Free NREMT EMR Exam Flashcards

The EMR's first action on arrival: (1) BSI/standard precautions, (2) scene safety, (3) mechanism of injury or nature of illness, (4) number of patients, (5) additional resources needed. Never enter an unsafe scene to reach a patient.

Treat every patient's blood and body fluids as infectious. Minimum PPE for routine patient contact is gloves; add eye protection and mask whenever splash or airborne exposure is possible, and a gown for heavy contamination.

Hold your thumb at arm's length toward the scene. If the thumb does not fully cover the hazardous area, you are too close. Stay uphill, upwind, and upstream and wait for trained hazmat teams.

Simple Triage And Rapid Treatment for adult MCIs. Categories: Green (walking/minor), Yellow (delayed), Red (immediate), Black (deceased/expectant). Decision points: respirations, perfusion (radial pulse or capillary refill), mental status (can follow commands).

Pediatric MCI triage tool for patients who appear under 8. Key difference from START: if a child is apneic but has a pulse, give 5 rescue breaths before tagging Black. Restored breathing tags Red.

One supervisor should manage 3-7 subordinates, with 5 being optimal. EMRs working at a multi-casualty scene report to the EMS branch under the Operations Section and never freelance.

Significant MOI in adults includes falls >20 ft, ejection from a vehicle, death of an occupant, unrestrained rollover, motorcycle crash >20 mph, and penetrating trauma to head/neck/torso. Any of these triggers full spinal precautions and rapid transport.

First step of the Primary Assessment: a 'doorway' look at appearance, work of breathing, and circulation (skin color) to decide sick vs not sick within seconds of approaching the patient.

Quick mental-status check: Alert, responds to Verbal stimulus, responds to Painful stimulus, Unresponsive. Used during the Primary Assessment before formal GCS or detailed neuro exam.

Head-tilt/chin-lift is the preferred airway maneuver for a medical, non-trauma patient. Jaw-thrust is the airway maneuver of choice whenever cervical spine injury is suspected because it opens the airway without extending the neck.

Measure from the corner of the mouth to the angle of the jaw or earlobe. Insert ONLY in patients with no gag reflex. If the patient gags or coughs, remove immediately to prevent vomiting and aspiration.

Measure from the tip of the nose to the earlobe; lubricate with water-based lubricant and insert with bevel toward the septum. Avoid in patients with suspected basilar skull fracture or significant facial trauma (CSF leak/raccoon eyes/Battle sign).

Normal adult resting rate: 12-20 breaths/min. <12 is bradypnea and >20 is tachypnea; either is abnormal and demands ventilatory support consideration. Below 8 or above 30 in an adult is an immediate life threat.

Infant (<1 yr): 30-60; Toddler (1-3): 24-40; Preschool (3-6): 22-34; School age (6-12): 18-30; Adolescent (12-18): 12-20. Sustained tachypnea in a child often precedes respiratory failure.

Ventilate an apneic adult with a pulse at 1 breath every 6 seconds (about 10/min). Each breath should be delivered over about 1 second with just enough volume to see visible chest rise; over-ventilation causes gastric distention and lowers cardiac output.

Ventilate an apneic infant or child with a pulse at 1 breath every 2-3 seconds (about 20-30/min) per the 2020 AHA update. Use the smallest BVM that delivers visible chest rise and avoid excessive volume.

Normal SpO2 is 94-100% on room air. Apply supplemental oxygen when SpO2 drops below 94% or when the patient has signs of inadequate perfusion or respiratory distress; titrate to 94-99% to avoid hyperoxia.

10-15 L/min, delivering roughly 90% FiO2. Inflate the reservoir bag before placing on the patient. Use for spontaneously breathing patients with severe hypoxia, significant trauma, or carbon monoxide exposure.

1-6 L/min, delivering roughly 24-44% FiO2. Use for stable patients with mild hypoxia or who cannot tolerate a mask. Above 6 L/min dries nasal mucosa without meaningfully increasing FiO2.

Carotid artery for adult and child >1 year. Take no more than 10 seconds; if no definite pulse is felt, begin CPR. Use the brachial artery for infants under 1 year.

Press a nail bed or fleshy area for 2 seconds and release; normal refill is under 2 seconds. Most reliable as a perfusion indicator in children under 6; environmental cold and adult age make it less reliable in adults.

Compressions first: rate 100-120/min, depth at least 2 inches (no more than 2.4 in), allow full chest recoil, minimize interruptions <10 sec. Compression-to-ventilation ratio 30:2 for one or two rescuers without advanced airway.

Depth: about 2 inches (one-third the AP chest diameter). One rescuer 30:2; two rescuers 15:2. Rate remains 100-120/min. Use heel of one or two hands depending on the child's size.

Two-finger technique (single rescuer) or two-thumb encircling hands (two rescuers). Depth about 1.5 inches (one-third AP). Ratio 30:2 single rescuer, 15:2 two rescuers. Brachial pulse check, max 10 seconds.

Apply adult pads as soon as available, even during pregnancy. Stop CPR only for rhythm analysis and shock; resume compressions immediately for 2 minutes after each shock or 'no shock advised' before reanalyzing.

