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Prepared exclusively for Ali Alquraini Transaction: PWP3586 No one other than the individual above should access
or use this study guide. Contents are copyrighted.
Copyright 2021 - Pass with PASS, LLC 1

Prepared exclusively for Ali Alquraini Transaction: PWP3586 No one other than the individual above should access or use this study guide. Contents are copyrighted.
About the
Authors
Adam Peddicord
Co-Founder, Pass with PASS, LLC
Adam has been a Paramedic since 1998 and started his fire
service career in 1993. He is currently the EMS Coordinator and
a Captain/Paramedic at Newport (KY) Fire/EMS Department
where he also serves as the Medical Commander of the Newport
Police Department SWAT Team.
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
Co-Founder, Pass with PASS, LLC
Brandon is currently the EMS Education Manager of the largest
and busiest fire department in Ohio. Previously, he was the
Director of EMS Education at Cleveland Clinic Akron General,
Assistant Paramedic Program Coordinator at Gateway
Community and Technical College and the Assistant EMS
Coordinator, Engineer/Paramedic, and SWAT Paramedic with the
Newport (KY) Fire/EMS Department for 8 years.
He completed his paramedic education at the University of

Cincinnati in 2010. Brandon has an Associate’s Degree in EMS,
Bachelor’s Degree in Health Sciences, 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 © 2021 by Pass with PASS, LLC. All rights reserved.

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Table of Contents
1 The NREMT Exam Page 5
2 Medical Terminology Page 7
3 Respiratory & Airway Page 19
4 Cardiology Page 47
5 Neurology Page 79
6 Toxicology & Pharmacology Page 93
7 Trauma Page 105
8 Medical Page 122
9 Special Populations Page 149
10 EMS Operations Page 152

1
CHAPTER 1
THE NREMT
EXAM

Chapter 1: The NREMT Exam
The NREMT Exam

The National Registry examinations are broken • Pilot Questions: 20 questions that are
into two segments: the cognitive exam (“the not factored into the student’s
written”) and the psychomotor exam (“hands- performance.
on”).
• Calculator: An onscreen calculator is
The cognitive exam is computer based and is available during testing. You are not
adaptive, meaning that the exam will tailor it’s permitted to bring your own calculator.
questions based on your performance and the
level of difficulty of each question. Once the • Pediatrics: 15% of the questions in
exam is 95% confident that you have reached each of the five categories are pediatric
the level of competency or is 95% confident based questions.
that you cannot reach competency, the exam
will stop (as long as you have answered the
minimum amount of questions, 80, or have not
exceeded the total time allowed, 2 hours and Psychomotor Exam
30 minutes).
Check out our 1-hour Psychomotor Exam
This study guide will primarily focus on the Review Lecture on our website!
cognitive examination.
Topic Area Percentage of Questions

Airway, Respiration, & Ventilation 18 – 22%
Cardiology & Resuscitation 22 – 26%
Trauma 13 – 17%
Medical/OB-GYN 25 – 29%
EMS Operations 10 – 14%

2
CHAPTER 2
Medical
Terminology

Chapter 2: Medical Terminology
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!

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.
Anion  an ion with a negative charge.
Aphasia  inability or difficulty in speaking.
Apnea  the cessation of spontaneous respirations.
Ascites  abnormal accumulation of fluid in the abdomen.
Ataxia  failure of muscle coordination.
Atrophy  shrinkage of a cell or muscle.
Aura  sensation (may be visual, smell, taste, etc.) that may precede a migraine or seizure.
B
Benign  nonmalignant, often not problematic.
Bile  secreted by the liver, stored in gallbladder.
Blebs  collection of air between the lung and visceral pleura that can result in spontaneous
pneumothorax.
Bruit  an abnormal sound or murmur due to a narrowing of the vessel.
Bursa  a sac containing synovial fluid that helps ease friction between tendons and bone.

