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Paramedic NREMT Study Guide Notes

About the Guide

  • Comprehensive study guide created by Brandon Schoborg and Adam Peddicord.
  • Designed to assist students preparing for the NREMT exam.
  • Experience of 38+ years in EMS education.
  • Features include interactive workbook, review quizzes, and a final exam.

Authors' Background

  • Adam Peddicord: Paramedic since 1998, retired Battalion Chief & Medical Commander for Newport Fire/EMS. Background in nursing (Associate's, Bachelor's, Master's) and EMS education.
  • Brandon Schoborg: Background as EMS Captain, EMS Education Manager, and Director of EMS Education. Education in EMS-Paramedic, Health Science, and MBA in Healthcare Management.

Table of Contents

  1. The NREMT Exam
  2. Medical Terminology
  3. Respiratory & Airway
  4. Cardiology
  5. Neurology
  6. Toxicology & Pharmacology
  7. Trauma
  8. Medical Emergencies
  9. Special Populations
  10. EMS Operations

Chapter 1: The NREMT Exam

  • Effective in 2023: no psychomotor exam, only a computer-adaptive cognitive exam.
  • Exam consists of multiple choice and multiple answer questions with case studies.
  • Stops when 95% confident of competency or inability to reach competency after answering at least 80 questions in a maximum of 2.5 hours.
  • 20 pilot questions not counted in performance.
  • Calculator provided on screen, personal calculators are not allowed.
  • Pediatric questions form about 15% of each category.
Percentages of Questions by Topic:
  • Airway & Respiratory: 8-12%
  • Cardiovascular: 10-14%
  • Medical: 24-28%
  • Trauma: 6-10%
  • EMS Operations: 8-12%
  • Clinical Judgement: 34-38%

Chapter 2: Medical Terminology

  • Importance of understanding medical terminology for the NREMT exam.
  • Examples of terminology: "dyspneic" (short of breath), "auscultate" (to listen), "bilateral" (both sides), "urticaria" (hives).
  • A thorough study of medical terminology enhances understanding and performance on the exam.
Key Terms:
  • Aerobic: presence of air or oxygen.
  • Agonist: enhances expected response.
  • Antagonist: inhibits effects of other drugs.
  • Apnea: cessation of spontaneous respirations.
  • Edema: excess fluid in tissues.
  • Dysphagia: difficulty in swallowing.
  • Hemorrhage: excessive blood loss.
  • Infarction: tissue death from lack of oxygen.

Chapter 3: Respiratory & Airway

  • Key Terms:
    • Ventilation: air movement into/out of lungs.
    • Perfusion: blood circulation through lung tissues.
    • Diffusion: gas exchange in alveoli.
  • Respiratory Patterns:
    • Eupnea: normal respirations.
    • Tachypnea: increased respirations.
    • Apnea: no respiration.
  • Airway Adjuncts & Devices:
    • Oropharyngeal Airway: for patients without gag reflex.
    • Nasopharyngeal Airway: for patients with intact gag reflex.
    • Non-Rebreather Mask: 80-100% oxygen.
    • CPAP: for conditions like COPD, with noted pressures of 4-20 cmH2O.

Chapter 4: Cardiology

  • Cardiac Anatomy: Three layers of heart muscle with specific functions.
  • Cardiac Emergencies: Includes angina, heart failure, TAM, and myocardial infarction.
  • Management Strategies for myocardial infarction include oxygen, aspirin, nitroglycerin, and morphine.
  • 12 Lead EKG: Critical for identifying myocardial infarctions and recognizing specific occlusions.
Key Medication Dosages for ACLS:
  1. Epinephrine: 1mg IV/IO (every 3-5 minutes).
  2. Amiodarone: 300mg IV for refractory VF/pVT.
  3. Atropine: 1mg, max 3 mg, for bradycardia.

Chapter 5: Neurology

  • Nervous System Overview: Control system via electrical impulses, CNS and PNS roles.
  • Seizures: Types and management strategies, status epilepticus defined.
  • Stroke Recognition and Management:
    • Ischemic vs. Hemorrhagic types.
    • Importance of assessing blood glucose in stroke patients.

Chapter 6: Toxicology & Pharmacology

  • Key Terms: Pharmacodynamics and pharmacokinetics definitions.
  • Cholinergic Poisoning: Symptoms and management (e.g., SLUDGE).
  • Antidotes for common poisonings: Naloxone for opioids, Flumazenil for benzodiazepines, and Sodium Bicarbonate for TCA overdose.
  • Alcohol Use Disorder (AUD) symptoms and management of complications.

Chapter 7: Trauma

  • Kinematics of trauma from various incidents (motorcyle, pedestrian vs. vehicle).
  • Burn Classifications: First, second, and third-degree burns with treatment protocols (Parkland formula).
  • Head Injuries: Understanding epidural vs. subdural hematomas.

Chapter 8: Medical Emergencies

  • Gynecology & Pregnancy terms: Definitions and emergency management strategies.
  • Conditions such as Preeclampsia, Abruptio Placenta, and Ectopic Pregnancy with key symptoms and management.
  • Pediatric Resuscitation Guidelines and common conditions (e.g., asthma, RSV bronchitis).

Chapter 9: Special Populations

  • Conditions Covered: Cerebral palsy, muscular dystrophy, cystic fibrosis with management strategies.
  • Amputation Trauma: Treatment protocols and considerations for specific populations such as the elderly.

Chapter 10: EMS Operations

  • Ambulance Standards: Types of ambulances and communications protocols.
  • Triage Systems: START and SALT methodologies for disaster response.
  • Incident Command System (ICS): Structure and roles within EMS operations.

Final Steps for Exam Preparation

  • Relaxation and proper rest before the exam.
  • Focus on understanding and processing each question carefully. Don't let pilot questions confuse you.
  • Engage in practical reviews that relate to real-world applications of the learned material.
  • Utilize all accompanying study materials such as videos and practice tests provided in the course.