NREMT Paramedic Cognitive Exam flashcards

A sequence of critical actions that, when performed in rapid succession, increase the likelihood of survival from cardiac arrest.

• Immediate recognition and activation.
• Early high-quality CPR.
• Rapid defibrillation.
• Effective advanced life support.

Memory trick: CPR is the Heart of Survival.

Prioritizing and securing the airway in severe anaphylaxis, especially when signs of upper airway obstruction (e.g., stridor, angioedema) are present, which can rapidly progress to complete obstruction.

• Airway compromise is a primary cause of death in anaphylaxis.
• Stridor indicates severe upper airway swelling.
• Prepare for advanced airway (intubation, cricothyrotomy) proactively.

Memory trick: Airway's tight, or the patient's flight to endless night.

The principle that EMS providers must prioritize their own and their team's safety, and the safety of the patient and bystanders, before initiating patient care.

• Always the first step in any emergency response.
• Involves identifying, evaluating, and mitigating potential hazards.
• Protects providers, patients, and bystanders from harm.

Memory trick: Safety First, Then Care, Always Aware.

Recording factual, measurable, and observable information in a patient care report, avoiding subjective interpretations, opinions, or assumptions.

• Based on facts, not opinions.
• Uses specific, measurable details (e.g., vital signs, GCS, timeframes).
• Avoids vague terms, speculation, or judgment.
• Enhances continuity of care and legal defensibility.

Memory trick: Facts Only, No Guesses, Time and Measure.

A condition where the right ventricle loses pumping power, leading to blood backing up in the body's veins.

• Commonly causes peripheral edema and jugular venous distension.
• Often a consequence of left-sided heart failure.
• Can lead to fluid accumulation in the abdomen (ascites).

Memory trick: JVD and Edema, Heart's Failing System.

The safe and legal operation of an ambulance under emergency conditions, balancing rapid patient transport with public safety.

• Emergency vehicles do not have absolute right-of-way.
• Drivers must always operate with due regard for the safety of all persons.
• Local laws and policies dictate specific procedures for intersections.

Memory trick: Safety First, then Patient's Urgency.

Emergency management of acute worsening of asthma symptoms in children, focusing on rapid bronchodilation, oxygenation, and reducing airway inflammation.

• Oxygen administration is crucial.
• Inhaled short-acting beta-agonists (e.g., Albuterol) are first-line.
• Ipratropium bromide can be added for synergistic effect.
• Corticosteroids (e.g., Dexamethasone) reduce inflammation but have delayed onset.

Memory trick: Oxygen, Bronchodilate, Inflame-Reduce, Repeat.

Emergency care for a patient with a suspected ruptured abdominal aortic aneurysm, prioritizing rapid transport to definitive surgical care while maintaining permissive hypotension and supporting vital functions.

• Definitive treatment is surgical repair.
• Avoid aggressive fluid resuscitation (permissive hypotension).
• Focus on rapid transport.
• Monitor for shock and provide symptomatic support.

Memory trick: Ruptured AAA: Run Fast, Don't Over-Fill, Get to OR.

A chaotic electrical activity in the ventricles causing them to quiver uselessly instead of contracting effectively, leading to immediate cardiac arrest. The primary treatment is rapid defibrillation.

• Life-threatening arrhythmia requiring immediate intervention.
• Characterized by irregular, uncoordinated electrical activity.
• Defibrillation is the definitive treatment.

Memory trick: Shock the heart, save the start!

A life-threatening condition where air enters the pleural space but cannot escape, building up pressure that collapses the lung and shifts mediastinal structures, impairing cardiac output.

• Absent breath sounds on affected side.
• Tracheal deviation (late sign, away from affected side).
• Increasing respiratory distress, hypotension, difficulty ventilating.
• Requires immediate needle decompression.

Memory trick: Tracheal shift, no breath, needle's gift, or face death.

The characteristic signs and symptoms of pain caused by an obstruction in the urinary tract, most commonly a kidney stone, leading to severe spasms.

• Sudden onset, severe, sharp pain.
• Unilateral flank pain radiating to the groin or genitals.
• Often accompanied by nausea, vomiting, and restlessness.
• Caused by obstruction (e.g., kidney stone) in the ureter.

