Clinical Judgment
31-35%of exam
Medical OB-GYN
25-29%of exam
Cardiology Resuscitation
11-15%of exam
ArrestECG BasicsACSShockable
Airway Respiration Ventilation
9-13%of exam
Trauma
7-11%of exam
HemorrhageChest TraumaBurnsSpine
EMS Operations
6-10%of exam
Scene SafetyMCILegalICS
Quick Facts
- Exam
- NREMT AEMT
- Format
- Linear CBT
- Items
- 135 total
- Scored
- 100 items
- Pilot
- 35 items
- Time
- 3 hours
- Provider
- Pearson VUE
- Fee
- $159
CJ Cycle
Recognize, analyze, hypothesize, solve, act, evaluate
Recognize cuesAnalyze cuesDefine hypothesisEvaluate response
Assessment vs Treatment
Assessment
- Find cues
- Form impression
- Trend response
Treatment
- Fix threats
- Follow protocol
- Reassess effect
Know before doing
Scenario Picker
- Unsafe scene→Stage away
- Major bleeding→Control hemorrhage
- Airway threat→Open airway
- Shock signs→Rapid transport
- Treatment fails→Reassess cues
- Many patients→Triage system
- Patient refuses→Assess capacity
- Handoff due→SBAR report
CJ Cycle
- Recognize cues
- Find critical data
- Analyze cues
- Sort likely causes
- Hypothesis
- Working impression
- Solutions
- Pick interventions
- Take action
- Treat priority first
- Evaluate
- Reassess response
SAMPLE
Signs, allergies, meds, past, last, events
SymptomsAllergiesMedicationsEvents
Scene Flow
- BSI
- Protect responders
- Scene size-up
- Hazards and MOI
- Primary
- Life threats
- OPQRST
- Pain story
- SAMPLE
- History snapshot
- Reassessment
- Trend changes
APGAR
Appearance, pulse, grimace, activity, respirations
1 minute5 minutesScore 0-2Ventilate if needed
Hypo vs Hyperglycemia
Hypoglycemia
- Fast onset
- Cool clammy
- Glucose low
Hyperglycemia
- Slow onset
- Warm dry
- Ketone odor
Low is fast
Medical Picker
- AMS diabetic→Check glucose
- Hypoglycemia awake→Oral glucose
- Anaphylaxis shock→Epinephrine
- Opioid breathing slow→Ventilate naloxone
- Stroke suspected→Stroke center
- Seizure active→Protect airway
- Prolapsed cord→Relieve pressure
- Newborn apneic→Warm ventilate
Medical Cues
- Hypoglycemia
- AMS diaphoresis
- Hyperglycemia
- Polyuria fruity breath
- Anaphylaxis
- Airway plus hypotension
- Stroke
- FAST positive
- Seizure
- Protect from injury
- Overdose
- Toxidrome pattern
- Sepsis
- Infection plus shock
Previa vs Abruptio
Previa
- Painless bleeding
- Placenta low
- Soft uterus
Abruptio
- Painful bleeding
- Placenta separates
- Rigid uterus
Pain points abrupt
OB Neonatal
- Preeclampsia
- HTN after 20 weeks
- Eclampsia
- Seizure with pregnancy
- Placenta previa
- Painless bleeding
- Abruptio
- Painful bleeding
- Prolapsed cord
- Elevate presenting part
- APGAR
- One and five
- Neonate CPR
- 3:1 ratio
Defib vs Cardiovert
Defib
- Pulseless rhythm
- Unsynchronized
- VF pulseless VT
Cardiovert
- Pulse present
- Synchronized
- Unstable tachy
No pulse no sync
Cardiac Arrest
- CPR rate
- 100-120 per min
- Adult depth
- 2-2.4 inches
- Compression ratio
- 30:2 adults
- Shockable
- VF pulseless VT
- Nonshockable
- PEA asystole
- Epinephrine
- Every 3-5 min
- ROSC
- Pulse returns
ECG ACS
- SVT
- Fast narrow regular
- V-tach
- Wide regular tachy
- Inferior
- II III aVF
- Anterior
