EMT NREMT Study Guide 2024 Update (1)

EMT NREMT
STUDY GUIDE
A Comprehensive, Yet Efficient, EMT NREMT Study Guide
Thousands of
Created by: students helped!
Brandon Schoborg
Adam Peddicord
Created by EMS Educators with 38+ years of experience

Pairs perfectly with our EMT NREMT Review Course!
About the Authors
Adam Peddicord, APRN, MSN, FP-C,
CC-P
Co-Founder, Pass with PASS, LLC
Adam has been a Paramedic since 1998 and started his fire
service career in 1993. In 2022, he retired from the Newport
Fire/EMS Department as a Battalion Chief & Medical Commander
of the Newport Police Department SWAT Team. In 2023, he
returned to the fire service as an Assistant Chief of Operations
with the Hebron (KY) Fire Protection District.
He holds multiples Associate’s Degrees along with a Bachelor’s

and Master’s Degree in Nursing and is a board-certified Family
Nurse Practitioner. As a Nurse Practitioner, Adam has experience
in orthopedics and addiction medicine. Adam has over 20 years of
experience in EMS education through the University of Cincinnati
and Gateway Community and Technical College.
Brandon Schoborg, MBA, NRP

Co-Founder, Pass with PASS, LLC
Brandon is currently the EMS Captain for the Hebron (KY) Fire
Protection District. Previously, he has spent time as the EMS
Education Manager of a hospital and college based
EMT/Paramedic Program in Kentucky; EMS Education Manager
for the Columbus (OH) Division of Fire; Director of EMS Education
at Cleveland Clinic Akron General; the Assistant EMS
Coordinator, Engineer/Paramedic, and SWAT Paramedic with the
Newport Fire/EMS Department in Kentucky for 8 years. He began
his teaching career at the University of Cincinnati Clermont
College.
He completed his paramedic education at the University of

Cincinnati in 2010. Brandon has an Associate’s Degree in EMS-
Paramedic, Bachelor’s Degree in Health Science, and a MBA in
Healthcare Management.
2
Disclaimer
All procedures listed in the study guide should only be performed by
appropriately licensed/certified, authorized, and trained personnel as your
local government, state, or country allow.
Medication dosages may differ across the country, any medication

dosages in the study guide are relatively standardized, however, we
encourage you to check your local protocol and/or program’s preferred
dosages.
Copyright © 2023 by Pass with PASS, LLC. All rights reserved. No part of
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Reference herein to any specific commercial product, process, or service

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imply its endorsement or recommendation by Pass with PASS, LLC.
Although we make every effort to ensure that the material contained within
the study guide is current and accurate, we cannot guarantee accuracy.
However, please know, that accurate and current study guides is extremely
important to us and we continuously review our guides for quality assurance.
This study guide is for supplemental/informational purposes only and does

not/is not offering and/or providing any type of medical guidance, direction, or
permission.
3
Copyright 2023 - Pass with PASS, LLC
Table of Contents
1 The NREMT Page 5
Exam
2 Medical Terminology & Patient Page 7

Assessment
3 Respiratory & Airway Page 20
4 Cardiology Page 42
5 Medical Page 55
6 Trauma Page 87
7 EMS Operations Page 104
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1
THE NREMT
EXAM
Chapter 1: The NREMT Exam
The NREMT Exam

The National Registry examinations are Pilot Questions: 10 questions that are
broken into two segments: the cognitive not factored into the student’s
exam (“the written”) and the psychomotor performance.
exam (“hands-on”).
Calculator: An onscreen calculator is
The cognitive exam is computer based and available during testing. You are not
is adaptive, meaning that the exam will permitted to bring your own calculator.
tailor it’s questions based on your
performance and the level of difficulty of Pediatrics: 15% of the questions in
each question. Once the exam is 95% each of the five categories are
confident that you have reached the level of pediatric based questions.
competency or is 95% confident that you
cannot reach competency, the exam will
stop (as long as you have answered the
minimum amount of questions, 70, or have
not exceeded the total time allowed, 2
hours).
This study guide will primarily focus on the

cognitive examination.
Topic Area Percentage of Questions

Airway, Respiration, & Ventilation 18 – 22%
Cardiology & Resuscitation 20 – 24%
Trauma 14 – 18%
Medical/OB-GYN 27 – 31%
EMS Operations 10 – 14%
Copyright 2023 - Pass with PASS, LLC 6

2
Medical
Terminology

Chapter 2: Medical Terminology & Patient Assessment
Medical Terminology
Do not underestimate the power of medical terminology! A good understanding and working
knowledge of medical terminology will often be a lifeline on the NREMT exam. Most often,
signs and symptoms will not be described using “common language”, rather it will be described
using medical terminology.
For example…
“You are dispatched to a 13 year old male who is dyspneic. Upon your arrival, you find the
patient in the tripod position, gasping for air. As your EMT partner applies oxygen via non-
rebreather mask, you auscultate lung sounds and hear bilateral expiratory wheezes. As you
expose the patient, you observe urticaria on the patient’s neck, chest, and back. What is your
primary impression of this patient?”
a. Asthma
b. Croup
c. Anaphylaxis
d. Epiglottitis
That was a pretty simple and straightforward question, but notice that medical terminology
was used at almost every opportunity…”dyspneic, auscultate, bilateral, urticaria.” If you did
not know that “dyspneic” = short of breath, “auscultate” = to listen, “bilateral” = both sides,
and “urticaria” = hives, this question could have been a lot more difficult to understand and
ultimately come up with the correct answer.
By the way, it was “C – Anaphylaxis”
We know that medical terminology isn’t the most invigorating thing to put your time and
energy into, but believe us, studying medical terminology thoroughly will payoff on test day.
Now, let’s get to it!
8
A
Aerobic  the presence of air or oxygen.
Agonist  to enhance an expected response.
Anaerobic  the absence of air or oxygen.
Aniscoria  a condition characterized by unequal pupil size.
Antagonist  to inhibit or counteract the effects of other drugs or undesired effects.
Aphasia  inability or difficulty in speaking.
Apnea  the cessation of spontaneous respirations.
Ascites  abnormal accumulation of fluid in the abdomen.
Atrophy  shrinkage of a cell or muscle.
Aura  sensation (may be visual, smell, taste, etc.) that may precede a migraine or seizure.
B
Blebs  collection of air between the lung and visceral pleura that can result in spontaneous
pneumothorax.
Brachial  artery found in the upper arm, used for pulse checks in pediatric patients.
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C
Cartilage  smooth and firm connective tissue.
Cell  basic unit of life.
Cilia  small, hair-like structures.
Coma  deep state of unconsciousness, unarousable.
Confabulation  made up stories to fill in gaps of lost memory.
Congenital  present at birth.
Contrecoup  occurs at a site opposite of the side of impact.
Crepitus  a grating sound or sensation often caused by bone on bone rubbing, or with
inflammation in joints.
D
Dehydration  an excessive loss of water or fluids from the body.
Dermatomes  specific area that is supplied by a single spinal nerve.
Dysarthria  poor articulation of speech. Often due to affected muscles used in

speaking.
Dyskinesia  disorder related to involuntary muscle movements.
Dysplasia  abnormal growth of a cell.
Dysphagia  difficulty in swallowing (stroke/anaphylaxis)
Dysuria  difficult or painful urination
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E
Edema  excess fluid in the interstitial spaces.
Epidemic  a widespread occurrence of an infectious disease in a community at a

particular time.
Erythrocytes  red blood cells.
F
Fascia  connective tissue that surrounds or separates muscles.
G
Gait  walking or moving on foot.
Gestation  period from fertilization of ovum to birth of fetus.
H
Hematuria  blood in the urine.
Hemiparesis  one-sided weakness; often seen in those with CVA’s.
Hemolysis  breakdown of red blood cells.
Hemophilia  hereditary bleeding disorders due to missing factors for proper blood
coagulation.
Hemoptysis  coughing up blood.
Host  an animal or human with exposure to an infectious agent.

I
Idiopathic  unknown cause.
Incontinence  inability to control bowel or bladder function.
Infarction  death of tissue from lack of oxygen.
Inferior  down/bottom, toward the feet.
J
Jejunum  part of the small intestine.
Joule  measurement of electrical energy.
K
Kyphosis  abnormal curvature of the spine, increased convexity as viewed laterally.
L
Lactate  found in cells during metabolism, byproduct of lactic acid.
Laryngitis  inflammation of the larynx.
M
Malaise  general weakness.
Mania  a mood disorder characterized by hyperactivity, agitation, excitement and

occasional violent and self-destructive behavior.
Melena  black, tarry stools containing digested blood.
Myalgia  muscle pain.

N
Necrosis  death of a cell or a group of cells as the result of disease, ischemia, or injury.
Nucleus  controlling body of a cell.
Nystagmus  involuntary jerking actions of the eyes.
O
Oliguria  diminished ability to create or pass urine.
Osmosis  the diffusion of solvent (water) through a membrane from a less

concentrated solution to a more concentrated solution.
Ostomy  a surgical opening that creates a hole from the inside of the body to the
outside.
Ovum  a female egg or egg cell.
P
Paresthesia  sensation of numbness tingling or “pins and needles.”
Pathogen  a cause of a disease.
Phobia  anxiety disorder characterized by an obsessive, irrational, and intense fear of

a specific object or activity.
Photophobia  a sensitivity to light that is abnormal.
Plasma  the fluid part of blood.
Platelets  fragments of cells that are responsible for initiating the clotting process.
Polyuria  excessive urination.
Priapism  a painful and persistent erection.

Q
Quadriplegia  weakness or paralysis of all four extremities and the trunk. Often occurs
after a high-level cervical spine fracture.
R
Referred pain  pain felt at a site away from its origin.
Rhonchi  abnormal, course, rattling respiratory sounds, usually caused by secretions

in the bronchial airways or muscular spasm/constriction.
S
Sclera  the white outer layer of the eyeball.
Slander  false statements about a person.
Stridor  high-pitched musical sound caused by an obstruction in the trachea or larynx.
Stroke volume  volume (amount in milliliters) of blood ejected from one ventricle in a
single heartbeat. Normal range is 60 – 100 with average being 70mL.
Subluxation  a partial dislocation.
Surfactant  substance that reduces the surface tension of the pulmonary fluids.
T
Tendons  bands of connective tissue that connect muscle to bone.
Tidal volume  volume (or amount) of air inspired or expired in a single breath.
Tort  personal harm or injury caused by civil versus criminal wrongs.

