NREMTP Review-Anneth J. 🚑🚒 "Initial Session"
WELCOME!!!!!!!!!!
Reasons why people are not passing this exam
Knowledge issues
Not knowing prioritizations or order of operations
Poor knowledge on medical terminology
Going off their local protocols
Pathophysiology
Not understanding what the question is asking
national
EMR
EMT-1
AEMT
Paramedic
This exam is not about the big obvious picture; it is about the small details and the deeper symptoms (Words, Phrases, Home meds, History, presentations, Risk factors, Etc.)
The NREMT knows that you guys know the big obvious topic.... they want to see if you can think outside the box, pay attention to detail, and utilize forward thinking & implement clinical judgement!!!
All categories must be passed!!! If someone does really well in Trauma, Airway, and Medical, but they fail the EMS Operations section, it is a failed attempt. So, you need to be a generalist, not a specialist. Study all categories!!
It takes 18-24 months to teach the entire National Paramedic Curriculum
This is NOT a local protocol exam!!!! The NREMT does not care where we are from or where we work. It is National curriculum, not state or local
One way to quickly FAIL this exam, is if you answer the questions based off your local protocols!!!!!! ☠️☠️☠️
Asthma attack
Albuterol-Beta-2 Agonist=bronchodilation
Atrovent (Ipratropium bromide)-Anticholinergic-Dries up mucus in the bronchioles
Mag Sulfate-Electrolyte
Levalbuterol (Xopenex)-Used for asthma pts. who also have cardiac or HTN history, it does NOT spike the HR or BP
Epinephrine-Status asthmaticus
Corticosteroids=Prednisone, solu Medrol
Asthma
Patho-A triggered disease (Cold temps, illness, exercise, smoke) that causes inflammation in the bronchioles, leading to an accumulation of thick mucus, causing bronchospasms/bronchoconstriction
COPD
Chronic bronchitis
Emphysema
Pneumonia
The 4 most important things
Pathophysiology (What is the disease or injury, and what is doing in the body)
Assessment Findings & knowing your signs/symptoms (Not just the obvious 2 or 3)
Prioritizations & Order of operations
Vocabulary-Knowing your medical terminology!!!!
Example of knowing signs/symptoms
You are on scene w/ a 2-year-old who presents w/ irritability, a seal bark cough, and flushed skins. The paramedic suspects Laryngotracheitis what other signs and symptoms would the paramedic expect to see?
Croup is a viral infection
Larynx=Vocal Cords
Types of infections
Bacterial Infection-High grade fever
Viral Infection-Low grade fever
Select 3 answers
A. Weight loss
B. Hoarseness-Correct
C. Low grade fever-Correct
D. High grade fever
E. Stridor-Correct
F. Lymphadenopathy
You are in route to a 45 y/o male patient c/o abdominal pain and nausea/vomiting. The patient is located on a 2nd story apartment and states he has a history of asthma. It is a warm summer day, w/ clear road conditions. What condition should the Paramedic suspect?
A. Pancreatitis-X
B. Appendicitis-Correct
C. Crohn's Disease flare up-X
D. Cholecystitis-X
Hot temps and exertional activity cause the appendix and surrounding tissues to swell and become inflamed
Pancreatitis
Alcoholism
Gallstones
Hepa=Liver
Hepatitis, hepatomegaly
Chol=Gallbladder
Stores Bile (Digestive Enzyme)
6 Fs of gallbladder Disease
Females
Fat
Forty
Fertile
Fatty/Fried food diet
Fair skinned
4-5 weeks to adequately prepare for this exam!!!! (If you are properly studying)
How to properly Study!!!!!!
