NREMT Emergency Medical Technician (EMT) Cognitive Exam flashcards

Techniques used to establish and maintain an open airway in a patient with suspected head and/or spinal injury, prioritizing cervical spine protection.

• Jaw-thrust maneuver is the primary manual method.
• OPA can be used if no gag reflex.
• NPA is contraindicated with suspected basilar skull fracture (racoon eyes, battle signs, CSF leak).

Memory trick: Head trauma, jaw thrust, and no nose tubes!

A critical stage of respiratory compromise in infants and children where compensatory mechanisms are failing, leading to inadequate oxygenation and ventilation, often with signs of poor perfusion.

• Signs include marked increased work of breathing (severe retractions, grunting, gasping), altered mental status, bradycardia, cyanosis, and signs of poor perfusion (weak pulses, prolonged capillary refill).
• This stage can rapidly progress to respiratory arrest.
• Requires immediate aggressive intervention, including positive pressure ventilation.

Memory trick: Distress compensates, but failure decompensates and collapses.

A condition characterized by a reduced rate and/or depth of breathing, leading to inadequate oxygenation and/or carbon dioxide elimination.

• Commonly caused by opioids, sedatives, or central nervous system depressants.
• Can lead to hypoxia, hypercapnia, and respiratory arrest.
• Requires immediate ventilatory support.

Memory trick: Breathe first, then reverse the poison.

A viral infection of the upper airway, primarily affecting children, characterized by inflammation and swelling of the larynx, trachea, and bronchi.

• Common in children 6 months to 3 years.
• Hallmark sign is a 'barking' or 'seal-like' cough.
• Often accompanied by inspiratory stridor and hoarseness, usually without high fever.

Memory trick: Kids' coughs tell tales, listen for the bark or the drool.

A manual maneuver used to open the airway of an unresponsive patient by extending the head and lifting the chin, displacing the tongue from the posterior pharynx.

• First-line airway opening technique for patients without suspected spinal injury.
• Relieves airway obstruction caused by the tongue.
• Performed by tilting the forehead back and lifting the chin forward.

Memory trick: Open the path, then check the breath.

The most effective way to ensure adequate tidal volume delivery during BVM ventilation is to observe visible chest rise and fall with each breath.

• Primary indicator: visible chest rise.
• Confirms air entering lungs.
• Other signs are secondary or indirect.

Memory trick: Look for the lift, listen for the whoosh, feel for the squeeze.

When two rescuers are performing CPR on a child or infant, ventilations should be delivered at a rate of 1 breath every 2-3 seconds.

• Applies to children and infants.
• Rate is 20-30 breaths per minute.
• Coordinated with chest compressions.

Memory trick: Kids need fast air, every 2-3, rescuers share.

Proper use of a metered-dose inhaler (MDI) is crucial for effective medication delivery to the lungs in patients with respiratory conditions like asthma or COPD.

• Ensure correct medication, expiration date, and patient understanding.
• Shake the inhaler well before use.
• Patient exhales completely, then seals lips around mouthpiece, activates inhaler while inhaling slowly and deeply.
• Hold breath for 5-10 seconds, then exhale slowly. Wait 30-60 seconds between puffs.

Memory trick: Shake, Exhale, Inhale, Hold – for your lungs, make it bold!

Infants in severe respiratory distress or failure often require positive pressure ventilation (BVM) to ensure adequate oxygenation and ventilation, as other devices may be insufficient.

• Signs: lethargy, pallor, marked retractions, very high RR.
• Non-rebreather and nasal cannula often insufficient.
• BVM provides ventilatory support and high-concentration O2.

Memory trick: Little lungs struggling, BVM is the big gun.

The jaw-thrust maneuver is the preferred method for opening the airway in trauma patients with suspected spinal injury, as it avoids neck hyperextension.

• Used when C-spine injury is suspected.
• Opens airway by displacing mandible.
• Minimizes neck movement.

Memory trick: Trauma = Thrust, No Tilt for the spine.

An oxygen delivery device that provides a precise and consistent fraction of inspired oxygen (FiO2) by mixing a specific volume of oxygen with room air.