U
Uremia  excess of urea and other nitrogen based wastes in the blood.
Urticaria  hives.
V
Ventilation  mechanical movement of air into and out of the lungs.
Vesicants  an agent that causes blistering.
Virulence  the harmfulness of a disease or poison.
W
Wheals  small areas of swelling that result from an allergic reaction. Similar to hives
(urticaria).
X
Xiphoid process  smallest of three parts of the sternum. Articulates caudally with the body
of the sternum and laterally with the seventh rib. Can fracture with inappropriate hand
placement during CPR.
Z
Zygote  a fertilized ovum (egg).
15
Patient Assessment Terminology

HPI - History of Present Illness
PMH - Past Medical History
OPQRST
Onset - What were you doing when it started?
Provocation/Palliation - Anything make it better or worse?
Quality - How would you describe the pain?
Radiation - Where is the pain and does it go anywhere?
Severity - On a scale of 1- 10, what would you rate your pain?
Time - How long ago?
AVPU - Assessing the level of consciousness

Alert - addressing you enter the room
Verbal - only notices you/looks at you when spoken to
Painful - needs pain to stimulate response (sternal rub)
Unresponsive - no reaction
SAMPLE
Signs & Symptoms
Allergies
Medications
Pertinent past history
Last oral intake
Events leading up to
DCAPBTLS
Deformities
Contusions
Abrasions
Penetrations/punctures
Burns
Tenderness
Lacerations
Swelling
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Primary Assessment
Scene Size Up
If scene is not safe or has potential to not be safe - LEAVE
Always consider an answer that puts your safety or your crew’s safety as being
paramount
ABC’s - if patient has signs of life, assess in this order
CAB’s -if patient appears lifeless, this is the order to confirm pulselessness for cardiac
arrest and bleeding control (severe bleeds - arterial)
ABC’s
Airway
Is it open?
Manually open the airway (ALWAYS THE FIRST STEP)
Insert airway adjunct: oropharyngeal or nasopharyngeal airway
Suction when needed
Breathing
Are they breathing? Is it adequate?
Deliver oxygen to patients in respiratory distress - agitation, stridor, wheezing,

tachypnea, tachycardia, nasal flaring, accessory muscle usage
Assist ventilations for patients with inadequate breathing - altered mental status, shallow
respirations, rates over 30 and under 10, bradycardia
Circulation
Do they have a pulse? Do they have a significant bleed?
Stop any exsanguinating bleeds immediately. Commonly used terms to describe this
are: “heavy, severe, arterial, spurting”

General Impression & Vital Signs

General Impression = “Sick or Not Sick”
Patient’s environment - does the environment gives clues to the condition?
Chief complaint - reason they called 911
Appearance - mental status (AVPU)
Normal Adult Vital Signs
Pulse: 60 - 100 - assess quality - regular, strong, weak (“thready”)
Respirations: 12 – 20
Temperature: 98.6 F
Blood Pressure: 120/80
Blood Glucose: 80 – 120 (can range nominally for patient’s normal)
Normal Pediatric Vital Signs - See “Medical Chapter”
Pulse Oximetry
Normal: 96 – 100%
Mild Hypoxia: 91 – 95%
Moderate Hypoxia: 86 – 90%
Severe Hypoxia: < 85%
**Please note, some protocols and texts reference a normal (or acceptable) SPO₂
range to be greater than or equal to 94%.**

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3
Respiratory &
Airway

Chapter 3: Respiratory & Airway
Key Terms
Tidal Volume: Hypoxia:
Amount of air moved in one Low oxygen levels in the cells
breath (500mL = average adult)
Dead Space: Hypoxemia:

Amount of air that is not available Low oxygen levels in the arterial blood
for gas exchange; moved in
ventilation but does not reach
alveoli (150mL = average adult)
Minute Volume:
Amount of air moved into and out
of the lungs per minute
MV = TV X RR

Key Terms (continued)

Ventilation: Perfusion:
The process of air movement into The circulation of blood through
and out of the lungs the lung tissues (alveoli)
Blood transition
Air In
through capillary
Air Out
membrane
Diffusion:
The process of gas exchange
(carbon dioxide and oxygen)
Inspiration (inhalation): active process
that creates negative pressure O₂ In
Expiration (exhalation): passive CO₂ Out

process that generates positive
pressure

Respiratory Anatomy
Nasopharynx
Respiratory center is housed
Oropharynx in the brainstem, more
specifically the medulla
Trachea oblongata
Bronchi
Lungs
Epiglottis
Vocal Cords
Glottic Opening

Lung Sounds
Crackles (rales): fine, bubbling sound heard on auscultation of the lung. Produced by air
entering the distal airways and alveoli that contain serous secretions.
Rhonchi: abnormal, coarse, rattling respiratory sounds, usually caused by secretions in the
bronchial airways.
Stridor: abnormal, high-pitched, musical sound caused by an upper airway obstruction

(subglottic).
Wheezing: form of rhonchi, characterized by a high pitched, musical quality. Produced in

the lower airways (bronchioles).
Stridor
(upper airway/subglottic
inspiratory)
Rhonchi
(expiratory wheezing)
Rales
(inspiratory/expiratory)
Wheezes
(expiratory)
Crackles
(end-inspiratory)

Respiratory Patterns
Eupnea: normal respirations
Tachypnea: increased (fast) respirations
Bradypnea: decreased (slow) respirations
Apnea: no respirations (not breathing)
Cheyne Stokes: abnormal respirations with regular, periodic breathing with intervals of
apnea and a crescendo-decrescendo pattern of respirations.
Biot’s: abnormal respirations characterized by regular deep inspirations followed by regular

or irregular periods of apnea.
Apneustic: abnormal rapid respirations associated with deep, gasping inspirations – most
often associated with stroke or trauma.
Kussmaul’s: rapid and deep respirations – most often associated with diabetic ketoacidosis
(DKA) as a compensatory mechanism in an attempt to correct the body’s metabolic acidosis

Opening the Airway

Head-Tilt, Chin-Lift: means of correcting the blockage of the airway by the tongue, by
tilting the head back and lifting the chin. Used when trauma is not suspected.
Jaw-Thrust: used when trauma, or injury, is suspected to open the airway without
causing further injury to the spinal cord in the neck.
**If patient is found unresponsive, then always consider it to be a traumatic

injury**
Head-Tilt, Chin-Lift (pictured below)

Airway Adjuncts & Devices

Oropharyngeal Airway:
Used on patients without gag reflex, moves tongue forward as it curves
back to pharynx
Measured from center of mouth to angle of jaw
Insert device along roof of mouth, rotate 180 degrees to sit anatomically
(can insert in “normal” position in pediatrics)
Nasopharyngeal Airway:
Used in patients with intact gag reflex, moves tongue and soft tissue
forward to provide channel for air.
Measured from patient’s nostril to the tip of the earlobe or to the angle of
the jaw
Bevel always goes towards the nasal septum
Nasal Cannula:
Liters/Minute: 1 – 6
Oxygen Concentration: 24 – 44%
Nebulizer:
Nebulized albuterol, ipratropium, and epinephrine
Liters/Minute: 4 – 6 (hand-held); 6 – 8 (mask)
Non-Rebreather Mask:
Liters/Minute: 12 – 15
Oxygen Concentration: 80 – 100%

Airway Adjuncts & Devices

Bag Valve Mask:
Liters/Minute: at least 15
Use two rescuers when possible to deliver ventilations
Deliver breath over 1 second of time, allow for adequate exhalation
Squeeze bag until you see chest rise, release bag

Average tidal volume in adult patient is 500mL
Average dead space in adult patient is 150mL
12 breaths per minute in adults

20 breaths per minute in pediatrics
CPAP (Continuous Positive Airway Pressure):

Tight fitting mask, not a leak tolerant system
Centimeters of water pressure (cmH₂O): 4 – 20

Most protocols do not exceed 10cmH₂O
Indications for CPAP:

F: Flail Chest
N: Near Drowning
“Go get the F’n
C: COPD CPAP!”
P: Pulmonary Edema, Pulmonary Embolism
A: Asthma, ARDS
P: Pneumonia
Typically not used in pediatrics (< 12 years of age), however, pediatric

CPAP is gaining traction in prehospital setting.
In pediatric CPAP, all settings are the same, it’s simply a smaller mask.

Supraglottic Airways
Laryngeal Mask Airway:

Sizes 1 – 5
Inserted through mouth into pharynx
Advanced until resistance is felt as end of tube “seats” in the

hypopharynx
Black line marked on LMA should rest midline against patient’s

upper lip
Confirm placement through traditional methods
i-gel:
Non-inflatable cuff
Designed to rest over the larynx
Insertion is same as LMA, but without inflation
Takes less than 5 seconds to insert, faster than LMA
King LT-D Airway:

Similar to i-gel and LMA
Single tube with two cuffs, that is placed into the esophagus, large
balloon is inflated in the esophagus
Holes between the two cuffs allow for ventilations to be delivered

near the glottis

Oxygen Cylinders
Filled under a pressure of 2,000 – 2,200 psi
Most considered “empty” at 200psi (safe residual pressure)

< 500 psi is too low to keep in service
Green color cylinders are commonly used in USA
Amount of O₂ when
Cylinder Size Conversion Factor Max PSI
full
D 0.16 4,000 350 liters
E 0.28 6,000 625 liters
M 1.56 3,450 3,000 liters
H or K 3.14 4,500 6,900 liters
Calculating Oxygen Cylinder Life

“The tank pressure of a D cylinder is 650 psi, you are
delivering 6LPM of oxygen to the patient. How long will your
cylinder last?”
Step 1: Subtract the safe residual pressure (always 200psi)

from the tank’s PSI
650 – 200 = 450
Step 2: Multiply the result above by the D cylinder

factor/constant to obtain the volume of gas.
450 X 0.16 = 72
Step 3: Divide the volume of gas by the LPM to determine

tank life in minutes.
72 / 6 = 12 minutes

Suctioning
Air intake of at least 30 liters per minute
Vacuum of more than 300mmHg when the tube is clamped
Suction set at - 80 to - 120 for adults
Adult: 15 seconds max

Children: 10 seconds max
Infants: 5 seconds max
Rigid Suction Soft Suction
Also called the “Yankauer” or “DuCanto” Also called flexible suction
Larger opening than soft-suction catheters Smaller opening than rigid suction
Suction only on the way out - only as far as you Can be passed through nasopharyngeal or
can see endotracheal tube for suctioning
Suctioning large chunks of food, vomit, blood, Come in various sizes (“French”); larger the
teeth, & thick secretions number - large the opening of the catheter
Not typically large enough to suction vomit

or thick secretions

Respiratory Emergencies
COPD
Asthma
Pneumonia
CHF
Pulmonary Embolism
Pneumothorax

COPD
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term that covers both
chronic bronchitis and emphysema. You may have found that asthma is at times classified
under the COPD umbrella, but many argue because it is fully reversible, it is not considered
COPD. For us, we will just leave it at chronic bronchitis and emphysema.
Chronic Bronchitis Emphysema