C
Carcinogens  cancer-causing agents.
Cartilage  smooth and firm connective tissue.
Cation  an ion with a positive charge.
Cell  basic unit of life.
Cerumen  ear wax found in external ear canal.
Chyme  mass of partially digested food passed from stomach to the duodenum.
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.
Demarcation  line or visible mark between living and necrotic tissues.
Dendrites  found at the end of neurons, allows propagation of message towards cell body.
Dentalgia  is a toothache.
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.
Copyright 2021 - Pass with PASS, LLC

10
D (continued)
Dysplasia  abnormal growth of a cell.
Dysphagia  difficulty in swallowing.
Dysuria  difficult or painful urination.
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
Facilitated diffusion  a carrier-mediated process moving substances from areas of high concentration
to low concentration.
Fascia  connective tissue that surrounds or separates muscles.
Fecalith  fecal impaction in the colon.
Fibrinogen  blood protein used in clotting cascade.
Frailty  characterized by exhaustion, slowed performance, weakness, weight loss, low physical activity,
often seen in the elderly.
G
Gait  walking or moving on foot.
Ganglia  a group of nerve cell bodies in the peripheral nervous system.
Gestation  period from fertilization of ovum to birth of fetus.
Globulins  simple proteins classified by their size, mobility, and solution.
Glomerulus  mass of capillaries found at the beginning of each nephron.

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.
Hydrocele  a fluid-filled sac along the spermatic cord.
Hymen  a mucous membrane covering the vaginal outlet.
Hyperemia  increased blood flow to an organ.
Hyperopia  distant vision is clear, but near vision is often blurry (farsightedness).
Hyperplasia  excessive increase in the number of cells.
I
Idiopathic  unknown cause.
Idiosyncrasy  an abnormal response to a drug.
Incontinence  inability to control bowel or bladder function.
Infarction  death of tissue from lack of oxygen.
Inferior  down/bottom, toward the feet.
Infiltration  how fluids pass into tissues.

J
Jejunum  part of the small intestine.
Joule  measurement of electrical energy.
K
Keloid  excessive scar tissue that goes beyond the original border.
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.
Lobules  small lobes.
Luxation  a complete dislocation.
M
Malaise  general weakness.
Malignant  cancerous, has ability to metastasize or spread.
Mania  a mood disorder characterized by hyperactivity, agitation, excitement and occasional violent
and self-destructive behavior.
Melena  black, tarry stools containing digested blood.
Metastasis  movement or spreading of cancer cells from location to another.
Myalgia  muscle pain.

N
Necrosis  death of a cell or a group of cells as the result of disease, ischemia, or injury.
Neoplasia  new and abnormal growth that may be malignant or benign.
Nephron  the structural and functional unit of the kidney.
Nocturia  excessive urination at night.
Nucleus  controlling body of a cell.
Nystagmus  involuntary jerking actions of the eyes.
O
Oliguria  diminished ability to create or pass urine.
Orchitis  inflammation of the testicle that may be painful.
Osmolality  osmotic pressure of a solution.
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
Parenteral  any medication route other than the oral route.
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.

14
P (continued)
Platelets  fragments of cells that are responsible for initiating the clotting process.
Poikilothermia  inability to regulate the body temperature in comparison to the ambient temperature.
Polycythemia  unusually large number of red blood cells in the blood as a result of their increased
production by the bone marrow. Often caused by COPD and/or right ventricular failure/enlargement.
Polyuria  excessive urination.
Priapism  a painful and persistent erection.
Pulsus paradoxus  abnormal decrease in systolic blood pressure (10-15mmHg) during inspiration.
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.
Renin  enzyme secreted by the kidneys that is involved in the release of angiotensin; plays an
important role in maintenance of blood pressure.
Rhinitis  inflammation of the mucous membranes of the nose.
Rhonchi  abnormal, course, rattling respiratory sounds, usually caused by secretions in the bronchial
airways or muscular spasm/constriction.

S
Sciatica  pain that radiates along the path of the sciatic nerve.
Sclera  the white outer layer of the eyeball.
Slander  false statements about a person.
Solutes  the minor component in a solution that is dissolved in solution.
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.
Synapse  junction between two nerve cells. Most often referred to with regards to sympathetic
(norepinephrine) and parasympathetic nervous systems (acetylcholine).
Synergism  the combined action of two agents is greater than the action of the agents independently.
T
Tendons  bands of connective tissue that connect muscle to bone.
Tetany  involuntary contraction of skeletal muscles.
Tetraplegia  weakness or paralysis of all four extremities and the trunk (another term for quadriplegia).
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.
Trismus  limited jaw range of motion commonly caused by muscle spasms of the jaw. Can be primary
symptom in tetanus.

