NREMT Paramedic Cognitive Exam flashcards

For a stable patient with regular, narrow-complex tachycardia that does not convert with vagal maneuvers, the next intervention is adenosine, a rapid-acting medication that briefly blocks AV nodal conduction.

• Patient must remain stable (no signs of hypoperfusion).
• Adenosine is given as a rapid IV push, followed by a saline flush.
• Common side effects include brief asystole, flushing, chest discomfort.
• If adenosine is ineffective, a second dose of 12 mg can be given.

Memory trick: Vagal Failed? Adenosine's the Aim!

First-degree AV block is an ECG finding where the conduction from atria to ventricles is delayed, resulting in a prolonged PR interval.

• PR interval > 0.20 seconds.
• Every P wave is followed by a QRS complex.
• Usually asymptomatic, but can be associated with other conduction abnormalities.

Memory trick: PR too long? First degree. Long, longer, drop? Wenckebach. Constant, drop? Mobitz II. P's and Q's don't agree? Third degree.

NSTEMI and Unstable Angina are Acute Coronary Syndromes (ACS) characterized by myocardial ischemia without complete ST elevation, often presenting with atypical symptoms.

• ECG shows ST depression or T wave inversion, not ST elevation.
• Cardiac markers are elevated in NSTEMI but not Unstable Angina.
• Management includes antiplatelets, anticoagulants, and consideration of PCI.

Memory trick: Heart attack warning, act with speed, Aspirin and transport, what they need.

Cardiogenic shock is a state of severe heart pump failure, often due to acute myocardial infarction, characterized by persistent hypotension, signs of tissue hypoperfusion, and signs of pulmonary congestion (e.g., crackles).

• Caused by severe pump dysfunction (e.g., large MI, severe heart failure exacerbation).
• Hallmark signs: hypotension (SBP < 90 mmHg), signs of hypoperfusion (AMS, cool skin, oliguria), and pulmonary edema (crackles, dyspnea).
• Treatment focuses on improving cardiac output and maintaining perfusion while treating the underlying cause.

Memory trick: H.O.C.D. - Hypo, Obstructive, Cardio, Distributive

An infarction affecting the posterior wall of the left ventricle. It is often missed on standard 12-lead ECG as direct ST elevation is not seen in typical leads, but reciprocal changes are present.

• Reciprocal changes: ST depression in V1-V3, tall/broad R wave in V1, dominant R wave in V2.
• Requires posterior leads (V7, V8, V9) for direct ST elevation.
• Often associated with inferior or lateral MI.

Memory trick: Posterior: 'Reciprocal' ST 'Depression' in the 'Anterior' leads!

A type of ventricular tachycardia characterized by a wide QRS complex that varies in shape and amplitude. If pulseless, it is a cardiac arrest rhythm and is treated with immediate defibrillation.

• Often associated with underlying cardiac disease or electrolyte imbalances.
• Pulseless PVT is treated as VF: immediate defibrillation.
• Torsades de Pointes is a specific type of PVT associated with QT prolongation.

Memory trick: Irregular Wide + Pulseless: 'Shock It' before 'Seeking Specifics'!

Ventricular fibrillation is a chaotic electrical activity in the ventricles, leading to ineffective pumping and cardiac arrest. It is a shockable rhythm.

• Characterized by irregular, chaotic waveforms on ECG with no discernible QRS complexes.
• Patient is pulseless and unresponsive.
• Immediate high-quality CPR and rapid defibrillation are critical.
• Medications (epinephrine, amiodarone) are adjuncts to defibrillation.

Memory trick: Shock the VF, Save a Life Fast!

Chest pain or discomfort caused by myocardial ischemia (reduced blood flow to the heart muscle) that is predictable, reproducible, and relieved by rest or nitroglycerin.

• Occurs with physical exertion or emotional stress.
• Relieved by rest or sublingual nitroglycerin.
• Consistent pattern over time.

Memory trick: Stable Angina: 'Predictable' and 'Relieved by Rest'!

Strategies to reduce intracranial pressure (ICP) in patients with severe traumatic brain injury, aimed at preventing secondary brain injury.

• Maintain adequate cerebral perfusion pressure (CPP).
• Avoid hypotension and hypoxia.
• Osmotic agents (mannitol, hypertonic saline) are key for acute ICP reduction.

Memory trick: ICP's Crisis: Osmotic Options Open.

A condition in which increased pressure within a confined fascial compartment compromises the circulation and function of the tissues within that compartment.

• Often follows trauma, fractures, or crush injuries.
• Key signs: '6 Ps' - Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (though not all may be present early).
• Surgical emergency requiring fasciotomy.