• Ideal for patients requiring precise oxygen concentrations, such as those with COPD.
• Different colored adapters correspond to specific flow rates and FiO2 percentages.
• Prevents over-oxygenation in patients with hypoxic drive.

Memory trick: Match the flow to the need, precision saves the COPD seed.

A blockage in one of the pulmonary arteries in your lungs, most often caused by blood clots that travel to the lungs from the legs (deep vein thrombosis).

• Symptoms include sudden dyspnea, chest pain, tachycardia, hemoptysis, and feeling of impending doom.
• Risk factors include recent surgery, prolonged immobility, oral contraceptives, cancer.
• Lung sounds are often clear initially.

Memory trick: Sudden chest pain, clear lungs, and a recent knife? Think clot!

Various devices are used to deliver supplemental oxygen, each providing different flow rates and oxygen concentrations, tailored to the patient's respiratory status.

• Nasal cannula: 1-6 L/min, 24-44% O2.
• Simple face mask: 6-10 L/min, 35-60% O2.
• Non-rebreather mask: 10-15 L/min, up to 90-100% O2.
• Venturi mask: Fixed concentrations (e.g., 24%, 28%, 35%, 40%, 50%) at specific flow rates.

Memory trick: Low flow for mild, high flow for severe, Venturi for precise, BVM for fear.

A condition where the volume of air moved into and out of the lungs is insufficient to maintain normal levels of oxygen and carbon dioxide in the blood.

• Can be caused by shallow breathing, slow breathing, or complete respiratory arrest.
• Signs include altered mental status, cyanosis, absent/diminished breath sounds, and accessory muscle use.
• Requires immediate ventilatory assistance.

Memory trick: Look for the subtle signs, not just the count.

Administering oxygen to patients with COPD, especially those who are chronic CO2 retainers, requires careful consideration to avoid depressing their hypoxic drive.

• Some COPD patients rely on low oxygen levels to stimulate breathing (hypoxic drive).
• High flow, uncontrolled oxygen can suppress this drive, leading to hypoventilation and CO2 retention.
• A Venturi mask provides precise, controlled oxygen concentrations (e.g., 24%, 28%, 35%) and is often preferred.
• Target SpO2 for COPD is typically 88-92%.

Memory trick: Venturi's precision, not full oxygen's decision, for COPD's respiration.

Opioid overdose primarily causes respiratory depression. While naloxone is the antidote, immediate airway and ventilatory support are paramount if breathing is inadequate.

• Signs include pinpoint pupils, respiratory depression (slow, shallow, or absent breathing), and altered mental status.
• Naloxone reverses opioid effects, but may take time or require multiple doses.
• If breathing is inadequate, positive pressure ventilation (BVM) is immediately necessary, regardless of naloxone administration.

Memory trick: Naloxone's great, but if they still can't ventilate, don't hesitate, manually inflate!

A blockage of the airway by a foreign object, requiring immediate intervention to restore breathing.

• Signs of severe obstruction: inability to speak/cough/cry, cyanosis, loss of consciousness.
• For conscious child (>1 year): abdominal thrusts.
• For conscious infant (<1 year): 5 back blows and 5 chest thrusts.

Memory trick: Age dictates the push, thrust or pat, to get the breath back.

When providing positive pressure ventilation to an adult with inadequate or absent breathing using a bag-valve mask, maintaining the correct rate is crucial for effective oxygenation and ventilation.

• Adults: 10-12 breaths per minute (1 breath every 5-6 seconds).
• Children/Infants: 12-20 breaths per minute (1 breath every 3-5 seconds).
• Each breath should be delivered over 1 second, with just enough volume to cause visible chest rise.

Memory trick: Adults go slow, kids go a bit faster, don't hyperventilate, or you'll cause a disaster!

A manual airway opening technique used for patients with suspected spinal injury, performed by lifting the angles of the mandible without tilting the head.

• Minimizes cervical spine movement.
• Often requires two rescuers for effective execution and airway maintenance.
• Indicated when head-tilt, chin-lift is contraindicated.

Memory trick: Trauma means no tilt, just thrust the jaw.

In trauma patients, especially those with suspected spinal injury, airway management must prioritize maintaining spinal immobilization while ensuring an open and clear airway.

