which can also help reduce pressure on a prolapsed umbilical cord by using gravity.

hepatitis

Liver inflammation, often caused by infection, alcohol use, or toxins, and can impair bilirubin processing leading to jaundice.

Hypoglycemia

Hypoglycemia is a condition where the blood glucose (sugar) level drops below normal, typically less than 80 mg/dL. It can cause symptoms like lightheadedness, confusion, pale and clammy skin, and in severe cases, unconsciousness. For EMTs, recognizing and treating hypoglycemia quickly is crucial to prevent serious complications.

fowler position

The Fowler position involves sitting the patient upright at a 45-60 degree angle, which helps improve breathing by allowing the lungs to expand more fully; it is commonly used for patients with respiratory distress or difficulty breathing.

Standard positioning for hypotensive patients.

supine with legs elevated. Do NOT automatically elevate legs if it worsens the condition:

Respiratory distress → let them sit up (breathing > BP)

cardiogenic shock → legs up can overload the heart

Suspected spinal injury → keep spine neutral

Late pregnancy → place on left side (relieves pressure on vena cava)

cardiac tamponade or breathing-related issues → position of comfort

If airway, breathing, or other conditions get in the way, then those come first position wise.

meningococcal septicemia

Meningococcal septicemia is a rapidly progressing, severe bloodstream infection caused by Neisseria meningitidis bacteria, often presenting with sudden petechiae, shock, and high risk of death if not treated immediately.

petechiae

Petechiae are tiny, non-blanching red or purple spots on the skin that result from bleeding under the skin and are a key warning sign of serious infections like meningococcal septicemia.

vesicant

A vesicant is a chemical agent that causes severe blistering and damage to the skin, eyes, and mucous membranes upon contact. Lewisite is an example of a vesicant, and exposure can result in immediate pain and tissue injury.

nerve agents

Nerve agents are highly toxic chemicals that disrupt the nervous system by inhibiting the enzyme acetylcholinesterase, causing overstimulation of nerves. Examples include Tabun, Sarin, Soman, and VX. Symptoms appear rapidly after exposure and can include difficulty breathing, muscle twitching, and seizures.

Hyperventilation

in the context of brainstem herniation, it is sometimes used to temporarily reduce intracranial pressure, but must be carefully monitored with

brainstem herniation

Brainstem herniation is a life-threatening condition where increased pressure inside the skull forces brain tissue downward toward the brainstem, potentially compressing vital centers that control breathing and heart rate; rapid intervention is critical to prevent death or severe disability.

waveform capnography

Waveform capnography is a monitoring tool that continuously measures and displays the concentration of carbon dioxide (CO2) in exhaled air, providing a real-time graph (waveform) and numeric value (ETCO2), which is essential for assessing ventilation in critically ill patients.

end-tidal carbon dioxide

End-tidal carbon dioxide (ETCO2) is the maximum concentration of CO2 measured at the end of an exhaled breath, reflecting how effectively CO2 is being eliminated by the lungs and serving as an important indicator of ventilation status. 30-35 mmHg levels for hyperventiliation.

irreversible death

Irreversible death refers to clear and reliable signs that a person cannot be revived, such as rigor mortis, dependent lividity, decapitation, or decomposition. These findings mean resuscitation efforts should not be started or should be stopped if already underway.

Hypercapnia

Hypercapnia is an abnormally high level of carbon dioxide (CO2) in the blood, usually caused by inadequate ventilation (hypoventilation), meaning the lungs are not effectively removing CO2 from the body.

Hypocarbia

Hypocarbia (or hypocapnia) is an abnormally low level of carbon dioxide in the blood, typically caused by hyperventilation, where too much CO2 is exhaled.

Eupnea

Eupnea is the medical term for normal, unlabored breathing, indicating that both oxygen and carbon dioxide levels are being maintained within normal ranges.

Tension pneumothorax

is a life-threatening condition where air gets trapped in the pleural space and can’t escape, causing pressure to build up in the chest.

Classic signs (high-yield)

• Severe respiratory distress

• Unilateral absent/decreased breath sounds

• JVD (neck vein distention)

• Hypotension

• Tracheal deviation (late sign)

• Tachycardia, cyanosis

Distributive shock

is a type of shock where blood volume is normal, but it’s poorly distributed due to widespread vasodilation. Sepsis, anaphylaxis, neurogenic. Unable to compensate, abnormal vaso-dialating, abnormal blood pressure`

Obstructive Shock

Stopping of blood flow in the body due to any reason. Pulmonary embolism, cardiac tamponade, tension pneumothorax

blow-by technique

The blow-by technique is a method of delivering oxygen to children who are frightened or resist a mask. Oxygen is delivered by holding the tubing or a cup/funnel connected to oxygen about 1-2 inches from the child's face, allowing oxygen to 'blow by' the nose and mouth.

Coronary perfusion

Blood flow (and pressure) that supplies the heart muscle itself, especially during the relaxation phase between compressions. Interrupting compressions lowers coronary perfusion pressure, making it harder to achieve return of spontaneous circulation (ROSC).

During CPR, you pause to check for a carotid pulse

Check for no more than 10 seconds

paradoxical motion

Paradoxical motion refers to a segment of the chest wall moving in the opposite direction of the rest of the chest during breathing, usually seen in flail chest when multiple ribs are broken in more than one place.

pulmonary contusion

A pulmonary contusion is a bruise of the lung tissue caused by blunt trauma, leading to bleeding and swelling that impairs oxygen exchange and can cause hypoxia.

flail chest

when a segment of the chest wall doesn’t raise with the other part because of ribs being broken.

hemophilia

A hereditary bleeding disorder where the body cannot form normal blood clots due to missing or low clotting factors (most often factor VIII or IX). For EMS, even “minor” trauma can cause prolonged or serious bleeding, including hidden internal bleeding.

Cincinnati Prehospital Stroke Scale

A quick, 3-part stroke screening tool used by EMTs that checks for facial droop, arm drift, and abnormal speech. If any one of these is abnormal, the patient is considered high risk for stroke and needs rapid transport to a stroke-capable facility.

12-lead ECG

A standardized ECG (electrocardiogram is a test that records the electrical activity of the heart over time using electrodes placed on the skin.) that uses 10 electrodes to generate 12 views of the heart (6 limb leads and 6 chest/precordial leads V1–V6). Correct lead placement is critical because misplacement can mimic or hide ischemia/infarction patterns on the exam and in practice.