Memory trick: Compartment's Cruel Clench: Pressure's Pains.

Controlled hyperventilation in severe traumatic brain injury (TBI) can temporarily reduce elevated intracranial pressure (ICP) by causing cerebral vasoconstriction.

• Used in severe TBI with signs of impending herniation.
• Causes cerebral vasoconstriction, reducing cerebral blood volume.
• Effect is temporary and must be used cautiously due to risk of cerebral ischemia.

Memory trick: Brain Crunch: Hyperventilate to avoid the Squish

Establishing and maintaining a patent airway in a trauma patient, often complicated by facial trauma, cervical spine injury, or altered mental status.

• Prioritize airway patency and protection.
• Maintain cervical spine immobilization.
• Orotracheal intubation is often definitive for severe TBI.

Memory trick: C-Spine, Facial Trauma: Intubate Immediately.

Injury to the liver, often caused by blunt abdominal trauma, leading to internal hemorrhage due to its high vascularity.

• Located in the right upper quadrant.
• Highly vascular organ, prone to significant bleeding.
• Presents with RUQ pain, tenderness, and signs of hypovolemic shock.

Memory trick: Right Upper Quadrant Trauma: Liver's Lair of Leaks.

A set of three primary signs that indicate increased intracranial pressure (ICP): hypertension (elevated systolic blood pressure), bradycardia (slow heart rate), and irregular respirations.

• Indicates severe brain compression.
• Often a late sign of increased ICP.
• Requires immediate intervention to prevent further brain damage.

Memory trick: Cushing's Triad: High Pressure, Slow Heart, Irregular Breath

A systematic approach to stop bleeding, progressing from least to most invasive: direct pressure, pressure dressing, tourniquet, and sometimes hemostatic agents.

• Direct pressure is the first and most effective step for most bleeding.
• Tourniquets are for severe, life-threatening extremity bleeding refractory to direct pressure.
• Arterial bleeding is characterized by bright red, spurting blood.

Memory trick: Direct, Dress, Turn, Pack

A collection of blood between the dura mater and the skull, typically caused by arterial bleeding (often middle meningeal artery) from a skull fracture, leading to rapid neurological deterioration.

• Often associated with a 'lucid interval' followed by rapid decline.
• Classic signs include ipsilateral pupil dilation and contralateral motor deficits.
• A surgical emergency requiring immediate decompression.

Memory trick: Brain Bleeds: Epidural Fast, Subdural Slow, SAH Thunder, DAI Diffuse

A formula used to calculate the amount of intravenous fluid (Lactated Ringer's) required for burn patients within the first 24 hours post-burn.

• Formula: 4 mL x patient weight (kg) x %TBSA burned.
• Half of the calculated total is given in the first 8 hours.
• The remaining half is given over the next 16 hours.

Memory trick: Parkland's Percent: Half in First Eight.

Immediate prehospital management of blunt or penetrating abdominal trauma with signs of hypovolemic shock focuses on airway, breathing, circulation (ABC) with aggressive fluid resuscitation and rapid transport.

• Hypotension and tachycardia indicate significant internal bleeding.
• Rigid/distended abdomen suggests peritonitis or internal hemorrhage.
• Large-bore IVs and crystalloid are crucial for fluid resuscitation.

Memory trick: ABCDE: Air, Blood, Circulation, Disability, Expose

Prehospital management of a suspected hip dislocation involves immobilizing the affected leg in the position found, providing pain management, and rapid transport.

• Posterior hip dislocations are most common (shortened, internally rotated leg).
• Anterior hip dislocations present with external rotation and abduction.
• Never attempt reduction in the prehospital setting.

Memory trick: Splint Smart: Assess, Align, Immobilize, Reassess

A more accurate method for estimating burn total body surface area (TBSA) in children, which adjusts for age-related proportional differences in body regions (e.g., larger head, smaller legs in infants/young children).

• More precise than the Rule of Nines for pediatric burns.
• Accounts for changes in body proportions with age.
• Different percentages for head, trunk, and extremities at various ages.

Memory trick: Lund-Browder: Child's Head Big, Legs Small

Increased risk of bleeding in patients taking anticoagulant medications, even from minor trauma, due to impaired blood clot formation.

• Common in elderly patients with comorbidities.
• Requires careful assessment and aggressive management of bleeding.
• Can lead to larger hematomas and increased blood loss from fractures.

Memory trick: Anticoagulants: Bleeding's Biggest Bad.

A condition resulting from inhalation of carbon monoxide (CO), which binds to hemoglobin with much greater affinity than oxygen, leading to tissue hypoxia despite normal pulse oximetry readings.