• Jaw-thrust maneuver is the primary method for opening the airway in trauma with suspected spinal injury.
• Avoid head-tilt, chin-lift if spinal injury is suspected.
• Facial trauma may contraindicate NPA insertion and make OPA insertion challenging.
• Gurgling indicates secretions or blood in the airway, requiring suctioning.

Memory trick: Trauma's got a jaw, so jaw thrust, don't let the spine get crushed!

A life-threatening condition where air accumulates in the pleural space under positive pressure, causing lung collapse, mediastinal shift, impaired venous return, and cardiovascular compromise.

• Key signs: sudden dyspnea, pleuritic chest pain, diminished/absent breath sounds on affected side, tracheal deviation (late sign), JVD, hypotension, tachycardia.
• Requires immediate decompression (needle thoracostomy) to relieve pressure.
• Often results from trauma but can occur spontaneously.

Memory trick: Unilateral breath sounds with a shifted trachea means tension's got ya!

For suspected epiglottitis, the most critical prehospital action is to avoid agitating the child, maintain a position of comfort, and arrange for rapid transport, while ensuring a calm environment.

• Symptoms: stridor, drooling, high fever, ill appearance.
• Avoid airway visualization or forced interventions.
• Maintain calm, position of comfort, rapid transport.

Memory trick: Epiglottis inflamed, don't provoke, just go, go, go!

Anaphylaxis is a severe, life-threatening systemic allergic reaction that can cause rapid airway compromise and circulatory shock. Prompt recognition and treatment are critical.

• Key signs include widespread urticaria, angioedema, respiratory distress (wheezing, stridor), and hypotension.
• Epinephrine is the primary treatment, reversing bronchospasm and vasoconstriction.
• Airway management, oxygen, and fluid resuscitation are also important supportive measures.

Memory trick: Epi first, then Airway and Oxygen, for the allergic reaction's big commotion.

A life-threatening condition where the respiratory system can no longer maintain adequate gas exchange, leading to insufficient oxygenation and/or carbon dioxide elimination.

• Signs include marked tachypnea, severe retractions, grunting, nasal flaring, altered mental status, cyanosis, mottling.
• Often progresses from respiratory distress as compensatory mechanisms fail.
• Requires immediate ventilatory support, often with a BVM.

Memory trick: Grunting, flaring, and mottled skin means 'Bag me now!'

Epiglottitis is a life-threatening inflammation of the epiglottis, often bacterial, causing rapid airway obstruction. Management focuses on minimizing agitation and rapid transport.

• Characterized by sudden onset, high fever, drooling, dysphagia, and inspiratory stridor.
• Patients often prefer an upright, 'sniffing' position.
• Avoid any interventions that could agitate the child or manipulate the airway, as this can lead to complete obstruction.

Memory trick: Don't poke the 'epi' with a stick, just rapidly transport and let them sit.

Gurgling in the airway indicates the presence of fluid; the immediate intervention is to suction the airway to clear the obstruction.

• Gurgling = fluid in airway.
• Suctioning is primary intervention.
• Prevents aspiration and allows effective ventilation.

Memory trick: Sounds of trouble, clear the pipe, then air can flow.

Management of acute pulmonary edema involves administering high-flow oxygen, often with CPAP, to improve oxygenation, reduce work of breathing, and help move fluid out of the alveoli.

• High-flow O2 is critical.
• CPAP is highly effective if available.
• Avoid supine positioning.

Memory trick: Puffy lungs, pink froth, push O2, use CPAP's path.

Pediatric respiratory distress is characterized by increased work of breathing (e.g., nasal flaring, retractions, tachypnea) while the child is still able to compensate.

• Increased respiratory effort.
• Still alert/responsive, may be anxious.
• Distinguished from failure by absence of decompensation signs.

Memory trick: Distress is huffing, failure is fading, arrest is done.

A chronic lung disease characterized by the destruction of the alveoli, leading to air trapping, reduced gas exchange, and increased work of breathing.

• Common signs include barrel chest, pursed-lip breathing, accessory muscle use.
• Patients often have a chronic cough and dyspnea.
• Smoking is the leading cause.

Memory trick: A chronic wheeze or a barrel chest, tells a tale of lung's long test.

When delivering positive pressure ventilation with a BVM, minimal or no chest rise indicates ineffective ventilation, most commonly due to improper airway positioning or a poor mask seal.