“Blue Bloater” “Pink Puffer“
Typically Overweight Thin, barrel-chest appearance
Productive cough with sputum Nonproductive cough
Coarse rhonchi Wheezing and rhonchi
Chronic cyanosis Pink complexion
Mild, chronic dyspnea Extreme dyspnea on exertion
Resistance on inspiration/expiration Prolonged inspiration (pursed-lip
breathing)
Clubbing of fingers
Management:
Oxygen and bronchodilators
Albuterol: 2.5mg in 3mL
Consider CPAP
Contact ALS

Asthma
Asthma is two-pronged issue: bronchoconstriction and inflammation. BLS prehospital
treatment is aimed at bronchodilation (albuterol), while ALS prehospital treatment is aimed
at bronchodilation, reducing inflammation, and relaxing the smooth muscle of the airways.
Consider calling ALS anytime an asthma attack is suspected.
Asthma Status Asthmaticus

Bronchoconstriction & inflammation Severe, prolonged asthma attack that has
not been stopped with repeated doses of
Signs & Symptoms: bronchodilators.
Dyspnea
Intercostal Retractions
Decreasing LOC
Inability to speak in complete sentences
Tachycardia
Tachypnea
ETCO₂ > 45mmHg
Management:
Oxygen and bronchodilators
Albuterol: 2.5mg in 3mL
Consider CPAP
Contact ALS

Pneumonia & CHF

Pneumonia CHF
Signs & Symptoms: Signs & Symptoms:

Viral or bacterial Hypertension and left ventricular failure
Fever No fever
Dry skin Pale
Green/yellow sputum Diaphoretic
Unilateral breath sound issue Moist skin
Rales Hypertension
Diminished Bilateral breath sound issue
Absent RALES
Crackles Dependent edema - increased when
laying flat
35
Pulmonary Embolism
Rapid onset of difficulty breathing and chest pain – especially high suspicion in the patient
without a significant cardiac or respiratory history.
Common patients:
Bedridden (chronically or after surgery)
Long flights
History of deep vein thrombosis (DVT)
Female patient (teens – 40’s) on birth control
(birth control produces increased levels of estrogen and progesterone which have been
proven to increase blood clots)
History of smoking
Signs & Symptoms
Rapid onset of dyspnea

Cough
Pain
Anxiety
Hypertension
Tachypnea
Tachycardia
Crackles, wheezes, rhonchi
Treatment
Identification and Rapid Transport!

Pneumothorax
Simple Pneumothorax
Presence of air in the pleural space – not necessarily causing problems… yet.
Tension Pneumothorax
May be a progression from a simple pneumothorax
The accumulation of air in the pleural space causes “tension”
Diminished or absent breath sounds

Dyspnea and restlessness
Tachypnea
JVD
Hyperresonance on percussion
Subcutaneous emphysema (rice krispy feeling under the skin)
Patient will ultimately become hypotensive due to obstructive shock

BLS Medications: Albuterol

Beta-2 Agonist - Bronchodilator - Dilates the bronchioles in the lower airways
Indications - asthma, COPD, wheezing breath sounds
Dosage - 2.5mg in 3mL of normal saline, nebulized
Patients commonly will have rescue inhalers - follow protocol to administer or contact
medical control
Patients will likely have increased heart rate and “jitters” after administration
Medication must be breathed deeply to reach alveoli - encourage patient to take deep
breaths and hold as long as possible

BLS Medications:
Oxygen
Oxygen is a medication!
Never withhold oxygen from any patient - A patient in respiratory distress qualifies for high-
flow oxygen
1 – 15LPM, depending on device
Target SPO₂ levels of 94 – 99% - especially in infants, suspected stroke and MI patients

Review Questions
1.) In the adult patient, the average tidal volume is: _________mL.
2.).) How much anatomical dead space is typically found in the adult patient?
___________________
3.) The oxygen concentration from a nasal cannula is: ____ to ____%.
4.) The oxygen concentration from a nonrebreather mask is: _____ to ____%.
5.) How many liters per minute should be administered through a nasal cannula? ___ to ___ LPM.
6.) This type of maneuver should be performed to open the airway in a non-trauma patient.
_____________________________
7.) This type of maneuver should be performed to open the airway in a suspected or known
trauma patient. ____________________________
8.) An oropharyngeal airway is measured from the ___________________________ to the

__________________.
9.) Which type of airway adjunct should be placed in the patient with an intact gag reflex?
______________________
10.) Which type of suction is best for large chunks of food and vomit? _________________
11.) JVD, diminished breath sounds, unilateral chest rise and fall, tracheal deviation, and
subcutaneous emphysema are all signs/symptoms of __________________ ________________.
12.) Albuterol is classified as a __________________________.
13.) Wheezes are heard on ___________________ and come from the _____________ airways.
14.) The process of air moving into and out of the lungs is called __________________.
15.) Low oxygen levels in the cells is called _______________.

Want more Respiratory &
Airway review?
Review Answers
1. 500mL (more specifically, 5 – 7mL/kg of ideal body weight
2. 150mL
3. 24 – 44%
4. 80 – 100%
5. 1 – 6
6. Head tilt - chin lift
7. Jaw thrust or modified jaw thrust
8. Center of the mouth to angle of jaw
9. Nasopharyngeal
10.. Rigid (Yankauer)
11.. Tension Pneumothorax
12.. Bronchodilator
13.. Expiration/exhalation, lower
14.Ventilation
15.Hypoxia
4
Cardiology

Chapter 4: Cardiology
Cardiac Anatomy
Top of Heart:
Base
Right Atrium
Left Atrium
Pulmonic Valve
Mitral Valve
Tricuspid Valve
Aortic
Aortic Valve
Valve
Right Ventricle Left Ventricle
Bottom of Heart:
Apex
Three Layers of Heart Muscle

Valve Order: Endocardium: Innermost layer
“Toilet Paper My A..” Myocardium: Middle layer
Pericardium or Epicardium: Outer layer
“Peri”/”epi” mean “around” or “on top of”

Blood Flow Through the Heart
Cardiac Blood Flow
1. Superior and Inferior Vena Cava returns blood to heart

2. Right Atrium - Tricuspid Valve
3. Right Ventricle - Pulmonic Valve - Pulmonary Artery
4. To the Lungs - Pulmonary Vein
5. Left Atrium - Mitral Valve
6. Left Ventricle - Aortic Valve
7. Aorta (largest artery in the body)
a.) Coronary Arteries supply heart muscle and are fed off of the aorta
8. Body

Cardiac Conduction
Impulse Conduction:
SA Node sends the impulse inferiorly to

the AV Node through the intranodal
atrial pathways.
AV junction (“gatekeeper”) slows

impulse; allows ventricles time to fill.
Then, impulse passes through the AV

Junction into the AV Node and onto the
AV fibers.
The AV fibers conduct the impulse from

the atria to the ventricles
In ventricles AV fibers form bundle of

His. Bundle of His divides into left and
right bundle branches
Right bundle branch delivers impulse to

apex of right ventricle. Left bundle
branch divides into anterior and
posterior fascicles which terminate at
the Purkinje system.
Intrinsic Rates Purkinje system spreads it across
Sinoatrial (SA) Node: 60 – 100 myocardium.
Atrioventricular (AV) Node: 40 – 60
Purkinjes: 15 – 40
Bradycardia: heart rate < 60 bpm
Tachycardia: heart rate > 100 bpm

Cardiac Emergencies
Acute Coronary Syndrome
Coronary Artery Disease
Angina
Myocardial Infarction
Cardiac Arrest

Acute Coronary Syndrome (ACS)

“Cardiac Compromise” - blanket term used to describe any time the heart may not be
getting enough oxygenated blood.
Signs and Symptoms

Pain or pressure in chest
Difficulty breathing (dyspnea)
Palpitations (fluttering sensation in chest)
Sweating (diaphoresis), nausea, vomiting
Anxiety, weakness
Abnormal heart rate and/or blood pressure
Management:
Place patient in position of comfort
Oxygenation to achieve SPO₂ 94% or higher
Transport immediately
Administer or assist with Aspirin (“ASA”) administration
Assist with nitroglycerin  repeat doses every 5 minutes; maximum of 3 times

*Monitor blood pressure with each nitro administration
**Blood pressure must be greater than 100mmHg systollically

Coronary Artery Disease (CAD)

“Diseases that affect the arteries of the heart”
Thrombus: Clot formed of blood and plaque attached to the inner wall of an artery
(“tunica intima”)
Embolus: Blockage of a vessel by a clot brought to the site by the blood flow
Atherosclerosis: Calcium and cholesterol build up inside the walls of blood vessels,
leading to ischemia
Arteriosclerosis: hardening of the arterial walls, preventing adequate vasoconstriction and

vasodilation

Angina
Angina is the term for “pain in the chest”. It occurs when the heart’s demand for oxygen
exceeds the blood’s oxygen supply. It’s commonly caused by atherosclerosis and coronary
artery disease (CAD). It may also results from a spasm of the coronary arteries.
May occur during exercise or strenuous activity - usually subsides with rest
Patients will likely have prescription for nitroglycerin (tablets, spray, or film)
Management:
Relieve anxiety/pain
Place patient in a position of comfort
Administer oxygen
Obtain a 12 lead EKG (interpreted by Paramedic)
Consider medication administration (MONA)

Oxygen
Aspirin, 81 – 325mg
Nitroglycerin (assist with patient’s if applicable)

Myocardial Infarction
Portion of the myocardium dies (“infarcts”) as a result of inadequate oxygenated blood
supply
Other terms for Myocardial Infarction - “AMI, MI, Heart Attack”
Blockage of a coronary artery leads to myocardial ischemia (low oxygen), injury, and the
infarction (muscle/tissue death).
“Sudden Death” - Death that occurs within 2 hours of symptom onset
Cardiac Arrest
Chain of Survival: Pulse/Breathing Check:
Immediate recognition and activation 5 – 10 seconds in all patients
Early CPR
Rapid defibrillation 2 minutes/5 cycles for all patients
Effective ALS
Integrated post-cardiac arrest care Child:
Recovery Carotid Pulse Check
100 – 120 compressions/minute
Adult: 30:2 (single rescuer) | 15:2 (multiple rescuers)
Carotid Pulse Check Compressing 1/3 of patient’s chest (or 2”)
100 – 120 compressions/minute
30:2 (single or multiple rescuer) Infant:
Compressing 2” – minimize interruptions to Carotid or Brachial Pulse Check
no more than 10 seconds 100 – 120 compressions/minute
30:2 (single rescuer) | 15:2 (multiple rescuers)
Start CPR in Neonate/Infant/Child if pulse Compressing 1/3 of patient’s chest (or 1.5”)
< 60
Neonate:
Shockable Rhythms: Brachial Pulse Check
Ventricular Fibrillation & Pulseless 100 – 120 compressions/minute
Ventricular Tachycardia 3:1 compression/ventilation ratio
Compressing 1/3 of patient’s chest (or 1.5”)

