Comprehensive NREMT Cheat Sheet Study Guide

NREMT Study Guide Introduction and Overview

• The NREMT Cheat Sheet is designed as an exhaustive resource to support students through EMT school and National Registry exam preparation.
• Goal: Simplify complex Emergency Medical Services (EMS) topics into organized summaries, emphasizing the "how" and "why" behind protocols.
• Core Competencies Targeted: Airway management, trauma, patient assessment, pharmacology, and confident decision-making.
• Study Strategic Recommendation: Use regularly alongside practice questions, flashcards, and group discussions to improve retention.
• Purpose: Prioritize critical concepts, reduce confusion and study stress, and identify knowledge gaps to ensure students enter exams calm and prepared.

Patient Assessment: Scene Safety and Primary Survey

• Scene Safety: Assess the Environment
      * First and most important priority upon arrival at an emergency scene.
      * Personnel must assess for hazards before assisting patients to minimize risk to the team and the patient.
      * Common Scene Hazards:
          * Traffic Hazards: Moving vehicles, especially at roadside incidents or accidents.
          * Hazardous Materials: Toxic substances, chemicals, or fuel spills causing dangerous exposure.
          * Structural Instability: Buildings or structures at risk of collapse; requires stabilization by specialists before entry.
• Primary Survey ($ABCs$)
      * Used to rapidly identify and manage life-threatening conditions.
      * Airway ($A$): Check for patency. If obstructed, clear immediately.
      * Breathing ($B$): Ensure effective breathing. Monitor for labored, irregular, or absent breathing.
      * Circulation ($C$): Assess pulse. If absent, initiate chest compressions and $CPR$.

Patient Assessment: History Taking and Vital Signs

• Secondary Survey ($SAMPLE$ History)
      * Signs & Symptoms: Symptoms (patient feelings like pain/dizziness) and Signs (observations like swelling/bleeding).
      * Allergies: Medications, food, or environmental triggers.
      * Medications: Current medications that might affect treatment decisions.
      * Past Medical History: Chronic conditions (e.g., diabetes, hypertension, cardiac disease).
      * Last Meal: Recent intake timing (critical for surgery or sedation decisions).
      * Events Leading to Illness/Injury: Context of the incident (sudden onset vs. accident).
• Core Vital Signs
      * Heart Rate ($HR$): Rapid/irregular pulses may indicate shock, dehydration, or cardiac arrest.
      * Respiratory Rate ($RR$): Abnormal patterns point to hypoxia, respiratory distress, or head injury.
      * Blood Pressure ($BP$): Deviations suggest cardiovascular issues, hemorrhage, or shock.
      * Temperature: Fever indicates infection; low temperature indicates hypothermia.
• OPQRST Pain Assessment
      * Onset: When did it start? Sudden vs. gradual.
      * Provocation/Palliation: What makes it better or worse?
      * Quality: Description (sharp, dull, burning).
      * Radiation: Does the pain spread?
      * Severity: Scale of $1$ to $10$.
      * Time: Duration and frequency (constant vs. intermittent).

Vital Signs Normal Ranges by Age Group

• Newborn ($0-1$ month):
      * Heart Rate: $120-160\,bpm$
      * Respiratory Rate: $30-50\,breaths/min$
      * Systolic BP: $60-90\,mmHg$
      * Diastolic BP: $30-60\,mmHg$
      * Temperature: $97.7-99.5\,^{\circ}F$
• Infant ($1-12$ months):
      * Heart Rate: $90-140\,bpm$
      * Respiratory Rate: $30-40\,breaths/min$
      * Systolic BP: $70-100\,mmHg$
      * Diastolic BP: $53-66\,mmHg$
      * Temperature: $97.7-99.5\,^{\circ}F$
• Toddler ($1-3$ years):
      * Heart Rate: $80-130\,bpm$
      * Respiratory Rate: $24-40\,breaths/min$
      * Systolic BP: $80-110\,mmHg$
      * Diastolic BP: $53-66\,mmHg$
      * Temperature: $97.7-99.5\,^{\circ}F$
• Preschool ($3-5$ years):
      * Heart Rate: $80-120\,bpm$
      * Respiratory Rate: $22-34\,breaths/min$
      * Systolic BP: $80-110\,mmHg$
      * Diastolic BP: $50-70\,mmHg$
      * Temperature: $97.7-99.5\,^{\circ}F$
• School Age ($6-12$ years):
      * Heart Rate: $70-110\,bpm$
      * Respiratory Rate: $18-30\,breaths/min$
      * Systolic BP: $80-120\,mmHg$
      * Diastolic BP: $50-80\,mmHg$
      * Temperature: $97.7-99.5\,^{\circ}F$
• Adolescent ($13-18$ years) & Adult ($18+$ years):
      * Heart Rate: $60-100\,bpm$
      * Respiratory Rate: $12-20\,breaths/min$
      * Systolic BP: $90-120\,mmHg$
      * Diastolic BP: $60-80\,mmHg$
      * Temperature: $97.7-99.5\,^{\circ}F$