Memory trick: Pain Location Points to the Problem's Core.

The paramount principle in managing hazardous materials incidents, emphasizing responder protection above all else, including patient care, until the scene is rendered safe.

• Responder safety is the highest priority.
• Never enter a hot zone without proper training and PPE.
• Scene control and specialized resources are essential.

Memory trick: Danger first, then help, or you'll be buried deep.

Verifying the correct placement of an intraosseous needle before administering fluids or medications.

• Key indicators: 'pop' sensation on insertion, standing needle, aspiration of marrow/blood.
• Lack of infiltration during flush.
• Initial flush resistance is common due to bone marrow density.

Memory trick: Aspirate to Confirm, Then Flush with Care.

The process of thoroughly documenting a patient's decision to refuse medical care or transport, ensuring it is informed, voluntary, and the patient has capacity.

• Patient must be of sound mind and understand consequences.
• Document assessment of mental capacity.
• List specific risks explained to the patient.
• Obtain signature and witness if possible.

Memory trick: Refusal Needs Capacity, Risks, Understanding, and Witness.

The process of determining the correct volume or amount of medication to administer based on the desired dose and the available concentration of the drug.

• Formula: Dose Ordered / Concentration Available = Volume to Administer.
• Ensure units are consistent (e.g., mg to mg, mL to mL).
• Crucial for patient safety and accurate drug delivery.

Memory trick: Desired on top, have on the bottom, times the volume, don't be forgotten!

A legal document or order signed by a patient or their legal proxy and a physician, instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) or other life-sustaining measures.

• Must be legally valid (signed, current, specific to the patient).
• Takes precedence over family wishes if valid.
• Paramedics must honor valid DNRs.

Memory trick: Patient's will, not family's thrill, keeps the legal bill still.

Providing essential medical care to an entrapped patient while extrication efforts are ongoing.

• Paramedics are patient advocates during extrication.
• Care includes airway, breathing, circulation, and pain management.
• Safety of personnel and patient is paramount.

Memory trick: Patient First, Even While Trapped.

Management of a slow heart rate in infants and children, which is most commonly secondary to hypoxia. Effective ventilation and oxygenation are the primary interventions.

• Bradycardia (<60 bpm) in infants is usually hypoxia-driven.
• Positive pressure ventilation is the initial priority.
• Chest compressions if bradycardia persists despite ventilation.

Memory trick: Bradycardia's breath, prevents infant's death.

Emergency treatment for fluid accumulation in the lungs, often due to left-sided heart failure, focusing on improving oxygenation, reducing cardiac workload, and removing fluid.

• Commonly caused by acute left ventricular failure.
• Symptoms include severe dyspnea, orthopnea, crackles, and often hypertension.
• Treatment involves oxygen, vasodilators (e.g., nitroglycerin), diuretics, and sometimes CPAP.

Memory trick: Oxygen, Sit Up, Nitro, Push the Fluid Out, Don't Drown.

Guidelines determining when a pediatric trauma patient requires transport to a specialized trauma center (Level I or II, often pediatric-specific) based on injury severity, mechanism, and physiological parameters.

• Physiological criteria: GCS < 14, SBP < 90, RR < 10 or > 29.
• Anatomical criteria: penetrating injuries, flail chest, pelvic fractures, amputations, paralysis, severe head/spinal injuries.
• Mechanism of injury: falls > 20 feet (adults), > 10 feet or 2-3x height (children), high-speed MVC, auto-pedestrian.

Memory trick: Severe Injury, High Center, Fast Transport.

Interventions aimed at maintaining cerebral perfusion and minimizing secondary brain injury in the prehospital setting for patients with traumatic brain injury.

• Primary goal is to prevent hypoxia and hypotension.
• Avoid aggressive hyperventilation unless signs of herniation are present.
• Head elevation aids venous drainage.

Memory trick: Normo-Vent, Head Up, Keep Brain Safe.

Early recognition and aggressive treatment of sepsis in the prehospital setting to improve patient outcomes.

• Prioritize airway, breathing, circulation.
• Aggressive fluid resuscitation for hypotension.
• Rapid transport to appropriate facility.

Memory trick: Fluids First, for Febrile Shock.