BLS Medications:
Aspirin
Antipyretic, Antiplatelet Aggregator - Blocks platelet aggregation (prevents platelets from
stick together, thus, reduces risk of clot formation)
Indications - Chest pain, acute coronary syndrome
Contraindications - children, known hypersensitivity, active ulcer disease, signs of or

history of stroke
Dose - 81 – 324mg (1 baby aspirin tablet = 81mg)

1 adult tablet = 325mg
If patient has taken aspirin in last 24 hours, give remaining tablets to total 324mg

BLS Medications:
Nitroglycerin
Potent Vasodilator
Indications:
Chest Pain - obtain 12 lead first and establish IV access
Dose: 0.4mg SL (3 times, every 3 – 5 minutes as needed, 1.2mg maximum total dose)
*Monitor blood pressure with each dose - do not administer with systolic blood pressure
under 100mmHg (some protocols may vary)
*Have ALS obtain IV access and 12 lead EKG prior to administration when possible

Review Questions
1.) Nitroglycerin is a __________ __________.
2.) What is the correct CPR ratio in the neonate? _____________
3.) What is the correct CPR ratio in a two rescuer cardiac arrest with a pediatric patient?
_____________
4.) A heart attack is another term for a _____________ _______________ and is caused by a
blockage of a coronary artery.
5.) What medication is commonly administered to the patient with chest pain and is classified as an
antiplatelet aggregator? ______________
6.) The medical term for “pain in the chest”. ________________
7.) Which vessel takes unoxygenated blood to the lungs? ______________________
8.) Which valve separates the right atrium and the right ventricle? _______________________
9.) Which valve separates the left ventricle and the aorta? ___________________
10.) A heart rate less than 60 is referred to as ___________________.
11.) A heart rate greater than 100 is referred to as ________________.
12.) Upon leaving the lungs, which vessel returns the oxygenated blood to the left atrium?
_______________________
13.) When the newborn’s heart drops below 60, _________ should be initiated.
14.) What is the middle layer of the heart muscle called? ___________________
15.) True or False: A blood pressure should be obtained prior to administering or assisting with
nitroglycerin administration.
16.) The Bundle of HIS delivers the electrical impulses down to the _____________________.
17.) What is the maximum amount of time that should be spent on a pulse check? _________ seconds
18.) Where should the pulse check occur on a 9-month old infant? ___________ artery

Want more Cardiology review?
Review Answers
1. Potent vasodilator
2. 3:1 (compressions to ventilations)
3. 15: 2 (compressions to ventilations)
4. Myocardial infarction
5. Aspirin
6. Angina
7. Pulmonary artery
8. Tricuspid
9. Mitral (or “bicuspid”)
10.Bradycardia
11.Tachycardia
12.Pulmonary vein
13.Compressions
14.Myocardium
15.True
16.Bundle branches
17.10
18.Brachial
5
Medical
Emergencies

Chapter 5: Medical Emergencies
Brain Anatomy
Cerebrum: The “actual” brain itself…when you think of “brain” you probably picture the
cerebrum.
Reticular Activating System:

Frontal Lobe Responsible for maintaining
consciousness and ability to respond
to stimuli
Temporal Lobe
Parietal Lobe The brain receives ~ 20% of body’s

total blood flow per minute
Consumes 25% of body’s glucose
Occipital Lobe
Diencephalon (interbrain): Involuntary actions

(temperature, sleep, water balance, stress, emotions)
Mesencephalon (midbrain): Pons, Medulla Oblongata
(Respirations, blood pressure, heart rate)
“We live and die in the brainstem”

Mental Status
Severity of AMS: DERM
Depth of coma
AEIOU TIPS: Mnemonic to rule in/rule out Eyes
reasons for altered mental status and/or Respiratory pattern
unconsciousness Motor function
Alcohol
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychogenic
Stroke/Syncope
Babinski Reflex: dorsiflexion of the

great toe and fanning of others –
indicates dysfunction of the CNS
Glasgow Coma Score: This is a

must know! “Extra Value Meal $4.56”
Decorticate Posturing: Deep

cerebral brainstem injury – flexes
towards the “cord”
Decerebrate Posturing: Deep

cerebral brainstem injury (more
severe than decorticate)

Stroke
Ischemic (Occlusive): Most common (80%), cerebral artery blocked by clot
Results in ischemia, inadequate blood supply to brain tissue, progresses to brain

muscle infarction
Possible TPA (fibrinolytic) candidate, gain last time seen normal, etc.
Typically a more gradual onset
Hemorrhagic (Bleed): Less common (20%), bleeding can be within brain or on outer
surface of brain.
*Sudden onset, severe headache
Transient Ischemic Attack (TIA): Temporary interference with blood supply to brain
(“mini stroke”).
Lasts for few minutes to several hours, symptoms fully resolve in no more than 24
hours
No evidence of residual brain or neurologic damage

Check blood glucose on all suspected stroke
patients
Gain a good history from patient or family members,

specifically, time of symptom onset/last seen normal
Be cautious with oxygen administration – do not give

oxygen unless SPO2/patient presentation warrant
58
Seizures
Generalized Partial
Electrical discharge in small area of brain Confined to limited portion of brain
Spreads to involve entire cerebral cortex Localized malfunction
Causes widespread malfunction May spread and become generalized
Includes tonic-clonic and absence Simple or Complex

seizures
Tonic-clonic = “grand mal seizure” Simple:
Generalized motor seizure Focal motor, sensory, Jacksonian seizures
Produces loss of consciousness Chaotic movement or dysfunction of one
area of the body
Specific progression of events: No loss of consciousness
Aura
Complex:
Temporal lobe or psychomotor seizures
Loss of consciousness
Distinctive auras:
Unusual smell, taste, sound
Tonic phase, hypertonic phase Metallic taste in mouth is common
Status Epilepticus
Clonic phase
Two or more generalized motor seizures
without intervening return of
Post seizure consciousness
Postictal Management:
Petit-Mal/Absence Seizures Move objects from around patient

Brief, generalized seizure Oxygen
10 to 30 second loss of consciousness or Contact ALS for benzodiazepine
awareness administration
Eye or muscle fluttering
Occasional loss of muscle tone #1 cause of seizure activity is non-
compliance with medications
Obtain BGL on all seizure patients

Diabetes
Diabetes Mellitus: Inadequate insulin activity. Insulin is critical to maintaining blood
glucose levels and enables the body to store energy as glycogen, protein, and fat.
Type I Diabetes Type II Diabetes
“Juvenile Diabetes”
Insulin resistance
Beta cell destruction
Non-insulin-dependent diabetes mellitus
Very low production of insulin (if any) (NIDDM)
Insulin-Dependent Diabetes Mellitus (IDDM)  Some patients may require insulin

requires insulin injections for homeostasis
Heredity and obesity play a role
Less common than Type II, but more serious
Far more common than Type I
Accounts for most diabetes-related deaths
Untreated presents with lower level of
If untreated, blood glucose levels rise because hyperglycemia and fewer major signs of
cells cannot take up circulating sugar metabolic disruption
BGL of 300 – 500 not uncommon May proceed to hyperglycemic hyperosmolar

non-ketotic syndrome (HHNK)
Constant thirst (polydipsia), excessive urination
(polyuria), ravenous appetite (polyphagia),
weakness, weight loss
Ketosis result of fat catabolism

Hyperglycemic Hyperosmolar Non-Ketotic
Syndrome (HHNK)
Cells resistant - BGL rises with slow onset
Severe dehydration (osmotic diuresis)
Diabetic Ketoacidosis (DKA) BGL much higher than DKA ~ >1,000mg/dL
No insulin - BGL rises with fast onset Higher mortality than DKA
Body switches to fat catabolism  ketones
Kussmaul’s respirations
Ketones on breath Hypoglycemia
BGL ~> 500mg/dL BGL < 60, treat with oral sugar
(if conscious and able to maintain airway)

60
BLS Medications:
Oral Glucose
Anti-hypoglycemic medication
Contains 15g of glucose
Administered orally
Do not give to a patient with an altered mental status!
Patient must have the ability to swallow - lack thereof results in aspiration risk

Toxicology
Opioids
Heroin
Morphine
Codeine
Fentanyl
Signs and Symptoms:

Altered LOC Alcohol Use Disorder (AUD)
Pinpoint Pupils
Labored/shallow/agonal respirations Can lead to, worsen, or hide other medical
conditions
Treatment:
ABCs Contact law enforcement when safety is a
Naloxone (0.5 – 2mg), IN concern
Uppers Signs and Symptoms:

Alcohol odor on breath
Substances like cocaine, methamphetamine, Slurred speech
and bath salts that act on the nervous system Nausea/vomiting
to cause excitation. Incoordination
Delayed reaction time
Confusion, altered mental status
Downers Blurred vision
Lack of memory
Substances like alcohol, benzodiazepines,
sleeping medications, and “date rape” drugs Withdrawals
that act to depress the nervous system. Can be serious (lethal in some cases) - cause
seizures and delirium tremens (“DTs”)
Hallucinogens
Substances like LSD, PCP, and certain types

of mushrooms that cause a increased
excitement or hallucinations.

BLS Medications:
Naloxone (Narcan)
Opioid Antagonist - Blocks opioid receptor sites
Administered to…
Unknown/unresponsive patients
Opioid overdose patients
Typically administered intranasally by the EMT

1mL of medication (1mg) per nostril
2mg single dose

Toxicology
Black Widow Spider:

Red hour glass on back
Females = venomous
< 1 hour, muscle spasms and cramps (neurotoxin)
Diazepam and Calcium Gluconate
Brown Recluse Spider:

Fiddle-shaped
Localized pain in 1 – 2 hours
Bite is surrounded by an ischemic ring, outlined by a red halo
May cause death
Poisonous Snakes:
Pit vipers: rattlesnakes, cottonmouth or water moccasin, and
copperhead.
Vertical, elliptical pupils and a triangular head
Hemolysis
Intravascular coagulation
Convulsions
Acute renal failure
Management:
ABCs, extremity - immobilize in neutral position, do not use ice packs
or tourniquets

Medication Administration
“Rights of Medication Administration”
Right Medication
(Prescribed to the patient?)
Right Dose
(Per standing orders or Medical Control)
Right Time
(Is it indicated?)
Right Route
(Per the medication)
Right Patient
(Prescribed to the patient?)
Right Date/Documentation
(Expiration date and document delivery
method and any effects)
Half-Life of a Medication
Time it takes to metabolize or eliminate half the total amount (peak concentration) of a drug
in the body.
A drug is considered eliminated from the body after 5 half-lives have passed.
Example: Drug X has a half-life of 2 hours, if 50mg of the drug is given, in 2 hours there will
be 25mg remaining, in another 2 hours, there will be 12.5mg …