Airway Management

• Head Tilt-Chin Lift Maneuver: Used for patients without suspected spinal injury; tilts head back and lifts chin to move tongue away from the back of the throat.
• Jaw Thrust Maneuver: Mandatory for suspected cervical spine ($C-spine$) injuries; uses both hands to lift the jaw forward without moving the head/neck.
• Oropharyngeal Airway ($OPA$):
      * Usage: Unconscious patients WITHOUT a gag reflex.
      * Function: Prevents tongue from blocking the airway.
      * Insertion: Via upside-down rotation or with a tongue depressor.
• Nasopharyngeal Airway ($NPA$):
      * Usage: Conscious or semi-conscious patients with a gag reflex or oral trauma.
      * Insertion: Through the nostril to bypass the tongue.
• Bag-Valve-Mask ($BVM$): Provides positive pressure ventilation for inadequate/absent respirations; requires a secure mask seal.
• Endotracheal Intubation: Advanced skill (typically Advanced Life Support/$ALS$) involving a tube in the trachea for prolonged support.

Breathing Interventions

• Assessment of Breath Sounds (Auscultation):
      * Normal: Clear and even.
      * Wheezing: Suggests asthma, bronchospasm, or obstruction.
      * Crackles: Indicates fluid (pneumonia, pulmonary edema).
      * Absent: Indicates collapsed lung or severe obstruction.
• Oxygen Administration:
      * Nasal Cannula: $24-44\%$ oxygen for mild distress ($1-6\,L/min$).
      * Non-rebreather Mask: Up to $90\%$ oxygen for moderate/severe distress ($10-15\,L/min$).
      * BVM: For patients not breathing independently.
• Chest Seal Application: Applied to open penetrating chest wounds to prevent tension pneumothorax by allowing trapped air to escape while sealing the wound.
• Needle Decompression: Insertion of a large-bore needle into the chest cavity to relieve pressure from a tension pneumothorax.

Circulation Management

• Peripheral Pulses: Evaluate radial, brachial, and femoral pulses to assess perfusion status. Absence indicates shock or arrest.
• Bleeding Control:
      * External: Apply direct pressure; use tourniquets for severe limb hemorrhage.
      * Internal: Identify shock signs and initiate fluid resuscitation.
• Intravenous ($IV$) Access: Required for administering fluids (Normal Saline or Lactated Ringer's), medications, or blood products.
• Fluid Resuscitation: Vital for hypovolemic shock, hemorrhage, or severe dehydration to restore volume and perfusion.

Cardiac Emergencies and CPR

• Cardiopulmonary Resuscitation ($CPR$):
      * Chest Compressions: Depth of at least $2\,inches$ (adults) at a rate of $100-120$ per minute.
      * Rescue Breaths: $2$ breaths for every $30$ compressions ($30:2$ ratio).
• Automated External Defibrillator ($AED$): Analyzes heart rhythm for ventricular fibrillation ($VF$) or pulseless ventricular tachycardia ($VT$). Early defibrillation is critical; survival decreases by $10\%$ for every minute delayed.
• Recognition of Cardiac Arrest: Unresponsiveness, absence of pulse, and absence of breathing.
• Acute Coronary Syndrome ($ACS$):
      * Includes unstable angina and myocardial infarction (heart attack).
      * Signs: Pressure/tightness in chest, radiating pain (arms/neck/jaw), nausea, sweating, dyspnea.
      * Interventions: Administer aspirin (to reduce clotting), nitroglycerin, and rapid transport.

CPR Quick Reference Chart

Trauma Management

• Mechanism of Injury ($MOI$): Evaluation of "how" an injury occurred (e.g., high-impact collisions, falls from heights, or penetrating trauma) to anticipate internal injuries.
• Spinal Motion Restriction ($SMR$): Preventions of further spinal cord damage using cervical collars and spinal boards. Essential for high-impact or suspected spinal injury cases.
• Head Injuries:
      * Assessment: Use Glasgow Coma Scale ($GCS$).
      * Signs of Intracranial Pressure ($ICP$): Vomiting, confusion, pupillary changes.
• Fractures and Dislocations: Require splinting (immobilization), potential realignment to restore circulation, and pain management.

Medical Emergencies

• Stroke Assessment ($FAST$):
      * Face: Drooping when smiling.
      * Arms: One arm drifts downward when raised.
      * Speech: Slurred or abnormal.
      * Time: Critical for immediate medical help application.
• Seizure Management: Protect patient from injury, maintain airway patency, and assess consciousness post-seizure.
• Diabetic Emergencies:
      * Hypoglycemia (Low): Confusion, sweating, shakiness. Treat with oral glucose (if conscious) or $IV$ glucose (if unconscious).
      * Hyperglycemia (High): Thirst, frequent urination, confusion.
• Anaphylaxis (Severe Allergic Reaction):
      * Symptoms: Sudden onset, widespread hives, facial/tongue swelling, hypotension, respiratory arrest.
      * Treatment: Immediate Epinephrine, $O_2$, airway support, and rapid transport.