• Always ensure proper head positioning (e.g., 'sniffing position' for adults, neutral for infants).
• Ensure a tight mask seal over the patient's nose and mouth.
• If initial ventilation is ineffective, reposition first, then reattempt. If still ineffective, suspect foreign body obstruction.

Memory trick: If the chest doesn't rise, adjust the head and try again, don't just despise!

For patients with inadequate breathing (too slow, too shallow, or absent), the primary intervention is to open the airway and provide positive pressure ventilation.

• Signs of inadequate breathing include respiratory rates below 8 or above 28, shallow chest rise, diminished or absent breath sounds, and cyanosis.
• Gurgling indicates fluid or secretions in the airway, often from the tongue falling back.
• Positive pressure ventilation (e.g., BVM) is critical to ensure adequate oxygenation and ventilation.

Memory trick: Open, Ventilate, and Oxygenate; don't wait for it to be too late.

The emergency care for an object that has penetrated the body and remains in place, focusing on stabilization and prevention of further injury.

• Do NOT remove the object unless it obstructs airway or CPR.
• Stabilize the object in place with bulky dressings.
• Control external bleeding around the object.
• Rapid transport to a medical facility.

Memory trick: Impaled: Don't Pull, Just Pad!

For an unconscious diabetic patient with hypoglycemia, rapid administration of glucose is critical. If IV access is not available or within scope, intramuscular glucagon is the next best option.

• Blood glucose < 60 mg/dL is generally considered hypoglycemic.
• Oral glucose is only for conscious patients with intact gag reflex.
• IV D50 is the most rapid and effective treatment.
• IM glucagon mobilizes glucose from the liver and is a good alternative when IV access is delayed or impossible.

Memory trick: No swallow? Glucagon to the muscle, or D50 to the vein!

A life-threatening overdose characterized by a classic anticholinergic toxidrome (dry skin, dilated pupils, tachycardia) and significant cardiotoxicity, including wide QRS complex and dysrhythmias.

• Anticholinergic effects (hot, dry, blind, mad, red).
• Cardiotoxicity: wide QRS, dysrhythmias, hypotension.
• CNS depression, seizures.
• Requires aggressive supportive care and often sodium bicarbonate.

Memory trick: TCA: Tachy, Cardiac, Anticholinergic

Conditions where oral glucose should not be administered, primarily related to the patient's ability to protect their airway.

• Unconsciousness
• Inability to swallow safely
• Known allergy to glucose

Memory trick: No Glucose If You Choke, Or Cannot Speak a Joke!

Albuterol is a short-acting beta-2 adrenergic agonist (SABA) that primarily causes bronchodilation.

• Stimulates beta-2 receptors in bronchial smooth muscle.
• Causes relaxation of airway muscles.
• Leads to bronchodilation and improved airflow.
• A rescue medication for acute bronchospasm.

Memory trick: Albuterol's a 'beta-2' friend, making tight airways expand and mend.

Hyperventilation syndrome is characterized by rapid, deep breathing often triggered by anxiety, leading to excessive carbon dioxide exhalation, and symptoms like lightheadedness, tingling, and chest pain.

• Caused by a decrease in arterial carbon dioxide (respiratory alkalosis).
• Symptoms include paresthesias (tingling), lightheadedness, carpopedal spasms, and chest pain.
• Treatment focuses on calming the patient and coaching slow, controlled breathing.
• Rule out other serious causes before diagnosing hyperventilation syndrome.

Memory trick: Calm the breath, calm the mind, no bag to bind!

The practice of rotating between different fever-reducing medications (e.g., acetaminophen and ibuprofen) due to their distinct pharmacokinetic profiles, particularly their metabolic pathways.

• Acetaminophen: Primarily liver metabolism (CYP450 system).
• Ibuprofen: Primarily liver metabolism (different CYP450 enzymes) and renal excretion.
• Different pathways reduce competition for enzymes and cumulative toxicity.
• Allows for sustained fever control while minimizing risk of overdose of a single drug.

Memory trick: Acetaminophen's liver task, Ibuprofen's different metabolic mask.

Injury to the abdomen caused by a non-penetrating force, often leading to internal organ damage and hemorrhage.