Sympathetic Nervous System

Two Types of Receptors:
Alpha-Adrenergic Receptors
Alpha 1
Alpha 2
Beta-Adrenergic Receptors:
Beta 1
Beta 2
Alpha 1 Receptors:
Vasoconstriction
Pupillary Dilation
Decreased Renin Secretion
Beta 1 Receptors: Beta 2 Receptors:

“You have 1 heart” “You have 2 lungs”
Stimulation Causes: Stimulation Causes:
Increased Heart Rate (Chronotropy) Bronchodilation
Increased Contraction (Inotropy) Vasodilation
Increased Automaticity/Conduction Selective Beta 2 Agonist

Impulse (Dromotropy) Albuterol
Nonselective Beta 2 Agonist

Dopamine
Selective Beta-Blocking Agents

Beta 1 – cardioselective agents – metoprolol, atenolol
Nonselective Beta-Blocking Agents

Beta 1 and Beta 2 Blocking – labetalol, nadolol, propranolol

Gynecology & Pregnancy Terms
Dysmenorrhea: pain during menstruation

Headache, faintness, dizziness, nausea, diarrhea, backache, and leg pain
Caused by muscular contractions of the myometrium, infection, inflammation
Presence of an intrauterine device (IUD)
Mittelschmerz: pain may occur as a result of follicular rupture and bleeding from
ovary during menstrual cycle
Pain in the right or left lower abdominal quadrant during normal mid-cycle of
menstrual period
Differentiate pain from appendicitis or other surgical emergencies
Gravida: # of times a women has been pregnant (including current)
Para: # of live birth (infants born after 20 weeks’ gestation)
Antepartum: the maternal period before delivery
Intrapartum: the maternal period during delivery
Postpartum: the maternal period after delivery
Term: a pregnancy that has reached 40 weeks gestation
First Stage of Labor: Begins with contractions and ends when the cervix is fully
dilated (10cm)
Second Stage of Labor: Measured from full dilation to delivery of the newborn
Third Stage of Labor: Begins with delivery of the baby and ends with placental
delivery
Precipitous Birth: onset of labor to birth is less than 3 hours

Gynecologic & Pregnancy

Emergencies
Ectopic Pregnancy: pregnancy that develops outside of the uterus (fallopian tube or
ovary)
Third leading cause of maternal death; typically found at 8 – 12 weeks gestation
Vaginal bleeding, crampy abdominal pain, spotting

Rigid, stiff, board-like abdomen
After rupture, severe abdominal pain, vaginal spotting, internal hemorrhage, sepsis,
and shock
Management https://www.completewomencare.com/ovarian-
Rapid Transport cysts/
Contact ALS
Normal
Ectopic
68

Emergencies
Placenta Previa: Abruptio Placenta:
Placental implantation in the lower uterine Partial or full detachment of a normally
segment, partially or completely covering the implanted placenta at more than 20 weeks
cervical opening gestation
Occurs in about 5/1000 deliveries Occurs in about 1% of all pregnancies;

results in fetal death in about 15% of
Signs and Symptoms cases
Third-trimester pain (aching)
Signs & Symptoms
Painless Third-trimester pain (stabbing)
Bright Red Bleeding Painful
Strongly associated with # of previous C- Dark Red Bleeding

sections & deliveries
Localized uterine tenderness
Most common cause of pre-term bleeding
Preeclampsia Eclampsia
Gestational hypertension after 20 weeks and Preeclampsia + Seizure = Eclampsia
at least one of the following:
Tonic-clonic activity (Grand Mal Seizures)
Proteinuria (protein/blood in urine) Labor can begin suddenly/progress rapidly
Low platelets
Impaired liver function Left lateral recumbent positioning
Renal insufficiency Oxygen
Pulmonary edema Contact ALS
Visual or cerebral disturbances
Each seizure increases fetal mortality by
Severe HTN characterized by systolic > 160 10%
and diastolic > 110 Can occur up to 4 weeks postpartum, rare
oxygen (PRN), calm transport


Emergencies
Postpartum Hemorrhage
500mL of blood loss after delivery
Occurs within first 24 hours
Accounts for 25% of obstetric deaths
Management - Fundal massage (releases oxytocin - helps with uterine contraction),

encourage newborn breastfeeding, contact ALS
Trauma During Pregnancy

ABCs first
Aggressive resuscitation
After first trimester, never transport pregnant patient flat on back

(Supine Hypotensive Syndrome)
Transport on left side - if spinally immobilized, “prop up” right side of backboard 6 – 12” to
achieve a leftward lean

Delivery & Complications

See Stages of Labor on “Gynecology & Pregnancy Terms” page
Imminent Delivery
Regular contractions, 45 – 60 seconds in length, at 1 – 2 minute intervals
Intervals are measured from beginning of one contraction to the beginning of next
Contractions > 5 minutes apart - transport
Mother has urge to bear down or has sensation of bowel movement
Crowning occurs
Mother believes delivery is imminent - always believe your patient!
Delivery
1. Crowning occurs - apply gentle counter pressure to fetus’ head (prevents explosive
delivery)
2. Observe for nuchal cord with delivery of head
3. Grab head with hands over ears to support head as it rotates for shoulder presentation
4. Once shoulders deliver, rest of baby delivers very quickly - use dry towel to grasp/support
5. Suction airway (mouth then nose) only if meconium staining is present along with
signs/symptoms of respiratory distress or coarse gurgling.
6. Dry newborn - Record sex and time of birth
Once baby is delivered/evaluated, cut umbilical

cord:
1. Cord should have stopped pulsating
2. Clamp cord - if baby does not need
resuscitation, allow for 30 seconds to 1 minute
after delivery to clamp/cut
3. Clamp 4 – 6” away from the newborn (in two
places)
4. Cut between the clamps – do not take the
clamps off!

“The Golden Minute”
Assign APGAR score at 1 and 5 minutes after birth

10 = best possible condition (unlikely in prehospital setting)
7 – 9 = generally normal
4 – 6 = moderately depressed
0 – 3 = severely depressed Shoulder Dystocia
Fetal shoulders are wedged against symphysis
** score of < 6 = likely resuscitation pubis, blocking shoulder delivery
Cephalopelvic Disproportion Common, 1:300

Newborn’s head is too large to pass
through birth canal Position patient in McRobert’s Maneuver and
apply gentle pressure to suprapubic area
Oxygen administration, rapid transport
Rapid transport
Breech Presentation
Largest part of fetus (head) is delivered last; more common in multiple births
Do not push!
Rapid transport, call for assistance, oxygen administration


Umbilical Cord Prolapse:
 Cord passes through the cervix at same
time or in advance of fetus
 Cord is compressed against fetus -
diminishing fetal oxygenation from placenta
 Occurs in 1:10 deliveries
Management
Assess for cord pulsation.
If pulsating, wrap with moist sterile dressing

and then dry dressing to maintain
temperature, continue to asses for pulse
If not pulsating, insert two gloved fingers into
vagina and attempt to move baby off of cord,
may also place mom in knee chest position.
Continue methods until cord begins
pulsating and follow directions above.
Nuchal Cord:
Cord is wrapped around fetus’ neck during
delivery.
Try to remove the cord from the fetus’ neck

during delivery, if unable, clamp in two places
and cut immediately!

Pediatrics
Sleeping Respiratory Blood

Age Awake Rate
Rate Rate Pressure
Neonate 100 – 205 90 – 160 40 – 60 80 + (2 x age*)
Infant 100 – 180 90 – 160 30 – 53 80 + (2 x age*)
Toddler 98 – 140 80 – 120 22 – 37 80 + (2 x age*)
Preschooler 80 – 120 65 – 100 20 – 28 80 + (2 x age*)
School-
75 – 118 58 – 90 18 – 25 80 + (2 x age*)
Aged
Adolescent 60 - 100 50 – 90 12 – 20 80 + (2 x age*)

*age in years

Pediatrics
Respiratory Differentiation
Croup Epiglottitis
Bronchiolitis
“Laryngotracheobronchitis” Epiglottis inflammation
Caused by a viral
Usually viral Uncommon
infection
6 months - 4 years Bacterial
Most commonly
Hoarseness, inspiratory Occurs at any age
RSV
stridor, barking cough Begins suddenly
Usually < 2 years of age
Temp = < 104 Muffled voice, drooling,
Often occurs in the
Most emergency episodes difficulty or painful
winter
occur at night swallowing
Generally not serious,
Cool mist or humidified Temp = > 104
may be life threatening
oxygen Often found in tripod
Coarse breath sounds
Nebulized/racemic position
Oxygen administration,
epinephrine may be Keep child calm, provide
albuterol, nebulized
indicated oxygen (if indicated,
epinephrine (ALS skill)
tolerable)
Petechiae
Meningitis
Viral or bacterial (bacterial is the most life-
threatening)
Stiff neck - Kernig’s and/or Brudzinski’s Sign
Fever (high fever)
Petechiae - pink/red rash (spots on skin)
Purpura
Purpura - dark purple lesions

Life threatening - Protect yourself with N95 mask!

Abdominal & GI Emergencies
Visceral Pain: “organ pain”, caused by stimulation of autonomic nerve fibers that
surround an organ.
Compression and inflammation of solid organs
Distention or stretching of hollow organs
Cramping, gas-type pain
Pain is generally diffuse, difficult to localize
Somatic Pain: produced by bacterial or chemical irritation of nerve fibers in the

peritoneum (peritonitis).
Usually constant and localized to a specific area
Sharp or stabbing pain
Referred Pain: pain in a part of the body considerably removed from the tissues that
cause the pain.
Grey’s Turner: Bruising of the skin of the Cullen’s Sign: The appearance of irregularly
flanks or loin in retroperitoneal formed hemorrhagic patches on the skin
hemorrhage and acute hemorrhagic around the umbilicus
pancreatitis

GI Bleeds
Upper
Above ligament of Treitz
Causes
Peptic ulcer disease
Gastritis, esophagitis
Variceal rupture
Mallory-Weiss tear (esophageal
laceration)
Gastric or duodenal ulcers
Symptoms
Hematemesis
Coffee ground emesis
Melena (probable)
Hematochezia (possible)
Lower
Below ligament of Treitz GI Bleed Treatment:

ABCs
Causes Left lateral recumbent/high semi-fowler’s position
Diverticulosis (protect airway)
Colon lesions Oxygenation via non-rebreather mask
Rectal lesions Contact ALS for fluid replacement and antiemetic
Anal fissures administration
Inflammatory bowel disorders
Ulcerative Colitis & Crohn’s
Mallory Weiss Tear (Upper GI Bleed):
Symptoms Laceration of the esophagus caused by excessive
Melena (possible) “retching” and vomiting - associated with bulimia.
Hematochezia (probable)
Tear does not extend through entire esophagus