- V1 through V4
- Lateral
- I aVL V5 V6
- Right MI
- Hypotension clear lungs
- Nitro hold
- SBP under 90
Oxygen vs Ventilation
Oxygen
- Improves FiO2
- Treats hypoxemia
- Patient breathes
Ventilation
- Moves air
- Removes CO2
- You breathe
O2 is not air
Airway Picker
- Suspect C-spine→Jaw thrust(Avoid extension)
- Unconscious no gag→OPA
- Gag present→NPA(Avoid skull fracture)
- Secretions visible→Suction(Limit pass time)
- Poor tidal volume→BVM(Chest rise only)
- BVM failing→SGA(Protocol dependent)
- Tube placed→Waveform ETCO2(Confirm ventilation)
- Asthma silent chest→Aggressive airway(Pre-arrest sign)
Airway Tools
- Jaw thrust
- C-spine airway
- OPA
- No gag reflex
- NPA
- Gag usually okay
- Suction
- Withdraw with suction
- BVM
- Visible chest rise
- SGA
- Rescue airway
- ETCO2
- Ventilation marker
Oxygen Ventilation
- Nasal cannula
- Low-flow oxygen
- NRB
- High FiO2
- Venturi
- Precise FiO2
- Adult BVM
- 10-12 per min
- Advanced airway
- One every six
- PEEP
- Keeps alveoli open
- Silent chest
- Severe obstruction
MARCH
Massive bleeding, airway, respirations, circulation, hypothermia
M: hemorrhageA: airwayR: breathingH: heat
Simple vs Tension
Simple pneumo
- Unilateral sounds
- Usually stable
- Monitor closely
Tension pneumo
- Shock signs
- Worsening distress
- Needs decompression
Shock makes tension
Trauma Priorities
- MARCH
- Trauma priority order
- Tourniquet
- Proximal not joint
- Pelvis
- Binder for shock
- Open chest
- Vented seal
- Tension pneumo
- Shock plus JVD
- Flail chest
- Paradoxical motion
- Evisceration
- Moist sterile dressing
Burns Spine
- Rule of nines
- Burn TBSA estimate
- Chemical eye
- Irrigate immediately
- Alkali burn
- Longer irrigation
- C-spine risk
- Neuro deficit pain
- Axial load
- Feet-first fall
- Impaled object
- Stabilize in place
- Crush injury
- Hyperkalemia risk
Operations Legal
- Express consent
- Patient agrees
- Implied consent
- Unable emergency
- Refusal
- Capacity required
- Abandonment
- No equal handoff
- Mandated report
- Suspected abuse
- Documentation
- Objective facts
- Scope
- Protocol plus law
ICS MCI
- IC
- Overall command
- Safety officer
- Stops unsafe acts
- Triage
- Sort scarce resources
- Red tag
- Immediate care
- Yellow tag
- Delayed care
- Green tag
- Walking wounded
- Black tag
- Expectant deceased
Common Traps
Oxygen vs ventilation
NRB adds oxygen ≠ BVM moves air
Shockable vs flatline
VF gets shock ≠ Asystole gets CPR
Previa vs abruptio
Previa painless ≠ Abruptio painful
Hypoglycemia vs stroke
Check glucose early ≠ Stroke still transports
Consent vs abandonment
Consent starts care ≠ Handoff ends care
Tourniquet vs dressing
Life bleeding tourniquet ≠ Minor bleeding dressing
Last Minute
- 1.Weights: CJ leads all
- 2.AEMT is linear CBT
- 3.135 items; 35 pilot
- 4.Peds integrated throughout
- 5.Unsafe scene means wait
- 6.Airway before transport details
- 7.Ventilate before naloxone focus
- 8.VF pulseless VT shock
- 9.Asystole PEA no shock
- 10.Previa painless; abruptio painful
- 11.Document objective facts
- 12.Reassess after every intervention
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