Use pediatric pads/dose attenuator for children under 8 years or under 25 kg when available. If unavailable, use adult pads but place one anterior and one posterior to avoid contact. Never delay defibrillation to find pediatric pads.

Perform abdominal thrusts (Heimlich) until the object is expelled or the patient becomes unresponsive. If unresponsive, lower to the ground, begin CPR starting with compressions, and look in the mouth before each set of breaths.

Alternate 5 back slaps (between scapulae, head down) and 5 chest thrusts (two-finger compressions over the lower sternum) until the object is dislodged or the infant becomes unresponsive. Never perform abdominal thrusts on an infant under 1.

Direct pressure first. If life-threatening extremity bleeding cannot be controlled by pressure, apply a commercial tourniquet 2-3 inches proximal to the wound (never over a joint), tighten until bleeding stops, and record the application time on the device.

Indicated for junctional or anatomic-site bleeding where a tourniquet cannot be applied (groin, axilla, neck). Pack the wound tightly to the source of bleeding and hold firm direct pressure for at least 3 minutes before securing with a pressure dressing.

Compensated shock: anxiety, tachycardia, tachypnea, pale/cool/clammy skin, narrowing pulse pressure, normal BP. Decompensated shock: falling BP, altered mental status, weak central pulses. Irreversible: organ failure despite resuscitation.

Place the patient supine and keep them warm; routine head-down Trendelenburg is NOT recommended because it does not improve perfusion and may worsen breathing and ICP. Treat the cause, give oxygen if hypoxic, and transport rapidly.

Head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%. For irregular burns, the patient's palm (including fingers) equals about 1% BSA. Pediatric rule shifts more BSA to the head (18%) and less to the legs.

Brush off dry powder first, then flush with copious water for at least 20 minutes. Remove contaminated clothing during irrigation. Do NOT attempt to neutralize an acid with a base or vice versa - the reaction releases heat and worsens injury.

Apply a vented (3-sided) occlusive dressing over an open pneumothorax to let air escape on exhalation while preventing entry on inhalation. Monitor for tension pneumothorax - if it develops, briefly lift the dressing to release trapped air.

Apply manual in-line stabilization in a neutral position as soon as spine injury is suspected and maintain it until full restriction is in place or injury is ruled out. Do not pull traction; just neutralize movement of the head and neck.

Use for unresponsive patients who are breathing adequately, have a pulse, and are NOT suspected of spinal injury. Roll as a unit onto the left side to keep the airway open and let secretions drain.

Signs/Symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading up. Standard mnemonic for the focused history taken during the Secondary Assessment.

Onset, Provocation/Palliation, Quality, Region/Radiation, Severity (0-10), Time/duration. Used to characterize chest pain, abdominal pain, or any focused complaint during the Secondary Assessment.

Reassess vital signs and the primary survey every 5 minutes for unstable patients and every 15 minutes for stable patients, and after every intervention. Document changes and trends - a deteriorating trend matters more than a single value.

Three-item screen: facial droop, arm drift, abnormal speech. Any one positive finding suggests a 72% likelihood of stroke. Note exact time last known well - this drives eligibility for thrombolytics or thrombectomy.

Cool/pale/diaphoretic skin, tachycardia, altered mental status, weakness, hunger; blood glucose <70 mg/dL. If the patient is alert and can swallow, give oral glucose (15 g); if unresponsive, manage airway and request ALS.

Hives plus airway swelling, wheezing, or hypotension after exposure. EMRs trained and authorized may assist with the patient's own epinephrine auto-injector: adult 0.3 mg IM into the lateral thigh, pediatric 0.15 mg, and request ALS.

Triad: pinpoint pupils, depressed respirations, decreased mental status. Support ventilation with BVM and supplemental oxygen first, then administer intranasal naloxone (typically 4 mg IN) if trained and authorized; repeat every 2-3 minutes as needed.

Protect from injury, do not restrain or place anything in the mouth, time the seizure. Post-ictal: position to protect airway, give oxygen for hypoxia, check glucose, and transport. A seizure >5 minutes or recurrent seizures without recovery = status epilepticus and requires ALS.

Heat exhaustion: heavy sweating, normal-to-elevated core temp, normal mental status - rest, cool, oral fluids if alert. Heat stroke: hot dry OR sweaty skin, core >104 F, altered mental status - active rapid cooling and rapid transport. Mental status change is the key differentiator.

Visible crowning, contractions <2 minutes apart lasting 60-90 seconds, urge to push, or sensation of bowel movement signal imminent delivery. Prepare to deliver on scene rather than transport; support the head, suction is no longer routine for vigorous infants.

Assess at 1 and 5 minutes after birth: Appearance, Pulse, Grimace, Activity, Respirations. Each 0-2 points (max 10). Score <7 at 5 minutes indicates the need for continued resuscitation and ALS support.

Document mental status/competence, that risks of refusal were explained (including possible death), the patient's verbatim refusal, signatures of patient and a witness, and that EMS would return if they change their mind. Refusal must be informed and from a competent adult.

Post-incident support for responders after high-stress calls (pediatric death, MCI, line-of-duty death). Includes defusing (within hours), debriefing (24-72 hours), and follow-up. Self-care is required to prevent burnout and PTSD across an EMS career.