• Common causes include MVCs, falls, assaults.
• Signs include pain, rigidity, distention, ecchymosis, signs of shock.
• Internal hemorrhage is a major concern.

Memory trick: Baseball Bat to Belly? Bleeding is Bad!

Emergency management of seizures in infants/children associated with high fever, prioritizing airway and breathing, followed by fever reduction and transport.

• Common in 6 months to 5 years.
• Often related to rapid temperature rise.
• Airway management and oxygenation are paramount.
• Cooling measures are important for fever reduction.

Memory trick: Airway First, Then Cool

Emergency care for a patient with a core body temperature below 95°F (35°C), focusing on preventing further heat loss and gentle rewarming.

• Remove wet clothing, wrap in dry blankets.
• Move gently to a warm environment.
• Avoid aggressive rewarming in the field.
• Monitor cardiac rhythm carefully.

Memory trick: Cold Patient: Move, Insulate, Be Gentle!

The calculation and administration of the correct volume of albuterol solution for nebulization based on the prescribed dose and available concentration.

• Standard pediatric dose: 2.5 mg.
• Albuterol solutions come in various concentrations.
• Often pre-measured vials contain 2.5 mg in 3 mL.
• Administered via nebulizer until the solution is consumed.

Memory trick: Desired over Have, times the Volume is the math to solve.

The standard prehospital dose of epinephrine for managing severe allergic reactions (anaphylaxis) based on patient age/weight.

• Adult dose: 0.3 mg IM
• Pediatric dose: 0.15 mg IM
• Administered via auto-injector into the lateral thigh

Memory trick: Adults need 3, Kids get 1.5, both in the thigh!

Classification of external bleeding based on the type of blood vessel injured, influencing the color, flow, and severity of hemorrhage.

• Arterial: Bright red, spurting, severe.
• Venous: Dark red, steady flow, easier to control.
• Capillary: Oozing, superficial, usually minor.

Memory trick: Blood Flow: Art-Bright-Spurt, Vein-Dark-Steady, Cap-Ooze-Light!

A method to estimate the total body surface area (TBSA) affected by burns in children, differing from adults due to proportional body size differences.

• Head and neck: 18%
• Each arm: 9%
• Each leg: 13.5%
• Anterior trunk: 18%

Memory trick: Kid's Head is Big, Legs are Smaller!

Management of fluid loss in infants and children, ranging from oral rehydration for mild cases to IV fluids for severe cases, always prioritizing oxygenation.

• Sunken fontanelle, dry mucous membranes, decreased urine output are signs of dehydration.
• Lethargy indicates severe dehydration or other systemic compromise.
• Oxygenation is a primary intervention for any pediatric distress.

Memory trick: Oxygen First, Fluids Next

Clinical indicators in infants and children suggesting significant fluid loss, often due to vomiting, diarrhea, or reduced fluid intake.

• Sunken fontanelle (in infants), dry mucous membranes, decreased skin turgor.
• Reduced urine output, absence of tears when crying.
• Lethargy, irritability, increased heart rate, weak pulses.
• Capillary refill time >2 seconds.

Memory trick: FONTANELLE Sinks, MOUTH Dries, PEE Less, ENERGY Low = Dehydrated Flow!

The immediate interventions provided by EMTs to patients suspected of having a myocardial infarction, following a specific order of priority.

• Prioritize oxygen if SpO2 < 94% or respiratory distress.
• Administer Aspirin (162-324 mg chewable) to inhibit platelet aggregation.
• Administer Nitroglycerin (0.4 mg SL) for vasodilation and pain relief, if BP allows.
• Consider pain management (e.g., morphine by ALS), monitor vitals, rapid transport.

Memory trick: MONA is the MI guide, but O2 first, if lungs are tied.

During a generalized tonic-clonic seizure, hypoxia is a common and dangerous complication due to impaired breathing. Oxygen administration is a priority.

• Protect the patient from injury.
• Do NOT restrain or force anything into the mouth.
• Administer supplemental oxygen for cyanosis or respiratory distress.
• Monitor airway and be prepared to manage post-ictal state.

Memory trick: Protect, Position, Oxygenate, then Paramedics!