Adenosine is an antiarrhythmic medication used to terminate supraventricular tachycardia (SVT) by temporarily blocking the AV node. It is given as a rapid IV push.

• Initial dose: 6 mg rapid IV push.
• Second dose (if needed): 12 mg rapid IV push.
• Always followed by a rapid saline flush.
• Fixed adult dose, not weight-based.

Memory trick: Adenosine's a blur, 6 then 12, make it occur!

A life-threatening condition where a weakened section of the aorta bursts, leading to massive internal bleeding.

• Classic triad: abdominal/back pain, hypotension, pulsatile abdominal mass (though often absent).
• Requires immediate surgical repair.
• Prehospital care focuses on fluid resuscitation and rapid transport.

Memory trick: Fluid First to Fight the Bleed.

Emergency care for patients who have ingested corrosive substances, focusing on airway protection, avoiding further harm, and rapid transport for definitive evaluation.

• Airway management is paramount due to potential edema/burns.
• Do NOT induce vomiting.
• Do NOT administer activated charcoal.
• Avoid dilution with milk/water unless specifically advised by poison control.

Memory trick: Caustic Airway First, No Puke, No Charcoal.

Potential issues that can arise after performing a needle decompression for a tension pneumothorax, often leading to a recurrence of symptoms.

• Temporary measure, not definitive treatment.
• Catheter can kink, clog, or become dislodged.
• Air can re-accumulate, leading to recurrent tension.

Memory trick: Needle's a start, but air's a dart, it can restart the heart's sad part.

Injuries that, if not immediately identified and managed, can rapidly lead to patient death due to compromise of vital functions (e.g., airway, breathing, circulation).

• Flail chest compromises ventilation.
• Tension pneumothorax, massive hemothorax, open pneumothorax.
• Cardiac tamponade, uncontrolled hemorrhage.

Memory trick: ABCDE, don't miss a beat, or the patient's fate you'll meet.

Calculating the volume of Dextrose solution needed to deliver a specific dose based on its percentage concentration.

• X% solution means X grams per 100 mL.
• Use dimensional analysis or ratio-proportion to solve.
• Always double-check calculations before administration.

Memory trick: Desired Over Have, Times Volume.

A medical order indicating that the patient desires interventions focused solely on symptom management, pain relief, and maximizing comfort, without initiating life-prolonging treatments.

• Prioritizes patient comfort and dignity.
• Does NOT mean withholding pain medication; often means aggressive pain management.
• Respects patient's wishes for end-of-life care.
• Is a legally binding medical order.

Memory trick: POLST for Comfort Means Pain Relief is a Must.

A rapid, systematic method for triaging mass casualty incident (MCI) patients into categories (immediate, delayed, minor, deceased) based on simple physiological assessments.

• Used for initial patient categorization in MCIs.
• Assesses ability to walk, respirations, perfusion, and mental status (RPM).
• Categories: Red (Immediate), Yellow (Delayed), Green (Minor), Black (Deceased).

Memory trick: Mass Casualty Needs START to Sort.

The legal principle that allows emergency medical care to be provided to an unconscious, incapacitated, or mentally impaired individual (e.g., due to psychiatric crisis or intoxication) who is unable to give express consent, especially when there is a threat to life or limb, or to self/others.

• Applies when patient lacks decision-making capacity.
• Used when patient is a threat to self or others.
• Often involves law enforcement for transport.

Memory trick: Capacity's key, or implied consent sets you free.

Infection control measures to prevent the spread of bacterial meningitis, primarily through respiratory droplets.

• Transmitted via respiratory droplets.
• Requires droplet precautions.
• Patient wears a surgical mask; providers wear surgical masks and eye protection.

Memory trick: Meningitis is Droplet, Mask Up.

A component of the START triage method that assesses circulatory status by checking for the presence or absence of a radial pulse.

• Radial pulse present = perfusion likely adequate.
• Radial pulse absent = hypoperfusion/shock, triage as Immediate (Red).
• This is a rapid assessment to identify life-threatening circulatory compromise.

Memory trick: RPM: Respiration, Perfusion, Mental Status.

An Incident Command System role within the Operations Section responsible for organizing, supervising, and providing medical care to patients in the designated treatment area during an incident.