Obstetric and Pediatric Emergencies

• Labor and Delivery: Monitor maternal/fetal status; prepare for delivery and neonatal resuscitation if imminent.
• Neonatal Resuscitation: Focus on airway clearance, temperature management (prevent hypothermia), and Positive Pressure Ventilation ($PPV$) via $BVM$.
• Pediatric Assessment: Higher heart/respiratory rates are normal. Watch for retractions or grunting as signs of distress. Use age-appropriate pain scales.

Environmental Emergencies

• Heat Exhaustion: Weakness, dizziness, heavy sweating, pale/clammy skin. Treat with cooling and oral/$IV$ rehydration.
• Heat Stroke: Emergency; core temperature $> 104\,^{\circ}F$ ($40\,^{\circ}C$), altered mental status, hot/dry skin. Treat with rapid cooling (cold packs to neck, groin, armpits).
• Hypothermia: Core temperature $< 95\,^{\circ}F$ ($35\,^{\circ}C$). Treat with gradual rewarming; avoid direct heat like hot water bottles to prevent skin damage.
• Frostbite: Frozen tissues appearing white and hard. Rewarm gently with warm water; never rub the tissue.
• Carbon Monoxide ($CO$) Poisoning: Odorless gas displaces oxygen. Symptoms: Headache, nausea, confusion. Treatment: Remove from source and give $100\%$ oxygen.

Documentation and Communication

• Patient Care Report ($PCR$): Legal and clinical document for continuity of care. Components: Patient demographics, history, assessment findings, interventions, and transport details.
• Handoff Communication ($SBAR$ style):
      * Situation: Current condition/vital signs.
      * Background: Medical history/medications.
      * Assessment: Important exam findings.
      * Recommendation: Interventions performed and next steps.
• HIPAA Compliance: Maintain patient confidentiality; use secure transmission and storage methods.

Legal and Ethical Considerations

• Duty to Act: Legal obligation to provide care established by employment; exists on and often off duty.
• Good Samaritan Laws: Protect individuals providing good-faith emergency assistance from liability.
• Informed Consent: Patient agrees after nature of treatment and risks are explained. Requires competence.
• Implied Consent: Presumed in emergencies where the patient is unconscious/unable to consent.
• Advanced Directives:
      * Do Not Resuscitate ($DNR$): Instructs not to perform $CPR$.
      * Living Will: Specifies wishes for life-sustaining treatments in terminal scenarios.
• Principles of Ethics: Beneficence (doing good), Nonmaleficence (doing no harm), Autonomy (respecting choices), and Justice (fairness).

EMS Operations

• Incident Command System ($ICS$): Standardized hierarchy (Command, Operations, Logistics, Planning) for efficient resource management in complex scenes/mass casualties.
• Vehicle Safety: Adhere to traffic laws even with lights/sirens; regular maintenance is mandatory.
• Radio Communication: Be clear and concise; use standardized terminology; give age, condition, and receiving facility name.

Pharmacology: Medications and Routes

• Administration Routes: Oral ($PO$), Intravenous ($IV$), Intramuscular ($IM$), Sublingual ($SL$), and Inhalation.
• Oxygen ($O_2$):
      * Dose: $1-15\,L/min$.
      * Indications: Hypoxia, shock, trauma, altered $LOC$.
• Albuterol:
      * Dose: $2.5\,mg$ in $3\,mL$ via nebulizer.
      * Indications: Asthma, wheezing, $COPD$.
• Epinephrine ($Epi$):
      * Dose: $0.3\,mg$ (adult), $0.15\,mg$ (pediatric).
      * Route: $IM$/Auto-injector.
      * Indications: Anaphylaxis.
• Aspirin ($ASA$):
      * Dose: $324\,mg$ (typically $4\times 81\,mg$ baby aspirin).
      * Route: Oral (chewed).
      * Contraindications: Allergy, GI bleed, recent surgery.
• Nitroglycerin:
      * Dose: $0.3-0.6\,mg$.
      * Route: $SL$.
      * Requirements: $SBP \ge 100\,mmHg$; no recent $ED$ medications (Viagra/Cialis).
• Oral Glucose:
      * Dose: $15-25\,grams$.
      * Requirement: Intact gag reflex; patient must be able to swallow.

Special Populations and Infection Control

• Geriatric Patients: Unique considerations include poor temperature regulation, frailty, and multiple medications.
• Behavioral Emergencies: Use de-escalation techniques; ensure safety of responders and patient.
• Standard Precautions: Hand hygiene and appropriate Personal Protective Equipment ($PPE$) like gloves, masks, and gowns.
• Isolation Precautions:
      * Airborne: $N95$ mask (e.g., Tuberculosis).
      * Droplet: Surgical mask (e.g., Influenza).
      * Contact: Gloves and Gowns (e.g., $MRSA$).