Abdominal & GI
Irritable Bowel: Abdominal pain, cramping, increased gas, altered bowel habits, food
intolerance, abdominal distention
Bowel Obstruction: Blockage of bowel lumen

hernias – opening in wall
Intussusception – telescoping effect
Volvulus – knotting
Adhesions
Causes: Foreign bodies, gallstones, tumors, adhesions from abdominal surgery,

bowel infarction
Appendicitis: Inflammation of vermiform appendix (junction of large and small

intestines). Occurs mostly in young adults. Acute appendicitis is the most common
surgical emergency in the field. Rupture leads to peritoneal irritation - sepsis
Location: Appendicitis pain starts periumbilical (around the umbilicus) and radiates to
the RLQ.
McBurney's Point - 1 – 2 inches between anterior iliac crest and umbilicus

Abdominal & GI
Cholecystitis vs. Cholelithiasis
Cholecystitis: Inflammation of the gallbladder, caused by gallstones. Acute attack =

RUQ pain and can occur after a “fatty” meal. Murphy’s sign - right costal tenderness.
Cholelithiasis: the actual formation of the gallstones, causes 90% of cholecystitis

cases.
Pancreatitis: Inflammation of the pancreas.
Four main causes: 30 – 40% Mortality

Metabolic = alcoholism
Mechanical = gallstones
Vascular = thromboembolus or shock
Infectious = infectious disease
Can have decreased blood flow resulting in ischemia

Lesions can erode and hemorrhage
Hepatitis Types
A: Fecal/Oral Route - poor handwashing

B: Bloodborne pathogens
C: Blood transfusions - needle sharing
D: Dormant use activated by HBV
E: Waterborne
G: Developed after transfusion
Signs and Symptoms

RUQ pain
Jaundice
Nausea/vomiting
Malaise
Photophobia
Pharyngitis
Coughing

Sickle Cell
Sickle Cell Disease - inherited disease that causes an abnormal shape and size of
red blood cells.
Sickle Cell Anemia - “SCD” will result in sickle cell anemia. Because of the abnormal
RBC shape, they are prematurely destroyed by the body.
Incredibly painful disease that does not have a cure. Prominent in African American
males. Contact ALS for fluid resuscitation and pain management.
Normal RBC Sickle Cell – RBC

Irregularly shaped RBC

Immunology
Immune System
Primary system involved in allergic reactions
Main Goal - Destruction or inactivation of pathogens, abnormal cells, & foreign molecules
such as toxins
Immunity (Two Types)

Cellular immunity - direct attack of foreign substance by specialized cells of immune system.
Physically engulf and deactivate (example: phagocytosis – think “PacMan”)
Humoral immunity - more complicated chemical attack of invading substance

Antibodies are used to accomplish the attack
Immunoglobulins (“Ig’s”)
5 different types of Ig’s but be most familiar with IgE
Allergen attaches to IgE of basophils and mast cells, which then produces histamines
Histamine release produces - bronchoconstriction, increased intestinal motility, vasodilation,

and increased vascular permeability
Histamine release leads to the allergic reaction and/or anaphylaxis
Anaphylaxis
Sudden onset (30 – 60 seconds) - the quicker the reaction, the more severe
“Feeling of Impending Doom”

Laryngeal edema/laryngospasm/complete airway obstruction
Tachypnea  wheezes, increasing diminished lung sounds
Diffuse rash, hives *raised on skin*
Management
Cardiac monitoring (ALS)
Consider early ALS for advanced airway management
Oxygen is 1ˢᵗ line medication
Epinephrine Auto-Injector (“Epi Pen”) - hold injector in place for 10 seconds  rectus femoris
and vastus lateralis (thigh muscles)

BLS Medications:
Epinephrine (Epi Pen)
Prescribed/used during severe allergic reaction/anaphylaxis
Vasoconstrictor
Anaphylaxis causes massive vasodilation = hypotension
Adult Dose - 0.3mg (over 66 pounds)
Pediatric Dose - 0.15mg (up to 66 pounds)
Increased heart rate and blood pressure will occur after administration

Distributive Shock
The term “distributive shock” is an umbrella term - it refers to a shock that is “distributive” in
nature - meaning there is a significant problem with vasodilation. However, the cause of the
vasodilation is further classified as neurogenic, anaphylactic, or septic, depending on the
underlying mechanism.
Neurogenic Anaphylactic Septic

Loss of normal vasomotor Most extreme form of Systemic inflammatory
tone due to unopposed anaphylaxis response syndrome
parasympathetic (SIRS)
response. Hypotension,
tachycardia, Can lead to severe organ
Massive vasodilation bronchoconstriction, dysfunction and death
edema, dyspnea
Hypotension and Profound circulatory,
bradycardia Ultimately leads to cellular, and metabolic
cardiorespiratory failure abnormalities cause
increased risk of mortality
than sepsis.
Hypotension, tachycardia,
edema, AMS, fever, and
dyspnea
Typically, Distributive Shock is a “pipes” problem, meaning the “shock state” is coming from
massive and prolonged vasodilation.
It is not a “fluids” problem as you see in Hypovolemic Shock or a “pump” problem as you
see in Cardiogenic and Obstructive Shock.
83
Special Populations
Cystic Fibrosis: Inherited metabolic disease of the lungs, sweat glands, and digestive
and reproductive systems.
Production of thick mucus - predisposes the patient to chronic lung infections
Management:
Oxygen
Positive Pressure Ventilation (CPAP)
Nebulized saline (to loosen mucus)
Suctioning as needed
Muscular Dystrophy: Inherited muscle disorder with a slow, but progressive

degeneration of muscle fibers. Diagnosed early, child is unable to sit up and walk at
common age.
Management:
No effective treatment exists, supportive care in the prehospital setting
Multiple Sclerosis: Demyelination of the myelin sheath - thought to be an autoimmune

disease in which the body begins to attack the myelin in the CNS, causing scarring and
nerve damage
Signs and Symptoms: Fatigue, vertigo, clumsiness, unsteady gait, slurred speech,
blurred vision
Management:
No cure exists, supportive care in the prehospital setting

84
Review Questions
1.) Gravida is: _______________________________________________
2.) This stage of labor begins with contractions and ends when the cervix is fully dilated. _________
3.) An ectopic pregnancy is typically found between ____ and ____ weeks’ gestation.
4.) A pregnancy complication that occurs in the third trimester that is painful with dark red bleeding.
_____________ __________
5.) A postpartum hemorrhage is defined as blood loss of greater than _______mL within first 24 hours
after delivery.
6.) What are two ways to help control postpartum hemorrhage? ____________________________
7.) An APGAR score should be assigned at ____ and ____ minutes after birth.
8.) When a newborn’s head is too large to pass through the birth canal. ______________________
9.) When the umbilical cord is wrapped around the fetus’ neck during delivery, it is termed:
_____________________.
10.) Petechiae and purpura are characteristic findings of _______________.
11.) This respiratory condition typically occurs in kids between 6 months and 4 years of age and
produces a stridorous sound.
12.) Laryngotracheobronchitis is another term for __________.
13.) Type I Diabetes can develop into which hyperglycemic condition? ______________________
14.) Which is more common, Type I or Type II diabetes? _________________
15.) What is the number one cause of upper GI bleeds? _____________
16.) The most common surgical emergency seen in the field that starts as periumbilical pain.
________________
17.) What is the first line medication (excluding oxygen) in the anaphylactic patient? _____________
18.) Left untreated, anaphylaxis will develop into anaphylactic shock. What major shock category is
anaphylactic shock apart of? __________________

Want more Medical review?
Review Answers
1. # of total pregnancies (including current – if applicable)

2. First
3. 8, 12
4. Abruptio placenta
5. 500
6. Fundal massage, encourage breast feeding
7. 1, 5
8. Cephalopelvic disproportion
9. Nuchal cord
10.Meningitis
11.Croup
12.Croup
13.Diabetic Ketoacidosis (DKA)
14.Type II
15.Peptic Ulcers
16.Appendicitis (young males)
17.Epinephrine
18.Distributive
6
Trauma

Chapter 6: Trauma
Trauma
Kinematics of Trauma
Motorcycle Crashes
Head-On Impact:
Over the handlebars - head and neck trauma, compression injuries to the chest and abdomen.
If feet remain on footrests during impact - mid-shaft femur fracture(s), perineal injuries
Angular Impact:
Rider is often caught between motorcycle and second object (vehicle, barrier, etc.)
Crush type injuries, open fractures to the femur, tibia, fibula
Fracture/dislocation of malleolus
Laying Motorcycle Down:

Massive abrasions (road rash) - treat as you would a burn
Fractures to the affected side
Vehicle vs. Pedestrian Vehicle vs. Pedestrian
Pediatric Patients Adult Patients
Tend to face oncoming vehicle Turn away from vehicle
Frontal impact - above knees/pelvis Lateral or posterior impacts
Initial impact - femur and pelvic injuries, Initial impact - bumper striking lower legs
internal hemorrhage (lower leg fractures)
Secondary impact - thrown backwards, head Secondary impact - hits hood/windshield,

and neck flexing forward femur, pelvis, thorax, spine fractures
Third impact - thrown to downward onto Third impact - thrown to ground, hip and
ground should injuries, deceleration injuries,
fractures/hemorrhage

Chapter 6: Trauma
Types of Impact
Car Crash: Frontal Impact (Head-On)
Down and Under Pathway:

Travels downward into the vehicle seat and forward into the dashboard or steering column
Knees become leading part of body – upper legs absorb most of impact - knee dislocation,
patellar fracture, femoral fracture, fracture or posterior dislocation of hip, fracture of acetabulum,
vascular injury and hemorrhage
Chest wall hits steering column or dashboard, head and torso absorb energy – tamponade,
cardiac contusion, pneumothorax
Up and Over Pathway:

Body strikes the steering wheel – ribs and underlying structures absorb momentum – rib
fractures, ruptured diaphragm, hemo/pneumothorax, pulmonary contusion, cardiac contusion,
tamponade, myocardial rupture, aortic aneurysm.
If head strikes windshield first - suspect cervical fracture (axial loading injury)
Car Crash: Lateral Impact Car Crash: Rotational Impact & Rollover
Crashes
Vehicle is struck from the side
(“T-bone collision”) Rotational: produces same injuries as commonly
found in head-on and lateral crashes
Fracture of clavicle, ribs, or pelvis
Rollover: ejection, may have several types of
Pulmonary contusion injuries
Ruptured liver or spleen Car Crash: Rear End Impact

(depending on side involved)
Vehicle struck from behind – back and neck
Head and neck injury injuries - hyperextension
Blast Injuries (Explosions/Bombs)
Primary Blast: pressure wave  injuries to ears (eustachian tubes), lungs, CNS, eyes, GI tract
Secondary Blast: flying debris – blunt, penetrating, and lacerating injuries
Tertiary Blast: patient is thrown and injured by impact on ground or other objects
Kinetic Energy = .5mass X velocity²