• Part of the Operations Section.
• Manages patient care within the treatment area.
• Reports to the Medical Branch Director (if established) or Operations Section Chief.

Memory trick: Treatment leader: care's main feeder.

A patient's decision to decline medical care or transport after being fully informed of their medical condition, the proposed treatment, alternative treatments, and the potential risks and consequences of refusal.

• Patient must have decision-making capacity.
• Must be informed of risks, benefits, alternatives.
• Documentation of informed refusal is legally crucial.

Memory trick: Inform and document, or legal woes will torment.

An AED message indicating that the patient's cardiac rhythm is not shockable (e.g., asystole or pulseless electrical activity), requiring immediate continuation of CPR.

• Means the rhythm is either asystole or PEA.
• Do NOT deliver a shock.
• Immediately resume high-quality chest compressions.
• Check pulse, if none, continue CPR.

Memory trick: Shock If Advised, Otherwise Pump Hard and Fast.

Intravenous methylprednisolone is a corticosteroid used in pediatric severe asthma exacerbations to reduce airway inflammation. The typical dose is 1 mg/kg IV.

• Corticosteroid for inflammation.
• Dose: 1 mg/kg IV.
• Used in severe asthma exacerbations.

Memory trick: For a 'severe asthma blast', 'one mg per kg' of 'methylprednisolone' will 'act fast'.

A pulmonary embolism occurs when a blood clot blocks an artery in the lungs. Classic symptoms include sudden dyspnea, pleuritic chest pain, hypoxemia, tachycardia, and a sense of impending doom, often with clear lung sounds.

• Sudden onset dyspnea and pleuritic chest pain.
• Hypoxemia, tachycardia, anxiety.
• Common risk factors: recent surgery, immobility, DVT.

Memory trick: When 'SUDDEN' dyspnea and 'SHARP' pain hit, think 'PE', it's a 'PULMONARY EMERGENCY'.

Epiglottitis is a critical pediatric airway emergency characterized by inflammation of the epiglottis. Management focuses on minimizing agitation, maintaining a patent airway, and rapid transport for definitive airway control.

• Do not attempt airway visualization.
• Minimize agitation and keep child comfortable.
• Rapid transport to an appropriate facility.

Memory trick: For 'EPIGLOTTITIS', 'E' means 'EMERGENCY', 'P' means 'POSITION OF COMFORT', 'I' means 'IMMEDIATE TRANSPORT', 'G' means 'GENTLY, NO AGITATION'.

A 'silent chest' in the context of a severe asthma exacerbation refers to diminished or absent breath sounds, often with a reduction in audible wheezing, despite ongoing and severe respiratory distress. It is an ominous sign indicating critically reduced airflow and impending respiratory failure due to severe airway obstruction and exhaustion.

• Indicates severe airflow obstruction and air trapping.
• A sign of impending respiratory arrest.
• Requires immediate and aggressive advanced airway interventions.

Memory trick: Silent Chest Spells Severe Crisis

Albuterol is a short-acting beta-2 adrenergic agonist (SABA) that causes bronchodilation by relaxing the smooth muscles in the airways. It is the first-line medication for rapid relief of acute bronchoconstriction in asthma exacerbations.

• Rapid onset of action (5-15 minutes).
• Administered via nebulizer or metered-dose inhaler.
• Common side effects include tachycardia and tremors.

Memory trick: Albuterol Always Addresses Asthma

CPAP applies continuous positive airway pressure to support ventilation, reduce work of breathing, and improve oxygenation in patients with COPD exacerbations, often preventing the need for intubation.

• Reduces work of breathing.
• Improves oxygenation.
• Non-invasive ventilation.

Memory trick: When oxygen alone 'falls flat', CPAP is the 'next step on the mat'.

Administering oxygen to COPD patients requires careful titration to maintain an SpO2 between 88-92% to avoid suppressing their hypoxic respiratory drive.

• Target SpO2: 88-92%.
• Avoid excessive oxygen.
• Monitor respiratory drive.

Memory trick: For COPD, 'Keep the Oxygen Calm, 88-92 is the Golden Balm'.

