NREMTP Review-Justin D. 🚒🚑 Initial Session
WELCOME!!!!!!!!!
This exam is not about the big obvious picture; it is about the small details!!!! (Words, Phrases, History, Home meds, 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
You are in route to a 45 y/o male patient c/o abdominal pain and N/V. 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
National Paramedic Curriculum takes 2 years to teach!!!
It takes 6-7 weeks to adequately prepare for this exam!!!!
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
Review home medications & risk factors (Important in the question)-HTN meds, ACE inhibitors, Beta Blockers, CCB, anticoagulants, corticosteroids, immunosuppressants
Focus on 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 (2-3 hrs.)-Mon (Trauma/Airway) .... Wed (Cardiac/Ops) .... Fri (Medical).... Sat (Specials-OB, Neonates, Peds)
When you study, split topics into body systems
Trauma
neuro (ICP, TBI, SCI)
Maxillofacial (La fort, Trismus
Write everything out while studying-Invest in a large white dry erase board
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)-***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?)
Trauma (Chest trauma)
Pneumothorax, tension PTX, Open PTX=Sucking chest wound, Hemothorax, cardiac tamponade, Flail chest, Pulmonary contusion
Tension Pneumothorax
Pathophysiology-A collapsed lung, caused by trauma, when air escapes from the lung, and accumulates in the pleural space. Every breath the pt. takes in, cannot be exhaled. On every inhalation tension builds, putting pressure on the heart, decreasing cardiac output
Signs/Symptoms-Chest Pain, Absent or diminished LS on affected side, SOB, Dyspnea, Hypoxia, Anxiety/agitation/restlessness, Cyanosis, Subcutaneous emphysema, Hyper resonant sounds, JVD, Tracheal shift
Interventions-Semi or high fowlers, High flow o2, PPV, Capnography, IVs, IV fluids, Monitor, keep the pt. warm, Needle decompression, Chest Tube, Transport to a TCF
Vital Signs-tachycardia, tachypnea, Hypotension, ETCO2 >45, Low Spo2, Normal temp
Priorities-1. Improve oxygenation & ventilation 2. Improve circulation
!!!!!!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
Example-You are on scene with a 1-year-old infant who presents with irritability, a seal bark cough, and is febrile to the touch. You suspect Laryngotracheitis (Croup). Upon assessment, what other symptoms or presentations would you expect to find?
Infections
Bacterial-High fever
Viral-Low fever
Fungal
Select 3 answers
A. High grade fever
B. Vomiting
C. Stridor *
D. Hoarseness *
E. Drooling
F. Low grade fever *
G. Tinnitus (Ringing in the ears)
Specific Test Taking Techniques for the NREMTP Exam
Medical terminology knowledge (Flash Cards)-"They use heavy med terminology!!!!!
Different Words=Same Meaning
Kidney Stones=Renal Calculi=Nephrolithiasis
Addison's Disease=Hypoadrenalism
Croup=Laryngotracheitis
Hypotension=Hypoperfusion=Low BP
Sucking chest wound=Open pneumothorax
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 the pt. most
Most appropriate immediate treatment? -priority
Definitive Treatment? The final end all be all treatment they need to fix that injury/condition
Cardiac Tamponade=pericardiocentesis
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?
ALWAYS read the last sentence first, then go back to the top, and read the entire question again
On priority questions, always go down your Primary Exam!!!!!!
Remember, BLS before ALS....Least invasive to most invasive
Primary Exam-Order of Operations on Priority Questions
1. Determine the differential diagnosis (What are the different things happening)
2. Safety!!!! (for us, the pt, bystanders-PPE, violent)
3. Manage any immediate life threats (Stop active external bleeding)
4. Airway (Open/Patent)-mucus, gurgling, blood, snoring, tongue, vomit, broken teeth, dentures, swelling, stridor
5. Breathing-WOB, adventitious lung sounds, spo2, skin signs, neuro
6. Circulation-skins, BP, cap refill, Pulse/HR
7. Transport Decision
If there are no findings or problems found in the Primary exam, then treat the symptoms and the complaints
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.
Differential Diagnosis
* What are the different injuries or condition that are happening
Dangerous words in answers to avoid!!!
Always
Never
All
Only
Sometimes
Probably
Usually
Stay away from definitive statements
4 critical rules to remember
NO ASSUMPTIONS!!!!!!!!
We can ONLY go off what the question tells us
Do NOT ADD to the question
If the question does NOT say it, it does NOT exist