Comprehensive NREMT

Alveoli Function

Site of gas exchange in lungs; passive diffusion of O2 and CO2 across alveolar-capillary membrane.

Cardiac tamponade

A life-threatening accumulation of fluid or blood in the pericardial sac that compresses the heart, severely impairing ventricular filling and leading to obstructive shock and decreased cardiac output. indications include Beck's triad (hypotension, jugular venous distension, and muffled heart sounds), pulsus paradoxus (systolic blood pressure drop $> 10\,\text{mmHg}$ during inspiration), and electrical alternans on ECG. Indications for emergent intervention (pericardiocentesis) include hemodynamic compromise and decompensated shock.

Hemoptypsis

Blood coughed up from lungs or tracheobronchial tree

Flail chest

Fracture of two or more adjacent ribs in two or more places that allows for free movement In the fractured segment

Tension Pneumothorax

Type of pneumothorax where air entering chest is prevented form escaping

Aspiration Risk

Breathing fluid/foreign material into lungs; increased in patients with altered mental status or absent gag reflex.

Snoring Respirations

Indicates upper airway obstruction, usually by tongue; managed with head-tilt/chin-lift or jaw-thrust.

Gurgling Respirations

Indicates fluid (blood, vomitus, secretions) in upper airway; immediate suctioning required.

Suctioning Maximum Duration (Adult)

10 to 15 seconds maximum; apply suction only while withdrawing catheter.

Suctioning Maximum Duration (Pediatric)

5 to 10 seconds maximum; avoid prolonged hypoxia.

Suction Catheter Depth

Measure from tip of nose/corner of mouth to earlobe/angle of jaw.

Rigid Suction Tip (Yankauer)

Used for suctioning mouth and pharynx; do not touch back of throat (gag reflex / vagal stimulation).

Soft Catheter (French)

Used for suctioning nose or stoma, or liquid secretions in nasopharynx.

Head-Tilt/Chin-Lift Maneuver

Primary manual airway opening technique for patients WITHOUT suspected spinal trauma.

Jaw-Thrust Maneuver

Primary manual airway opening technique for patients WITH suspected spinal trauma.

Oropharyngeal Airway (OPA) Indication

Unresponsive patient WITHOUT a gag reflex to maintain open airway.

Oropharyngeal Airway (OPA) Sizing

Measure from corner of mouth to angle of jaw or earlobe.

OPA Insertion Technique (Adult)

Insert upside down with tip facing roof of mouth, rotate 180 degrees past soft palate.

OPA Insertion Technique (Pediatric)

Insert straight in with tongue blade holding tongue down (no rotation to avoid tissue damage).

Nasopharyngeal Airway (NPA) Indication

Patient with decreased level of consciousness WHO HAS an intact gag reflex or facial trauma preventing OPA.

Nasopharyngeal Airway (NPA) Contraindications

Severe facial trauma or suspected basilar skull fracture (risk of entering brain cavity).

Nasopharyngeal Airway (NPA) Sizing

Measure from tip of nose to earlobe or angle of jaw; choose diameter matching patient's pinky finger.

Hypercarbia / Hypercapnia

Elevated carbon dioxide levels in bloodstream; primary drive to breathe in healthy individuals.

Hypoxic Drive

Secondary respiratory drive reliant on oxygen levels rather than CO2; common in severe chronic COPD.

Hypoxia Definition

Inadequate oxygen delivery to body tissues.

Early Signs of Hypoxia

Restlessness, anxiety, irritability, tachycardia, tachypnea.

Late Signs of Hypoxia

Cyanosis, bradycardia, confusion/altered mental status, lethargy.

Tidal Volume Definition

Volume of air moved in or out of lungs during a single breath (~500 mL in average adult).

Dead Space Air

Air in respiratory tract (trachea, bronchi) that does not participate in gas exchange (~150 mL).

Minute Ventilation Formula

Minute Ventilation = Tidal Volume x Respiratory Rate.

Agonal Respirations

Ineffective, gasping breaths seen during cardiac arrest or severe brain ischemia; treated as apnea.

Apnea Definition

Complete cessation of breathing.

CPAP Indications

Alert, conscious patient in severe respiratory distress (CHF/pulmonary edema, COPD) able to follow commands and breathe spontaneously.