Croup is a common viral infection of the upper airway, primarily affecting young children, characterized by inflammation and swelling of the larynx, trachea, and bronchi. Key symptoms include a distinctive 'barking' cough, inspiratory stridor, and hoarseness.

• Caused by viral infection (e.g., parainfluenza virus).
• Affects children 6 months to 3 years most commonly.
• Symptoms: barking cough, inspiratory stridor, hoarseness, low-grade fever or afebrile.
• Management: humidified oxygen, nebulized racemic epinephrine, corticosteroids.

Memory trick: Barking, stridor, no fever? Croup's the clear receiver.

Opioid overdose reversal involves administering an opioid antagonist (naloxone) to reverse respiratory depression and providing ventilatory support (BVM) to maintain oxygenation and ventilation until the naloxone takes effect.

• Respiratory depression is the primary cause of morbidity and mortality.
• Naloxone has a rapid onset but short half-life.
• Monitoring respiratory effort and effectiveness is paramount.

Memory trick: Naloxone's Rapid Respiration Revival

Oxygen delivery in pediatric patients requires consideration of age, tolerance, and the need for high FiO2. Blow-by oxygen is often preferred for infants and young children in respiratory distress who may not tolerate a tight-fitting mask, providing high-concentration oxygen without increasing anxiety.

• Infants/children may become agitated by tight masks.
• Blow-by oxygen delivers high FiO2 if flow is high and mask is close.
• Goal is to improve oxygenation while minimizing distress.

Memory trick: Blow-By Best for Baby's Distress

Tension pneumothorax is a life-threatening condition caused by air entering the pleural space and becoming trapped, leading to increasing pressure that collapses the lung and shifts mediastinal structures. In intubated patients, positive pressure ventilation can exacerbate this rapidly.

• Classic signs: sudden dyspnea, absent breath sounds unilaterally, tracheal deviation (late), JVD, hypotension.
• In intubated patients, positive pressure ventilation can worsen air trapping and accelerate development.
• Treatment: immediate needle decompression on the affected side (2nd intercostal space, midclavicular line or 4th/5th ICS, mid-axillary line).

Memory trick: DROP in O2, absent sounds, BP low? Think tension, let the air flow!

Croup is a viral infection causing inflammation of the larynx, trachea, and bronchi, characterized by a 'barking' cough and inspiratory stridor. Treatment ranges from humidified air for mild cases to racemic epinephrine and steroids for more severe presentations.

• Humidified air/oxygen for mild cases.
• Racemic epinephrine for moderate/severe stridor.
• Corticosteroids reduce inflammation.

Memory trick: Croup's 'bark' needs 'cool mist' to 'calm' the airway.

A technique used to open the airway in patients with suspected cervical spine injury by displacing the mandible anteriorly without extending the neck.

• Used for unconscious patients with suspected C-spine injury.
• Minimizes neck movement.
• Opens the airway by lifting the jaw.

Memory trick: Jaw-Thrust: When you 'jaw-thrust' a patient, you're 'thrusting' them towards safety from spinal injury.

During cardiopulmonary resuscitation (CPR) for infants, the recommended ventilation rate is 20-30 breaths per minute (1 breath every 2-3 seconds) to provide adequate oxygenation without causing hyperventilation, which can compromise circulation.

• Infants have higher metabolic rates and smaller lung capacities.
• Higher ventilation rate compared to adults/children.
• Avoid hyperventilation as it can decrease cardiac output.

Memory trick: Adults Slow, Kids Medium, Babies Fast Breaths

For an adult patient with inadequate breathing requiring positive pressure ventilation, the recommended rate is 10-12 breaths per minute (one breath every 5-6 seconds).

• Adults: 10-12 breaths/min.
• One breath every 5-6 seconds.
• Avoid hyperventilation.

Memory trick: Adults need 'Ten to Twelve' breaths to 'feel alive'.

Continuous Positive Airway Pressure (CPAP) is a non-invasive ventilation technique that applies constant positive pressure to the airways, primarily used in prehospital settings for patients with acute pulmonary edema or severe respiratory distress to improve oxygenation and reduce the work of breathing.

• Reduces preload and afterload, decreasing cardiac workload.
• Increases functional residual capacity and alveolar recruitment.
• Decreases intubation rates and hospital length of stay in appropriate patients.