U
Untoward effects  side effects that prove harmful to the patient.
Urea  a nitrogen containing waste product.
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.
Viscosity  the degree of friction between liquid molecules.
Volvulus  twisting of the intestines.
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
Zone of coagulation  central area of a burn wound that has sustained the most intense contact with the
thermal source.
Zone of hyperemia  area in which blood flow is increased as a result of the normal inflammatory
response to injury in a burn.
Zone of stasis  area of burn tissue that surrounds the critically injured area from a burn.
Zygote  a fertilized ovum (egg).

3
CHAPTER 3
Respiratory &
Airway

Chapter 3: Respiratory & Airway
Key Terms
Perfusion:
Ventilation: The circulation of blood through
The process of air movement into the lung tissues (alveoli)
and out of the lungs
Air In
Blood transition through

capillary membrane
Air Out
Diffusion:
The process of gas exchange
(carbon dioxide and oxygen)
O2 In
CO2 Out

Respiratory Anatomy
Nasopharynx
Oropharynx
Respiratory center is housed in
the brainstem, more specifically
Trachea the medulla 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 Rhonchi
inspiratory) (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

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
C: COPD the F’n
P: Pulmonary Edema, Pulmonary Embolism
A: Asthma, ARDS CPAP!”
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

Intubation
Miller Blade:
Straight blade, sizes 1 – 4
Tip of blade is applied directly to the epiglottis to expose vocal cords
Typically recommends for infant intubation  provides greater

displacement of the tongue
May be better for anterior airways
Macintosh Blade:
Curved blade, sizes 1 – 4
Tip of blade is inserted into the vallecula  displaces tongue to the left to
lift the epiglottis without touching it
May reduce chance of dental trauma
Stylet:
May be inserted through ET tube before intubation, adds rigidity and
shape to tube
Must be recessed 1 - 2” into the tube, should not pass the “Murphy’s Eye”
Bougie:
60 – 70cm in length
Can be used in place of stylet, performs very well in difficult and anterior
airways
Patient can be “intubated” with the bougie, then ET tube is slid over
bougie into the airway (remove bougie after tube is in place)

Intubation
Endotracheal Tube:
Sizes: 0.5 – 10
Average Adult Male: 7.5

Average Adult Female: 7
Direct placement through glottis opening into trachea
Confirm placement with traditional methods – capnography is gold

standard!
Endotrol:
Same sizes as endotracheal tubes, performs same way as endotracheal
tube
Often used for nasotracheal intubation due to ring at top of tube that
allows for distal manipulation/movement of the tube
BAAM Device:
Placed on end of endotracheal tube (or Endotrol) to help identify proximity
of glottis opening and when patient is inhaling/exhaling during
nasotracheal intubation. Device will produce loud whistling noise.
Glottis is largest during inspiration, which is when tube should be

advanced into glottic opening.
Things to Remember:
Nasotracheal intubation can only “DOPE” (diagnosing tube problems)
occur in the patient with respirations Displacement or dislodgement
Obstruction
Pediatric Tube Size Formula: Pneumothorax
(16 + age*) / 4 Equipment failure
*age in years

Arterial Blood Gases

One of the most fierce enemies of the paramedic student, arterial blood gases. ABGs are the
often argued, “Why does this apply to me as a paramedic student…I’m not drawing blood
gases in the prehospital setting!?”
You’re right, most paramedics are not drawing blood gases in the prehospital setting, but
ABGs aren’t going anywhere soon…so as the phrase goes, “If you can’t beat em’, join em’!”
When approaching ABG interpretation, try to keep things in their simplest form (I know,
simple and ABGs seem like oxymoron's). But seriously, when making an ABG interpretation,
you are looking at three values (pH, CO2, HCO3) to determine what is happening with the pH
- is it low (acidic), normal, or high (alkalotic) and then determine if the CO2 or the HCO3
correlates with the pH.
The most critical step in ABG interpretation is knowing what values are considered normal.
pH: 7. 35 – 7.45
Carbon Dioxide, CO2: 35 – 45
Bicarb, HCO3: 22 – 26

A mnemonic often discussed with ABGs is “ROME”

“Respiratory Opposite, Metabolic Equal”
ROME refers to the directions that the pH and CO2 or HCO3 move in correlation with one
another.
Respiratory Opposite:
In respiratory-caused conditions, when the pH decreases (< 7.35, acidic) the CO2 increases
(> 45, acidosis)
Conversely, when the pH increases (> 7.45, alkalosis) the CO2 decreases (< 35, alkalosis)
Metabolic Equal:
In metabolic-caused conditions, when the pH decreases (< 7.35, acidic) the HCO3
decreases (< 22, acidosis)
Conversely, when the pH increases (> 7.45, alkalosis) the HCO3 increases (> 26, alkalosis)