Study strategies for the NREMTP Exam
Don't JUST do random practice questions (That is NOT studying!!!!) you need to review material & concepts
Medic tests, Pocket Prep, LC Ready are good resources, but they only have a couple thousand questions, the NREMTP Exam has over 75,000 questions in their bank. Chances are you will NOT see the exact same topics & questions
Focus on a max of 2 categories/day (Medical by itself & Specials Populations (Peds, O.B, neonates) by itself) so you can know your weaknesses
Example-3-4 days/week (2-4 hrs.)-Mon (Trauma/Airway) .... Wed (Cardiac/Ops) .... Fri (Medical).... Sat (Specials-OB, Neonates, Peds)
When studying, split the conditions into body systems (Trauma, Medical-abdominal, acid/Base, Endocrine)
Neurological Trauma (TBI, Brain bleeds, ICP, concussions, Diffuse axonal injury, SCI
Write everything out while studying-Invest in a large white dry erase board
tension PTX, Cardiac Tamponade
When you are studying, be able to answer the following questions
"5 Pillars of Studying"
1. What is the pathophysiology of the injury or condition? (What is the condition & what causes it)-***Extremely Important!!!!!!
2. How will the patient present? (Signs/symptoms)-7-10 signs/symptoms-"Not just the obvious ones"
3. How will I treat this injury or condition? (Interventions, meds, oxygen, positioning, comfort, assessments, transport destinations)
4. How will the vital signs present?
5. What are my priorities for this injury/illness? (On scene? En route?)
!!!!!!At the end of your study session, the last 20 min, this is when you do some questions, based off the topics you just studied
Monday
Airway/cardiology
Airway
Specific Test Taking Techniques for the NREMTP Exam
Medical terminology knowledge (Flash Cards)-"They use heavy med terminology!!!!!
Differentiating signs & symptoms!!! ("Critically IMPORTANT") .... Dyspnea (Asthma, COPD, Emphysema, Chronic bronchitis, Pneumonia)
KNOW your LUNG SOUNDS!!!!! (Wheezing, Rhonchi, Stridor, Crackles/Rales, Pleuritic friction rub)
They are extremely deliberate about the words they use!!!!
What would you do first? -priority
What would you do next? -priority
Most appropriate treatment? (What will benefit your pt. the most)
Most appropriate immediate treatment? -priority
Definitive Treatment?
What is the end all be all intervention they need to fix that condition
Initial Intervention? -priority
Biggest risk factor?
Most accurate statement?
All of the following except?
What risk factor will cause the pt. to have a poor outcome?
Clinical Outcome=Live or Die
ALWAYS read the last sentence first, then go back to the top, and read the entire question again
Diffuse=All over or everywhere
Diffuse abdominal pain=Pain in all 4 quadrants
Asthma attack. What is your definitive intervention?
A. Place pt. in high fowlers
B. Initiate an albuterol nebulizer
C. High flow O2
D. Administer a steroid
On priority questions, always go down your Primary Exam!!!!!!
* Treat the patient and the pathophysiology, not the numbers or monitor
Remember, BLS before ALS....Least invasive to most invasive
Primary Exam-Order of Operations on Priority Questions
Once you have read the question Determine the differential diagnosis (What are the different things happening)
1. Safety!!!! (for us, the pt, bystanders-PPE, violent)
2. Manage any immediate life threats (Stop active external bleeding)
3. Airway (Open/Patent)-mucus, gurgling, blood, snoring, tongue, unresponsive, vomit, broken teeth, dentures, swelling, stridor
4. Breathing/Oxygenation-Work of Breathing, adventitious lung sounds, spo2, skin signs, neuro
5. Circulation-skins, BP, cap refill, Pulse/HR
6. Transport Decision
If there are no findings or problems found in the Primary exam, then treat the symptoms and the complaints
Epinephrine
MOA
Decreases laryngeal spasms and opens the upper airway
Causes bronchodilation
causes vasoconstriction
+ Inotropic=Increases the strength of the heartbeat
Do NOT use current or past experience to answer the question (Do not go off your Local protocols) ......Paramedics throughout the country administer drips, infusions, blood products, perform pericardiocentesis, other advanced procedures and give dozens of different medications
Dangerous words in answers to avoid!!!
Always
Never
All or Everyone
Solely
Only
Sometimes
Probably
Usually
Stay away from definitive statements
4 critical rules to ALWAYS REMEMBER!!!!!!!
NO ASSUMPTIONS!!!!!!
Do NOT ADD ANYTHING INTO THE QUESTION
If the question doesn't say it...it does NOT exist
We can only go off what the question tells us