Chapter 6: Trauma
Burns
First Degree (Superficial): Reddened skin, pain at burn site, involves only epidermis, no
blistering. Heals spontaneously in 2 -3 days.
Second Degree (Partial Thickness): Intense pain, white to red skin, blistering, moist-
mottled skin, involves epidermis and dermis.
Third Degree (Full Thickness): Dry, leathery skin (white, dark brown, or charred), painless,
all dermal layers/tissues may be involved.
Fourth Degree: Involvement of muscle and bone, charred appearance, painless
Rule of 9s – Adult
Rule of 9s – Pediatric

Chapter 6: Trauma
Burns
Inhalation Injury
Toxic inhalation: synthetic resin combustion - cyanide and hydrogen sulfide - systemic
poisoning - more frequent than thermal inhalation burn
Signs and Symptoms of Inhalational Injury Above Glottis

The upper airway “normalizes” the temperature of the inspired air (which is great,
because it protects our lower airway from these extreme temperatures), however, it
sustains the impact of the superheated air.
Facial burns, signed nasal or facial hair, “sooty” sputum, hypoxemia, stridor, red mucus
membranes, grunting respirations.
Signs and Symptoms of Inhalational Injury Below Glottis

Steam inhalations more likely to reach lower airways – has 4,000 times the heat carrying
capacity than dry air.
Wheezes, crackles or rhonchi, productive cough, hypoxemia, bronchial spasm

Carbon Monoxide Poisoning
Affinity for hemoglobin is 250 times greater than oxygen - creates carboxyhemoglobin
Odorless, tasteless gas
Cherry red skin only presents at levels > 40% (late sign)
“Multiple people feeling ill in same residence/building” - nausea/vomiting, headache,

decreased LOC, weakness, tachypnea, tachycardia
CO produces false pulse oximetry reading
High flow, high concentration oxygen is best treatment for these patients
Acid vs. Alkali Burns

Acids - burning process lasts just 1 – 2 minutes - will cause coagulation
Alkalis - burning process lasts minutes to hours - will cause liquefaction necrosis

Chapter 6: Trauma
Head Trauma
Types of Head Bleeds
Subdural Subarachnoid Epidural

Collection of blood
Collection of blood Intracranial bleeding between cranium and
between dura and into cerebrospinal fluid dura in epidural space
arachnoid matter (CSF)
Arterial bleed (Middle
Venous bleed Sudden and severe Meningeal Artery - most
headache common)
More common than
epidural bleeds Slow onset of Transient loss of
symptoms consciousness, followed
Slow onset of symptoms “Worst headache of by a lucid interval which
Nausea/vomiting my life” neurologic status returns
Headache Dizziness to normal, followed by
Decreasing LOC Neck stiffness decreasing LOC
Coma Unequal pupils
Posturing Vomiting Headache
Seizures Decreasing LOC
Decreasing LOC Increased ICP (“Cushing’s
Triad”)
Significant head injuries can lead to intracerebral

Irr
swelling and increased intracranial pressure

egu
dia
Increased Intracranial Pressure

lar
car
“Cushing’s Triad” or “Cushing’s Reflex” .

Cushing’s
Re
dy
spi
Bra
Triad
rat
Treatment:
SPO2 > 94%
ion
Capnography monitoring of 35 – 40mmHg

s
Systolic Blood Pressure

Chapter 6: Trauma
Head & Neck Trauma
Raccoon Eyes
“Bilateral Periorbital Ecchymosis” - bruising
around the eyes
Associated with orbital fractures
Battle’s Signs
“Retroauricular Ecchymosis” - bruising around
the ears
Associated with a fracture of the auditory canal

and lower areas of the skull
Cover open neck wounds with an occlusive

dressing to prevent air embolisms and a
“Target” or “Halo” Sign “sucking wound”
CSF drainage from ears -
may produce a halo effect
on gauze

Chapter 6: Trauma
Spinal Cord Injuries

The spine has 33 total vertebrae
Cervical Spine: 7 vertebrae
Thoracic Spine: 12 vertebrae
When in doubt, Lumbar Spine: 5 vertebrae
immobilize!
Sacral Spine: 5 vertebrae
Coccyx Spine: 4 vertebrae
Meninges:
Main job is to protect or “PAD”
Pia Mater: innermost layer, directly on CNS
Arachnoid Mater: middle layer, web-like (arachnoid = spider)
Dura Mater: Outermost layer (“durable”)

Chapter 6: Trauma
Chest & Abdominal Trauma

Hemothorax/Tension Pneumothorax Similarities:
tachypnea, dyspnea, cyanosis, diminished or decreased breath sounds, tracheal deviation
(late sign), asymmetrical chest rise
Hemothorax/Tension Pneumothorax Differences:

Hemothorax Tension Pneumothorax
Accumulation of blood in the pleural space Accumulation of air in the pleural space
May be massive: 2 – 3L
Dullness on percussion (hyporesonance) JVD

Narrow pulse pressure Hyperresonance on percussion
Hypotension/hypovolemia Subcutaneous emphysema
No JVD Patient’s will become hypotensive in late
stages (obstructive shock)

Chapter 6: Trauma
Flail Chest
“Two or more adjacent ribs are fractured in two or more places”
Signs and Symptoms

Bruising
Tenderness
Crepitus
Paradoxical motion with inspiration and expiration (late sign)
Treatment
SPO₂ and ETCO₂ monitoring
Assist ventilations to achieve SPO2 > 94%
Consider CPAP
Contact ALS for advanced airway management
Commotio Cordis
Leading cause of death in youth baseball in US
(2 – 3 deaths per year)
Blunt chest trauma, timed during upstroke of T wave (relative refractory period – “R on T
phenomenon”
Induces ventricular fibrillation

Chapter 6: Trauma
Cardiac Tamponade
A cardiac tamponade often occurs due to blunt trauma (think steering wheel to the chest).
Tamponade carries a heavy mortality rate but before we jump into mortality, let’s review
what happens in tamponade…
The heart is surrounded by a sac, called the

pericardial sac. This sac has three layers (or
linings). The innermost lining is the visceral
pericardium (visceral to the vasculature!), then the
parietal pericardium, then the fibrous pericardium.
In between the visceral pericardium and parietal

pericardium is 25mL of pericardial fluid.
Beck’s Triad
When a tamponade occurs, there is an excess n
Mu
tio
accumulation of fluid that builds up in the
ten
pericardial sac. Because the sac is tough (think

leather) it does not expand well with this excess ffle
Dis
fluid – this excess fluid and lack of expansion puts dH

more pressure on the heart which prevents it from Key Signs & Symptoms
ein
ea
filling and pumping like it needs to. This causes
rt
cardiogenic or obstructive shock
rV
So
(EMS Standards recognize Tamponade as both
ula
forms of shock).
un
Jug
ds
Tamponade can be caused by trauma, an MI,

pericarditis, or neoplasms.
Hypotension
Management Other Signs & Symptoms
ABCs Chest Pain, Dyspnea, Orthopnea, Narrowing
Oxygen Pulse Pressure, Electrical Alternans, Pulsus
Contact ALS Paradoxus, Altered LOC

Chapter 6: Trauma

Evisceration
Protrusion of an internal organ(s) or the peritoneal contents through a wound
Management
Cover eviscerated contents with moist, sterile dressing
Cover moist dressing with dry dress to conserve organ temp
Never attempt to place organs back in cavity
Solid Organ Injury Hollow Organ Injury

Rapid and significant blood loss Sepsis, wound infection, abscess
Solid organs most injured = liver and spleen formation - spillage of their contents is
Both can be life threatening primary concern
Liver Stomach - not often injured by blunt

Largest organ in abdominal cavity trauma
Often injured by trauma to 8ᵗʰ – 12ᵗʰ ribs on
right side Colon and small intestine - more likely to
Second most commonly injured intra- be injured by penetrating trauma than
abdominal organ blunt trauma
Mortality rate = 54%
Spleen Abdominal Trauma Treatment

Left upper quadrant
40% of patients have no symptoms… Stabilize the patient & rapid transport
immediately
Pain in left shoulder (Kehr’s Sign) Position of comfort
Oxygen
Check for other injuries
Reassess every 5 minutes

Chapter 6: Trauma
Fractures
Ligaments - connect bone to bone
Types of Fractures
Tendons - connect muscle to bone
Sprain - stretching and tearing of

ligaments
Strain - overstretching and/or

overexertion of muscle
Blood Loss Associated with

Fractures
Rib = 125mL
Radius or Ulna = 250 – 500mL
Humerus = 500 – 750mL
Tibia or Fibula = 500 – 1,000mL
Femur = 1,000 – 2,000mL
Pelvis = 1,000mL +
Greenstick - most common fracture in
children
Injury Presentations
Hip Fracture
Affected leg is shortened and externally rotated
*Fractures closer to the head of the femur may present similarly to anterior hip
dislocation - shortened leg and an internally rotated.
Hip Dislocation
Affected leg is shortened and internally rotated.
Usually a posterior dislocation of the femoral head.
Femur Fracture
Affected leg is shortened and externally rotated with mid-thigh swelling (from
hemorrhage)

Chapter 6: Trauma
Types of Shock
Commonly Associated
Hypovolemic Cardiogenic with Trauma
Obstructive
Due to inadequate Compromise of cardiac Inability to produce

circulating blood and/or output despite adequate adequate cardiac output
fluid volume circulating blood volume despite normal blood
volume and myocardial
Most common causes: Results from heart failure, function.
hemorrhage and cardiac tamponade, MI,
dehydration third degree heart block Results from cardiac
tamponade, tension
Hypotension, tachycardia, Most common cause = pneumothorax, &
anxiety and confusion myocardial infarction pulmonary embolism.
Hypotension, tachycardia, Difficulty breathing, JVD,

pulmonary edema, anxiety tachycardia, anxiety and
and confusion confusion
Stages of Shock
Compensated Decompensated Irreversible
Mild tachycardia Moderate tachycardia Bradycardia, severe

dysrhythmias
AAO, lethargic, slightly Confusions, decreasing
confused, restless, to unconsciousness Coma
anxious
Delayed capillary refill, Pale, cold, clammy skin
Delayed capillary refill, cold extremities,
cool skin cyanosis BP: Significant
hypotension
BP: normal or slightly BP: decreased systolic
elevated and diastolic blood
pressures

Chapter 6: Trauma
Environmental Emergencies
Hypothermia
Core body temp (CBT) of less than 95 degrees - lose the ability to shiver
Mild hypothermia: 89.8 – 95

Moderate hypothermia: 82.5 – 89.7
Severe hypothermia: < 82.4
Increased risk of enter Ventricular Fibrillation
Management:
Handle with care
Move to warm environment and start rewarming process
Remove wet/cold clothing
Heat Exhaustion Heat Stroke
CBT up to 103 CBT > 104
Signs & Symptoms Signs & Symptoms

Severe cramps Confusion/irrational behavior
Dizziness Coma
Nausea Flushed skin
Profuse sweating Pulmonary edema
Headache Dysrhythmias
GI bleeding
Management: Clotting disorders
Move to cool environment Reduced renal function
Cool patient with a cool water spray Hepatic injury
Contact ALS Electrolyte abnormalities
**Sweating may be absent**
Management:
Move to cool environment
Cool by fanning, keep the skin wet
Contact ALS

Chapter 7: Trauma
Review Questions
1.) In a blast injury, the pressure wave occurs during which phase of the blast? _______________
2.) If a patient’s head strikes the windshield, what type of spinal cord injury should be suspected?
______________________
3.) Carbon monoxide has an affinity for hemoglobin that is _____ times greater than that of
oxygen.
4.) _____________ skin is a late finding in high carbon monoxide levels.
5.) This type of inhalation burn has the greater likelihood of reaching the lower airways.
_____________
6.) This type of burn causes liquefaction necrosis. ________________
7.) This type of burn causes coagulation. _______________
8.) Bradycardia, irregular respirations, and an increasing blood pressure collectively form
___________ _______.
9.) This type of head bleed is arterial in nature and most commonly involves the middle meningeal
artery. ______________
10.) The inability to create new memories. ___________________
11.) This type of head bleed is venous in nature and is more common than epidural bleeds.
___________
12.) What is a major difference between a hemothorax and a tension pneumothorax?