Respiratory Acidosis: Hypoventilation (retaining too much CO2)

Treatment: increase ventilatory rate
Respiratory Alkalosis: Hyperventilation (blowing off too much CO2)

Treatment: decrease ventilatory rate
Metabolic Acidosis: Build up of lactic acid – lactic acidosis, diabetic ketoacidosis, renal
failure, sepsis, toxic ingestion
Treatment: controlling respiratory rate, IV fluids, sodium bicarbonate
Metabolic Alkalosis: Rare, loss of hydrogen ions (vomiting or gastric suction) – consumption
of large amounts of baking soda or antacids
Treatment: correct underlying condition
Example
pH 7.28
CO2: 54
HCO3: 24
What is the pH doing? It’s below 7.35 therefore it’s acidic.
Now, which of the other values are also acidic?
CO2! A normal CO2 is 35 – 45, the given value is 54 which is higher than normal and is
acidic.
The HCO3 is within a normal range.
Interpretation: Respiratory Acidosis
Believe it or not, as paramedic students, we cover ABGs on a surface level – there is much more to ABG
interpretation, but a basic understanding of interpretation and the most common causes of abnormalities is
what we are most concerned with!

31
Capnography
Hear us when we say, “Capnography is the GOLD standard in endotracheal tube

intubation and confirmation!”
Capnography is an AHA Class I recommendation for cardiac arrest patients –

essentially meaning that there is no patient risk and all benefits.
We’ve already discussed normal values of carbon dioxide (CO2) so, let’s jump right into
the actual capnography waveform (or “capnogram”).
CO2
Phase 1: The respiratory baseline. It is flat when no CO2 is present and corresponds to
the late phase of inspiration and the early part of expiration.
Phase 2: The respiratory upstroke. This represents exhalation of a mixture of dead-

space gases and alveolar gases from alveoli with the shortest transport time.
Phase 3: The respiratory plateau. It reflects the airflow through uniformly ventilated
alveoli with a nearly constant CO2 level. The highest level of the plateau is called the
“ETCO2” and is recorded as such by the capnometer.
Phase 4: The inspiratory phase. It is a sudden down stroke and ultimately returns to the
baseline during inspiration. The respiratory pause restarts the cycle.

32
Capnography Waveforms
Normal
Square box waveform
ETCO2 = 35 – 45mmHg
Dislodge Endotracheal Tube (ETT)

Loss of waveform
Loss of ETCO2 reading
Management: Replace ETT
Esophageal Intubation (or apnea)

Absence of waveform
Absence of ETCO2 reading
Management: Ventilate or intubate

33
CPR
Square box waveform
ETCO2 = 10 – 15mmHg
Management: Change rescuers if ETCO2 falls

below 10mmHg
Obstructive Airway
“Shark fin” waveform
With or without prolonged expiratory phase
Can be seen before actual “attack” or
“exacerbation”
Bronchospasm  asthma, COPD,
anaphylaxis, FBAO
Management: Bronchodilators & treat

underlying cause
(albuterol, atrovent, racemic epinephrine,
epinephrine)
ROSC
During CPR, sudden increase of ETCO2
above 10 – 15mmHg
Management: Check femoral or carotid pulse
34
Rising Baseline
Patient is rebreathing CO2
Management: Check equipment for adequate

oxygen flow, allow more time for exhalation,
ensure cuff has good seal
Hypoventilation
Prolonged waveform
ECTO2 > 45mmHg
Management: Assist ventilations, increase

respiratory/ventilatory rate
Hyperventilation
Shortened waveform
ECTO2 < 35mmHg
Management: Slow respirations/ventilatory

rate
Consider other causes: DKA, sepsis, TCA

overdose, methanol ingestion

35
Breathing Around ETT
Angled, sloping down stroke on waveform
Ruptured cuff or ETT too small
Management: Check cuff and tube size,

possible re-intubation
Curare Cleft
Neuromuscular blockade is wearing off
Patient takes small breath that causes the
cleft
Management: Consider re-administration of

neuromuscular blockade medication

36
Respiratory Emergencies
COPD
Asthma
Pneumonia
ARDS
Pulmonary Embolism
Hyperventilation Syndrome
Pneumothorax
Acute Mountain Sickness
High Altitude Pulmonary Edema