CPAP Contraindications

Respiratory arrest/apnea, inability to follow commands, chest trauma/pneumothorax, gastrointestinal bleeding or active vomiting.

Flow-Restricted Oxygen-Powered Ventilation Device (FROPVD)

Oxygen delivery device providing 100% O2 under pressure; contraindicated in pediatrics and chest trauma.

Tracheostomy Tube Suctioning

Insert soft suction catheter until resistance felt (no more than 3-5 inches), apply suction while twisting and withdrawing.

Ventilating a Stoma Patient

Use pediatric mask over stoma attached to adult BVM; seal mouth and nose if air escapes.

Ventilation Rate for Patient with Advanced Airway

1 breath every 6 seconds (10 breaths/min) continuously without pausing chest compressions.

Bag-Valve-Mask (BVM) Volume

Adult BVM holds ~1,200 to 1,600 mL; squeeze until clear chest rise observed (~500-600 mL delivered).

Pulse Oximetry (SpO2) Limitations

Inaccurate in carbon monoxide poisoning, severe anemia, hypothermia, vasoconstriction/shock, bright ambient light.

Capnography (ETCO2) Normal Value

35 to 45 mmHg.

Low ETCO2 Causes

Hyperventilation, severe pulmonary embolism, cardiac arrest, hypovolemic shock.

High ETCO2 Causes

Hypoventilation, severe asthma/COPD exacerbation, ROSC (Return of Spontaneous Circulation).

Shark-Fin Capnography Waveform

Indicates bronchospasm (Asthma, COPD, Anaphylaxis).

Coronary Artery Function

Supply oxygenated blood directly to myocardium (heart muscle).

Pericardium Definition

Double-walled sac enclosing the heart and roots of great vessels.

Preload Definition

Degree of stretch on heart muscle fibers at end of diastole; volume of blood returning to heart.

Afterload Definition

Resistance against which heart must pump blood to eject it from left ventricle into aorta.

Cardiac Output Formula

Cardiac Output = Stroke Volume x Heart Rate.

Stroke Volume Definition

Volume of blood pumped out of left ventricle with each contraction (~70 mL).

Pulse Pressure Definition

Difference between Systolic and Diastolic Blood Pressure (Systolic - Diastolic).

Narrowing Pulse Pressure Causes

Cardiac tamponade, tension pneumothorax, severe hypovolemic shock.

Widening Pulse Pressure Causes

Increased intracranial pressure (ICP), severe aortic regurgitation.

Atherosclerosis Definition

Build-up of fatty plaques/cholesterol inside arterial walls leading to narrowing and restriction of blood flow.

Arteriosclerosis Definition

Hardening and loss of elasticity of arterial walls.

Acute Coronary Syndrome (ACS) Terminology

Umbrella term covering unstable angina, NSTEMI, and STEMI.

Stable Angina Pectoris

Chest pain occurring during physical exertion/stress, predictable, relieved within 15 minutes by rest or nitroglycerin.

Unstable Angina Pectoris

New or changing chest pain occurring at rest or with minimal exertion, not fully relieved by rest/nitro.

Acute Myocardial Infarction (AMI) Definition

Death of heart muscle tissue resulting from sudden lack of blood supply/oxygen.

Atypical AMI Presentation

Common in women, elderly, and diabetics; presents as weakness, nausea, dyspnea, unexplained diaphoresis without chest pain.

Silent MI Definition

Myocardial infarction occurring without chest pain, frequently seen in diabetic patients due to neuropathy.

Right Ventricular Infarction Caution

Avoid Nitroglycerin due to severe sudden drop in preload leading to profound hypotension.

Nitroglycerin Action

Vaso/venodilator that decreases preload and workload on heart, reducing myocardial oxygen demand.

Nitroglycerin Route and Repeat Dose

Sublingual tablet or spray; 0.4 mg every 5 minutes up to 3 doses if BP > 100 mmHg and permitted by protocol.

Aspirin (ASA) Action

Antiplatelet aggregator (prevents blood clots from growing larger); not an analgesic in cardiac care.

Automatic External Defibrillator (AED) Shockable Rhythms

Ventricular Fibrillation (V-Fib) and Pulseless Ventricular Tachycardia (V-Tach).