• Cherry-red skin is a classic but unreliable sign.
• Pulse oximetry is misleadingly normal because it cannot differentiate between O2Hb and COHb.
• Treatment is high-flow 100% oxygen to displace CO from hemoglobin.

Memory trick: CO=O2: Carbon Out, Oxygen In

For severely angulated long bone fractures with absent distal pulses, gentle manual traction to realign the limb and restore perfusion is the immediate priority after ABCs.

• Absent pulses indicate a limb-threatening emergency.
• Manual traction can often restore pulses by relieving pressure on vessels.
• If pulses are restored, then proceed with definitive splinting.

Memory trick: Fracture Fix: Assess, Traction, Splint, Reassess

The process of gently restoring an angulated fracture to a more anatomical position to reduce pain, prevent further injury, and facilitate splinting.

• Indicated for angulated fractures with intact distal neurovascular status.
• Performed gently and with continuous assessment of neurovascular status.
• Aids in proper splint application.

Memory trick: Open Fracture Angulation: Realignment Rescues.

An immobilization device filled with small beads that, when air is evacuated, molds to the patient's body contours, providing rigid support while minimizing pressure points.

• Superior to backboards for comfort and pressure sore prevention.
• Conforms to body shape, providing better immobilization.
• Can be used for various types of trauma, including spinal, pelvic, and extremity injuries.

Memory trick: Spine Safe: Vacuum Molds, Backboard Board, Collar Cares, KED Sits

A condition in which three or more adjacent ribs are fractured in two or more places, resulting in a segment of the chest wall that moves paradoxically to the rest of the chest during respiration.

• Caused by blunt chest trauma.
• Hallmark sign is paradoxical chest wall movement.
• Often associated with underlying pulmonary contusion.

Memory trick: CRASH: Chest Ribs Airway Shock, Heart

Prehospital care for a fractured femur, primarily involving the application of a traction splint to reduce pain and prevent further injury.

• Classic presentation: shortened, internally/externally rotated leg.
• High energy mechanism of injury.
• Traction splints are the definitive prehospital splint for femur fractures.

Memory trick: Femur's Fury: Traction's True Task.

Prehospital management of lightning strike victims prioritizes immediate CPR for cardiac/respiratory arrest, often with a focus on ventilation due to respiratory paralysis, and addressing associated injuries.

• Cardiac arrest is the most common immediate cause of death.
• Respiratory arrest is common due to brainstem stunning.
• Burns are often present but are usually secondary to cardiorespiratory compromise.

Memory trick: Lightning Life: CPR First, Then Burns

Threat to airway patency due to direct injury, swelling, or hematoma formation in the neck region, requiring immediate intervention.

• Rapidly expanding hematoma can compress the trachea.
• Gurgling respirations and stridor are warning signs.
• Definitive airway management is often required early.

Memory trick: Neck Hematoma: Airway's Alarm, Act Immediately.

Sudden cardiac arrest due to a blunt, non-penetrating blow to the chest wall over the heart, occurring during a critical period of the cardiac cycle, resulting in ventricular fibrillation.

• Often seen in young athletes.
• Impact must occur during the T-wave upstroke.
• Immediate defibrillation is the only effective treatment.

Memory trick: Blunt Blow to Chest: Commotio's Cruel Call.

A collection of blood between the dura mater and the skull, typically caused by arterial bleeding (e.g., middle meningeal artery) after head trauma.

• Often associated with temporal bone fracture.
• Classic presentation: 'lucid interval' followed by rapid deterioration.
• Key signs: Ipsilateral fixed and dilated pupil, Cushing's triad.

Memory trick: Epidural's Evil: Pupil's Peril, Pressure's Peak.

Prehospital care for an injury where an object is embedded in the body, emphasizing stabilization rather than removal.

• Do not remove impaled objects (unless interfering with airway/CPR).
• Stabilize the object in place with bulky dressings.
• Control bleeding around the object.

Memory trick: Impaled: Immobilize It, Don't Dislodge It.

A type of distributive shock caused by a severe spinal cord injury (typically above T6) that results in loss of sympathetic nervous system tone, leading to widespread vasodilation, hypotension, and bradycardia.

• Characterized by hypotension, bradycardia, and warm, dry skin.
• Distinguish from spinal shock (which is a temporary loss of function, not a circulatory shock).
• Requires fluid resuscitation and often vasopressors to increase blood pressure.

Memory trick: Shock Says: Hypo=Fast, Neuro=Slow, Anaphy=Hives, Cardio=Wet

Rapid accumulation of more than 1500 mL of blood in the pleural space, often from chest wall or mediastinal vessel injury, leading to lung collapse and hypovolemic shock.

