NREMTP Review-Radley P. 🚑🚒 "Initial Session"
WELCOME!!!!!!!!
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!!
The 3 most important things
Pathophysiology (What is the disease or injury, and what is doing in the body)
Assessment & knowing your signs/symptoms (Not just the obvious 2 or 3)
Prioritizations & Order of operations
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 (Croup), what other signs and symptoms would the paramedic expect to see?
Infections
Bacterial-High grade temp
Viral-Low grade temp
Select 3 answers
A. Weight loss
B. Hoarseness
C. Low grade fever
D. High grade fever
E. Stridor
F. Lymphadenopathy
Example knowing Order of Operations
30 F-Asthma attack
Semi or high fowlers position
High flow oxygen
Albuterol-bronchodilator
Atrovent (Ipratropium)-Anticholinergic-Dries up mucus
Mag Sulfate
Levalbuterol (Xopenex)-Bronchodilator-Used when the pt. has a history of cardiac issues or HTN-It does NOT spike the HR or BP
Epinephrine
Corticosteroids-Decrease inflammation
Insensible water loss-Every time we exhale or cough-we are losing fluid as water vapor=Dehydration=IV Fluids
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
D. Cholecystitis-X
Hot temps cause the appendix and surrounding tissues to become inflamed and swollen
Pancreatitis
Alcoholism
gallstones
Gall Bladder Disease
6 Fs of gallbladder disease
Females
Fat
Forty
Fertile
Fatty fried diet
Fair Skinned
The Paramedic curriculum was designed to be taught over 18-24 months!!! So don't try and cram!!! It won't work!!!
Commit your time to mastering this craft and learning the material that you may have not received in Paramedic school!!!!!!
Time needed for a successful outcome on this exam!!!
5-6 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 (2-3 hrs.)-Mon (Trauma/Airway) .... Wed (Cardiac/Ops) .... Fri (Medical).... Sat (Specials-OB, Neonates, Peds)
When studying, split the conditions into body systems
Example-Trauma
Neuro Trauma-ICP, Brain bleeds, DAI, SCI, Cranial nerve
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 & 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?)
Trauma
Chest trauma
Tension Pneumothorax
Collapsed Lungs
Pneumothorax (Simple/Closed)
Open Pneumothorax=Sucking Chest Wound
Tension PTX
Hemothorax
hemopneumothorax
Patho-A collapsed lung, caused by trauma, when air escapes from the lung, and accumulates in the pleural space. Every breath the pt. takes in, it cannot be exhaled. With every inhalation TENSION build, putting pressure on the HEART, decreasing cardiac output
Signs/Symptoms-Chest pain, absent or diminished sounds on affected side, SOB, Dyspnea, Hypoxia, anxiety/agitation/restlessness, cyanosis, subcutaneous emphysema, Hyper resonant (echo) sounds, JVD, Tracheal shift
Interventions-Semi or high fowlers, High flow oxygen, PPV-BVM, IVs, Keep them warm, IV fluids, Waveform Capnography Monitor, needle decompression, chest tubes, Transport to level I or II
Vital Signs-Tachycardia, Tachypnea, Hypotension, Low Spo2, ETCO2=>45, CO2-Carbon Dioxide=carbonic ACID!!!!!!!=Respiratory acidosis, Normal temp
Priorities-1. Improve the ventilation and oxygenation 2. Improve the 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
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? (End all be all treatment to fix them and save their life)-Cardiac tamponade=Pericardiocentesis
Example-22 M-Multiple GSW-Internal bleeding=Surgery
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=There are only 2 outcomes a pt will have=Live or Die
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
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, 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
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 remember
NO ASSUMPTIONS!!!!!!!!
We can ONLY go off what the question tells us
Do NOT ADD to the question
If the question doesn't say it....it does NOT exist