Memory trick: CPAP Cures Patients' Awful Puffs

Gastric distension during bag-valve-mask (BVM) ventilation occurs when air enters the stomach, often due to excessive ventilation pressure or volume. It can lead to regurgitation and aspiration, and can impair lung inflation. Proper technique involves using minimal tidal volume and a slow, gentle breath.

• Caused by excessive pressure or volume.
• Increases risk of regurgitation and aspiration.
• Can reduce lung compliance and ventilation effectiveness.

Memory trick: BVM's Big Volume Mistakes

Pulmonary embolism (PE) is a life-threatening condition caused by a blood clot (embolus) lodging in the pulmonary arteries. Its presentation can be varied but often includes sudden onset dyspnea, pleuritic chest pain, anxiety, and a feeling of impending doom, sometimes with relatively clear lung sounds.

• Classic triad: dyspnea, chest pain, hemoptysis (infrequent).
• Often presents with sudden onset symptoms out of proportion to physical exam.
• Risk factors: immobility, surgery, cancer, oral contraceptives, previous DVT/PE.
• Physical exam: tachycardia, tachypnea, sometimes clear lung sounds, or non-specific wheezing/crackles.

Memory trick: Sudden doom, clear lungs, no asthma? PE's the silent drama.

Bronchiolitis is a common viral lower respiratory tract infection in infants and young children, characterized by a preceding URI, wheezing, tachypnea, and respiratory distress.

• Affects infants/young children.
• Often follows URI.
• Key symptom: expiratory wheezing.

Memory trick: Bronchiolitis' 'B' is for 'Baby Wheezing' after a 'Bad Cold'.

PPV, typically delivered via BVM, manually forces air into the lungs of a patient who is apneic or has inadequate breathing, ensuring oxygenation and ventilation.

• Used for apnea or inadequate breathing.
• Requires a patent airway.
• Delivers breaths manually.

Memory trick: When breathing is 'low and slow', you need to 'blow' with a BVM to make it 'go'.

Flail chest results from multiple rib fractures causing a segment of the chest wall to move paradoxically with respiration. Initial prehospital management focuses on aggressive oxygenation, pain control, and potentially positive pressure ventilation to stabilize the chest wall and improve gas exchange.

• Paradoxical chest wall movement is characteristic.
• Severe pain and hypoxemia are common.
• Positive pressure ventilation (e.g., CPAP or BVM) can internally splint the segment.

Memory trick: Oxygen First for Trauma's Flailing Chest

Management of severe asthma exacerbation involves rapid administration of bronchodilators, oxygen, and systemic corticosteroids. Reassessment of clinical status and objective measures like PEFR is critical to guide further therapy, which may include additional bronchodilators, magnesium sulfate, or consideration of advanced airway.

• PEFR < 50% of personal best indicates severe exacerbation.
• Initial treatment: oxygen, inhaled SABA (albuterol), ipratropium, systemic steroids.
• Reassessment guides further treatment (repeat SABA, magnesium, intubation if respiratory arrest imminent).

Memory trick: Bronchodilate, reassess, then escalate or stabilize the stress.

An OPA is a curved device inserted into the oropharynx to prevent the tongue from obstructing the airway in unresponsive patients without a gag reflex. It lifts the tongue off the posterior wall of the pharynx, creating a patent airway.

• Indicated for unresponsive patients without a gag reflex.
• Contraindicated if patient has a gag reflex or oral trauma.
• Proper sizing is crucial (corner of mouth to angle of mandible or earlobe).
• Can be inserted rotated 180 degrees then flipped, or directly with tongue depressor.

Memory trick: Snoring means tongue, OPA's the key, then breathe free.

Administering oxygen to patients with Chronic Obstructive Pulmonary Disease (COPD) requires careful titration to avoid suppressing their hypoxic drive, which can lead to hypoventilation and CO2 retention. A Venturi mask is often preferred for its ability to deliver precise concentrations of oxygen.

• COPD patients may rely on hypoxic drive to breathe.
• Excessive oxygen can abolish hypoxic drive, leading to hypoventilation.
• Target SpO2 for COPD is typically 88-92%.

Memory trick: Venturi's Very Controlled Oxygen Flow