AED Non-Shockable Rhythms

Asystole and Pulseless Electrical Activity (PEA).

Defibrillation Goal

Depolarize all cardiac cells simultaneously to allow heart's natural pacemaker (SA node) to resume organized rhythm.

CPR Compression to Ventilation Ratio (Adult)

30 compressions to 2 ventilations for 1 or 2 rescuers.

CPR Compression to Ventilation Ratio (Child/Infant 2-Rescuer)

15 compressions to 2 ventilations.

CPR Compression Rate

100 to 120 compressions per minute for all age groups.

CPR Compression Depth (Adult)

At least 2 inches (5 cm), no more than 2.4 inches (6 cm).

CPR Compression Depth (Child)

About 2 inches (5 cm) or 1/3 anterior-posterior chest diameter.

CPR Compression Depth (Infant)

About 1.5 inches (4 cm) or 1/3 anterior-posterior chest diameter.

CPR Chest Recoil Importance

Allows complete ventricular refilling between compressions; incomplete recoil reduces cardiac output.

ROSC Sign Recognition

Patient movement, spontaneous breathing, sudden jump in ETCO2 (> 40 mmHg), palpable pulse.

Left Ventricular Assist Device (LVAD)

Mechanical pump implanted in left ventricle for severe heart failure; patient may not have palpable pulse or measurable BP.

Hypertensive Emergency

Systolic BP > 180 mmHg or Diastolic > 120 mmHg accompanied by target organ damage (headache, vision changes, pulmonary edema).

Aortic Dissection Pain Quality

Sharp, tearing, or ripping sensation radiating straight to back between shoulder blades.

Pericarditis Presentation

Sharp chest pain relieved by sitting forward, exacerbated by deep inspiration or lying flat.

Synchronized Cardioversion

Timed electrical shock delivered on R-wave for unstable patients with organized tachycardias.

Pacemaker Failure Signs

Bradycardia, dizziness, syncope, hiccups (diaphragmatic stimulation by loose lead wire).

Peripheral Edema Significance

Swelling in lower extremities/sacrum indicative of Right-Sided Heart Failure (fluid backing up into systemic circulation).

Pulmonary Edema Significance

Fluid accumulation in alveoli indicative of Left-Sided Heart Failure (fluid backing up into lungs).

Central Nervous System (CNS) Components

Brain and spinal cord.

Peripheral Nervous System (PNS) Components

Cranial nerves and spinal nerves extending throughout body.

Autonomic Nervous System Divisions

Sympathetic ("Fight or Flight") and Parasympathetic ("Rest and Digest").

Sympathetic Nervous System Effects

Pupil dilation, increased heart rate, bronchodilation, vasoconstriction, decreased digestion.

Parasympathetic Nervous System Effects

Pupil constriction, decreased heart rate, bronchoconstriction, vasodilation, increased digestion.

Transient Ischemic Attack (TIA)

Temporary neurological deficit ("mini-stroke") caused by transient ischemia; completely resolves within 24 hours without permanent damage.

Ischemic Stroke Thrombolytic Window

Typically within 3 to 4.5 hours from Last Known Well time for administration of tPA (tissue plasminogen activator).

Hemiparesis Definition

Weakness on one side of body, classic sign of stroke in opposite cerebral hemisphere.

Hemiplegia Definition

Paralysis on one side of body.

Dysarthria Definition

Slurred or difficult speech caused by lack of muscular control over speech structures.

Aphasia Types

Expressive (cannot produce speech), Receptive (cannot understand speech), Global (inability to speak or understand).

Generalized Tonic-Clonic Seizure

Seizure involving loss of consciousness, tonic contraction (stiffening), and clonic spasms (jerking) of body.

Absence Seizure (Petit Mal)

Brief sudden loss of awareness without loss of postural tone; common in children, presents as staring blankly into space.

Focal (Partial) Seizure

Seizure activity originating in localized area of brain; may occur with or without impaired awareness.

Febrile Seizure

Seizure in infants/children caused by sudden rapid spike in body temperature; generally benign but requires evaluation.

Seizure Management Priorities

Protect patient from trauma, clear immediate environment, position on side post-seizure, apply O2, maintain airway.