A spectrum of conditions associated with sudden, reduced blood flow to the heart, requiring immediate interventions like aspirin to reduce clot formation.

• Symptoms: chest pain (crushing, radiating), shortness of breath, diaphoresis, pallor.
• Aspirin is a primary intervention to inhibit platelet aggregation.
• Rapid transport to a cardiac-capable facility is critical.

Memory trick: MONA (Morphine, Oxygen, Nitroglycerin, Aspirin - in order)

Urinary tract infections in older adults often present with non-specific symptoms like confusion, lethargy, and functional decline, rather than classic urinary symptoms or fever.

• Altered mental status is a common presentation.
• May not have fever or dysuria.
• Increased risk in long-term care residents.
• Early recognition prevents severe complications (e.g., sepsis).

Memory trick: Confused Elder, Check Bladder

The principle of immobilizing a suspected extremity fracture in the position it is found, without attempting to realign it, to minimize further injury, pain, and potential complications.

• Prevents further soft tissue or nerve damage.
• Reduces pain for the patient.
• Avoids converting a closed fracture into an open fracture.
• Realign only if distal circulation is compromised and protocols allow.

Memory trick: Found It, Fix It (in place)!

Opioid overdose can cause severe respiratory depression, leading to hypoxemia and hypercapnia, requiring immediate ventilatory support and naloxone.

• Pinpoint pupils are a classic sign.
• Respiratory rate can drop dangerously low.
• Ventilatory support is the priority, even before naloxone, if breathing is inadequate.

Memory trick: Breathing First, Then Specifics

The emergency administration of an opioid antagonist to reverse the effects of an opioid overdose, primarily respiratory depression.

• Indications: Suspected opioid overdose with respiratory depression.
• Common routes: Intranasal (IN), Intramuscular (IM).
• Typical adult dose: 2 mg IN or 0.4 - 2 mg IM.
• Goal: Restore adequate spontaneous breathing.

Memory trick: Naloxone to the nose or muscle, for breath that's slow and in a tussle.

The immediate treatment of a severe, life-threatening allergic reaction, primarily involving the administration of epinephrine to counteract systemic effects.

• Recognize signs of anaphylaxis: respiratory distress, circulatory compromise, skin/mucosal changes.
• Epinephrine is the first-line medication; assist with patient's auto-injector if prescribed.
• Administer oxygen; monitor airway, breathing, and circulation.
• Rapid transport to a medical facility is essential.

Memory trick: Mild is Meds, Severe is Shot, then Swift Transport's the lot!

The primary management for suspected extremity fractures, involving the use of a splint to immobilize the injured area and adjacent joints to prevent movement, reduce pain, and avoid further injury.

• Prevents further soft tissue, nerve, or vascular damage.
• Reduces patient pain and discomfort.
• Minimizes the risk of a closed fracture becoming an open fracture.
• Always assess neurovascular status before and after splinting.

Memory trick: Stabilize, then Chill and Elevate!

Conditions or situations where the administration of nitroglycerin is not recommended or is actively harmful.

• Systolic blood pressure below 90-100 mmHg
• Recent use of erectile dysfunction medications (e.g., sildenafil, tadalafil)
• Head injury
• Known hypersensitivity

Memory trick: Nitro's low BP warning: watch the pressure, not just the pain.

The correct steps and patient instructions for using a metered-dose inhaler to ensure optimal medication delivery to the lungs.

• Shake the inhaler before use.
• Exhale completely.
• Depress canister and inhale slowly and deeply.
• Hold breath for 5-10 seconds.

Memory trick: Shake, breathe out, press and breathe in, then hold it tight, let relief begin!

A serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones, often due to insufficient insulin.

• High blood glucose (>250 mg/dL)
• Kussmaul's respirations (deep, rapid breathing)
• Fruity breath odor (acetone)
• Dehydration, altered mental status

Memory trick: Sugar High, Acid Fry

A serious condition in which the inner layer of the aorta tears, allowing blood to surge through the tear and separate the inner and middle layers of the aorta.

• Sudden, severe, tearing pain (chest, back, abdomen)
• Pulse deficits or unequal blood pressures between extremities
• Rapidly fatal if not surgically managed

Memory trick: Tear and Transport, Time is Tissue