____________
13.) Blunt chest trauma, timed during the upstroke of the T-wave that produces ventricular
fibrillation. ___________________________________
14.) The most common type of fracture in the pediatric patient. ___________________
15.) Left untreated, a tension pneumothorax will develop into ______________ shock.

Want more Trauma review?
Review Answers
1. Primary
2. Cervical
3. 300
4. Cherry red
5. Steam
6. Alkalotic
7. Acidic
8. Cushing’s Triad
9. Epidural
10.Anterograde amnesia
11. Subdural
12.Jugular Vein Distention (JVD)
13.Commotio Cordis
14.Greenstick
15.Obstructive
7
EMS Operations

Chapter 7: EMS Operations
Communications
Radio Bands & Frequencies
Ultrahigh Frequency (UHF)
Very High Frequency (VHF)
Radio Communications
Simplex Transmissions: transmit and receive on same frequency; cannot do both
simultaneously - dispatch systems and on-scene communications
Duplex Transmissions: simultaneous two-way communications by using two frequencies

for each channel - works like a telephone
Ambulance Standards
Oversight for EMS usually falls to state governments; requirements for ambulance service
written in state statute or regulations.
National standards and trends have influence on development of laws.
State standards set minimum standards, rather than gold standard, for operation.
Local and/or regional EMS systems more detailed and approach to gold standard.

Ambulance Design
Type I: conventional truck cab-

chassis with modular ambulance
body
Type II: standard van, forward

control integral cab-body
ambulance
Type III: specialty van, forward

control integral cab-body
ambulance
Medium Duty Ambulance:

designed to handle heavier loads

Air Medical Operations

Launch Information
Requesting agency identity, contact radio frequencies, call back cell phone number
Local weather conditions
Presence of hazardous materials
Number of patients; basic medical description
Landing Zone
Landing Zone Officer should be designated; coordinates incoming aircraft operations
with incident commander (IC)
Selection of site: site preparation, site protection and control, air-to-ground
communications, updating IC on estimated time of arrival
LZ, ideally 100’ by 100’ with little to no slope
Clear of readily visible debris or obstructions
If area is dusty, consider lightly watering area with fog pattern
Never necessary to have charged hose line pointing at aircraft
Mark LZ with cones (daytime) or strobes (nighttime)
Avoid shining lights up towards aircraft
Avoid using flares
LZ Site Prep
Mnemonic:
HOTSAW
Hazards
Obstructions
Terrain
Surface
Animals
Wind/weather

Triage
Primary Triage
Used at the site to rapidly categorize patient conditions for treatment and transport needs
Secondary Triage
Used at the treatment area, where patients are triaged again. Patients are labeled with
tags to assign priorities.
START Triage
60 second assessment
Assesses ability to walk, respiratory effort, pulses/perfusion, and neurological status
Step 1: Ability to walk - walk and understand basic commands = delayed
Step 2: Respirations:
Absent respirations = dead
< 10 or > 30 = critical
Normal respirations = delayed
Step 3: Pulses/Perfusion
Absent pulse = dead
Present at carotid and absent radial = critical
Step 4: Mental Status

Alert and Oriented?
Have patient perform motor task
Patient who can perform both tasks = delayed
If the patient does not have any serious injuries and is alert and oriented = hold

Hazardous Materials
NFPA 704 (“Global Harmonized System”)
Fixed at facilities to identify hazardous
materials
HazMat Zones
Hot Zone: site of contamination

Warm Zone: contamination reduction zone
Cold Zone: safe zone – no contaminants
Tox Terms
LEL – Lower Explosive Limit

UEL – Upper Explosive Limit
IDLH – Immediately Dangerous to Life or
Health CBRNE Agents
Chemical
Terrorism Targets Biological
Public buildings, major infrastructures, historical Radiologic
buildings, divisive businesses (abortion clinics, Nuclear
etc.) Explosive
Self Protection
Time, Distance, Shielding
Smell of Freshly Cut Grass – Think Phosgene
Levels of PPE
Level A - Highest level of protection, full encapsulating suit, SCBA
Level B - Highest level of respiratory protection, lower level of skin protection, SCBA,
chemical resistant clothing.
Level C - Used during transport of contaminated patients, face mask, chemical splash suit,
coveralls.
Level D - Work uniform, provides minimum protection

Review Questions
1.) What chemical smells like freshly cut grass? ____________________
2.) The ideal landing zone should be _______ x ______ feet.
3.) Which level of PPE offers the highest level of protection in hazardous materials situation?
____________
4.) What three components are critical to self protection during hazardous material incidents?
__________, _______________, ________________.
5.) How should the landing zone be marked during the day? _________ How should it be marked at
night? _____________
6.) What is the mnemonic for landing zone site preparation? _______________
7.) When operating an emergency vehicle, you must drive with _______ _________. (not included in
guide)
8.) The hot zone is the site of ______________.
9.) Making false statements about a person is termed: __________________ (see medical terminology)
10.) What are the CBRNE agents? ______________, ________________, ______________,

______________, ______________
11.) Simultaneous two-way communications by using two frequencies for each channel  works like a
telephone. ___________________
12.) Transmit and receive on same frequency; cannot do both simultaneously  dispatch systems and
on-scene communications. _______________________

Want more EMS Operations
review?
Review Answers
1. Phosgene
2. 100, 100
3. A
4. Time, Distance, Shielding
5. Cones; Strobes
6. HOTSAW
7. Due regard
8. Contamination
9. Slander
10.Chemical, Biological, Radiological, Nuclear, Explosive
11.Duplex transmission
12.Simplex transmission
Final Steps…
As you finish this study guide, you are probably feeling on the top of your game! But, the
journey isn’t over yet. You still have to conquer that exam, which you WILL do!
Check out some of our tips before taking the exam!
Do not pay attention to the timer – less than 1% of candidates fail because of time
Do not pay attention to the question number, a percentage of students will get all 120
questions regardless of their performance – the question number doesn’t matter!
Get a good night’s sleep and eat a good breakfast before the exam – do not
underestimate this!
Do not over study on exam day, “tying loose ends” is fine, but no heavy studying – stop
reviewing several hours before the exam. Your brain needs rest too.
Beat the test one question at a time, pause, relax, take a deep breath and pick the best
answer.
10 questions will be pilot questions and will not be scored. So, if you get a really
difficult questions, just assume it’s a pilot question and give your best answer by
process of elimination – don’t dwell!
Read every question twice – a lot of students skip over key words and information –
reading each question twice will help you pick up on information you didn’t catch the
first time.

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EMT NREMT

Created by EMS Educators with 38+ years of experience

He holds multiples Associate’s Degrees along with a Bachelor’s

Brandon Schoborg, MBA, NRP

He completed his paramedic education at the University of

Medication dosages may differ across the country, any medication

Reference herein to any specific commercial product, process, or service

This study guide is for supplemental/informational purposes only and does

2 Medical Terminology & Patient Page 7

3 Respiratory & Airway Page 20

7 EMS Operations Page 104

The NREMT Exam

This study guide will primarily focus on the

Topic Area Percentage of Questions

Cardiology & Resuscitation 20 – 24%

EMS Operations 10 – 14%

Copyright 2023 - Pass with PASS, LLC 6

Copyright 2023 - Pass with PASS, LLC

By the way, it was “C – Anaphylaxis”

Agonist  to enhance an expected response.

Anaerobic  the absence of air or oxygen.

Aniscoria  a condition characterized by unequal pupil size.

Antagonist  to inhibit or counteract the effects of other drugs or undesired effects.

Aphasia  inability or difficulty in speaking.

Apnea  the cessation of spontaneous respirations.

Ascites  abnormal accumulation of fluid in the abdomen.

Atrophy  shrinkage of a cell or muscle.

Cell  basic unit of life.

Cilia  small, hair-like structures.

Coma  deep state of unconsciousness, unarousable.

Confabulation  made up stories to fill in gaps of lost memory.

Congenital  present at birth.

Contrecoup  occurs at a site opposite of the side of impact.

Dermatomes  specific area that is supplied by a single spinal nerve.

Dysarthria  poor articulation of speech. Often due to affected muscles used in

Dyskinesia  disorder related to involuntary muscle movements.

Dysplasia  abnormal growth of a cell.

Dysphagia  difficulty in swallowing (stroke/anaphylaxis)

Dysuria  difficult or painful urination

Epidemic  a widespread occurrence of an infectious disease in a community at a

Erythrocytes  red blood cells.

Gestation  period from fertilization of ovum to birth of fetus.

Hemiparesis  one-sided weakness; often seen in those with CVA’s.

Hemolysis  breakdown of red blood cells.

Hemoptysis  coughing up blood.

Host  an animal or human with exposure to an infectious agent.

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Incontinence  inability to control bowel or bladder function.

Infarction  death of tissue from lack of oxygen.

Inferior  down/bottom, toward the feet.

Joule  measurement of electrical energy.

Laryngitis  inflammation of the larynx.

Mania  a mood disorder characterized by hyperactivity, agitation, excitement and

Melena  black, tarry stools containing digested blood.

Myalgia  muscle pain.

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Nucleus  controlling body of a cell.

Nystagmus  involuntary jerking actions of the eyes.

Osmosis  the diffusion of solvent (water) through a membrane from a less

Ovum  a female egg or egg cell.