• Causes absent breath sounds on affected side.
• Can lead to jugular vein distension due to mediastinal shift or hypovolemia affecting venous return.
• Hypotension and tachycardia are common due to blood loss.

Memory trick: Chest Check: Breath, Blood, Bones, Big Veins

Spinal injury resulting from a compressive force applied along the long axis of the spine, often seen in falls where the person lands on their feet or buttocks.

• Commonly causes compression fractures.
• Lumbar spine is a frequent site of injury (L1-L2).
• Often associated with calcaneal fractures.

Memory trick: Feet First Fall: Lumbar's Last Stand.

Rapid reduction of heart rate and blood pressure to decrease aortic shear stress and prevent further dissection.

• Beta-blockers are first-line to reduce HR and BP.
• Pain control is secondary to hemodynamic stability.
• Avoid medications that cause reflex tachycardia.

Memory trick: Dissecting Aorta: Don't Rush Blood, Relax the Heart!

Use of devices to restrict movement of the head, neck, and torso to protect the spinal cord from further injury.

• Required for suspected spinal trauma based on MOI or symptoms.
• Includes manual stabilization, C-collar, and long backboard/vacuum mattress.
• Goal is to prevent secondary injury to the spinal cord.

Memory trick: Spine Safe: Secure, Protect, Immobilize Now, Everyone!

Nitroglycerin should be used with extreme caution or avoided in inferior MIs, especially if hypotension is present or develops, due to potential right ventricular involvement and preload dependence.

• Inferior MIs often involve the right ventricle.
• RV MIs are preload-dependent.
• Nitroglycerin reduces preload, risking severe hypotension.

Memory trick: Inferior MI, BP's Low, Nitro's a NO-GO!

Management involves vagal maneuvers, then adenosine, or calcium channel blockers/beta-blockers for rate control.

• Vagal maneuvers are first-line.
• Adenosine is drug of choice if vagal maneuvers fail.
• Ensure patient is hemodynamically stable.

Memory trick: Vagal's Vain, Adenosine's Aim, Diltiazem's Game!

The selection of an oxygen delivery device depends on the patient's oxygenation status, respiratory effort, and underlying condition, aiming to achieve adequate tissue oxygenation.

• Non-rebreather mask delivers highest FIO2 (up to 90-100%) for severe hypoxia.
• Nasal cannula provides low flow (1-6 L/min) for mild hypoxia.
• Venturi mask delivers precise FIO2 (24-60%) for controlled oxygen therapy.
• Bag-valve mask assists ventilation in apneic or hypoventilating patients.

Memory trick: O2 Devices: How Much Oxygen Do They Need?

When an AED advises 'no shock advised', it indicates a non-shockable rhythm (asystole or PEA). The immediate next step is to resume or continue high-quality CPR for 2 minutes before re-analyzing the rhythm.

• AED assesses cardiac rhythm.
• 'No shock advised' means non-shockable (asystole or PEA).
• Immediate action: Continue CPR for 2 minutes.
• Re-analyze rhythm after 2 minutes of CPR.

Memory trick: No Shock? Keep Pumping for Two!

Clinical manifestations resulting from elevated pressure within the skull, often due to brain injury, hemorrhage, or edema.

• Altered mental status is an early sign.
• Pupillary changes (anisocoria, sluggish reaction) are common.
• Cushing's triad (hypertension, bradycardia, irregular respirations) is a late and ominous sign.

Memory trick: Pressure in the brain makes a patient look CRAZY!

Applying firm, consistent pressure directly over a bleeding wound to compress blood vessels and promote clotting.

• First-line treatment for most external bleeding.
• Uses a sterile dressing or clean cloth.
• Maintain pressure for several minutes without peeking.

Memory trick: Don't Panic, Just Press Hard!

Emergency care for a fracture where the skin is broken, exposing the bone to the environment.

• Control bleeding first.
• Cover exposed bone with sterile dressing.
• Do not attempt to push bone back in.
• Immobilize the fracture.

Memory trick: Broken Bone Out, Bleeding Out, Better Bind!

Caustic ingestions can cause severe burns to the upper airway and esophagus, leading to rapid swelling and airway compromise. The primary prehospital concern is to assess and secure a patent airway before addressing other interventions.

• Caustic substances cause chemical burns.
• Airway swelling/burns are immediate life threats.
• Drooling, stridor, hoarseness indicate airway compromise.
• Activated charcoal and inducing vomiting are contraindicated.

Memory trick: Caustic: Airway First, Don't Make Them Puke!