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.
Management:
Oxygen and bronchodilators
DuoNeb: Albuterol: 2.5mg in 3mL / Ipratropium: .5mg
Consider steroids for inflammation

suppressesacuteandchronicinflammation
Consider CPAP
Corticosteroid

Asthma
Asthma is two-pronged issue: bronchoconstriction and inflammation. Prehospital treatment
is aimed at bronchodilation (albuterol) and reducing inflammation (steroids). In severe cases,
epinephrine is considered for additional bronchodilatory effects along with nebulized
magnesium sulfate to act as smooth muscle relaxer.
Management:
Oxygen and bronchodilators
DuoNeb: Albuterol: 2.5mg in 3mL / Ipratropium: .5mg
Nebulized Magnesium Sulfate
Consider steroids for inflammation
IV fluids
Epinephrine IM
Consider CPAP

Pneumonia & ARDS

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
Obstructive Shock Pain
PE will develop into Anxiety
Obstructive Shock Hypertension
Tachypnea
Once patient has Tachycardia
entered shock state, Crackles, wheezes, rhonchi
administer 20mL/kg
fluid boluses, Treatment
repeating as needed
to support BP Identification and Rapid Transport!
Additional EKG Findings (higher level – not necessarily entry-level)

Right Axis Deviation
S1 Q3 T3
S-wave in lead I, Q-wave in lead III, inverted T-wave in lead III

Hyperventilation Syndrome
CALM DOWN!
But seriously…try to coach your patient to calm down. Hyperventilation syndrome is often
produced by an anxiety or panic attack. Try to move them to a quiet, calm, and controlled
environment and coach them to slow down their breathing (apply oxygen if needed).
Remember, hyperventilation will cause too much CO2 to be eliminated, so put the patient on
capnography and monitor their CO2.
Other Potential Causes:

Hypoxia
Cardiac or pulmonary disease
Infection/fever
Pain
Pregnancy
Drug use
Signs and Symptoms:

Dyspnea
Tachypnea
Chest pain
Carpopedal spasms

Pneumothorax

High Altitude Emergencies

Review Questions
1.) In the adult patient, the average tidal volume is: _________mL.
2.) Most commonly, the maximum cmH2O we should administer through CPAP is: ______cmH2O.
3.) When using the Miller blade, the tip of the blade is applied directly to the ________ to expose the cords.
4.) When using the Macintosh blade, the tip of the blade is inserted into the ______________.
5.) True or False: When nasotracheally intubating a patient, he or she must be breathing.
6.) Which mnemonic should be used to assist in diagnosing endotracheal tube problems? ____________
7.) A normal ETCO2 level is: ____ to ____.
8.) When the pH falls below 7.35, it is considered to be: ___________.
9.) The normal HCO3 (or bicarbonate) range is: ____ to ____.
10.) What is considered to be the “gold standard” in confirming endotracheal tube placement?
____________________
11.) This type of patient, is commonly referred to as a “pink puffer” due to polycythemia. He or she can also
experience clubbing of the fingers, a non-productive cough, and a barrel-chest appearance.
________________________
12.) This type of patient is chronically hypoxic and therefore experience chronic cyanosis. Additionally, he or
she has a productive cough and is typically overweight. __________________
13.) In the pneumonia patient, you would typically expect to find a fever and unilateral / bilateral (circle
one) diminished breath sounds.
14.) If left untreated, a pulmonary embolism will develop into _______________ shock.
15.) Which characteristic type of capnography waveform is seen during an asthma attack or COPD
exacerbation? ___________________________
16.) How much anatomical dead space is typically found in the adult patient? ___________________
17.) The oxygen concentration from a nasal cannula is: ____ to ____%.
18.) What is the medical term for cramping of the fingers (as seen in hyperventilation syndrome)?
_________________________________________

Want more Respiratory &

Airway review?
Check out our Paramedic Respiratory & Airway
Study Guide or our Respiratory & Airway Review
Lecture for more in-depth information!
www.passwithpass.com
4
CHAPTER 4
Cardiology

47
Chapter 4: Cardiology
Cardiac Anatomy
Valve Anatomy
Chordae Tendineae
Papillary Muscle
Right Atrium
Left Atrium
Pulmonic Valve
Mitral Valve
Tricuspid Valve
Aortic Valve
Right Ventricle Left Ventricle
Valve Order:
“Toilet Paper My A..”
Three Layers of Heart Muscle

Endocardium: Innermost layer
Myocardium: Middle layer
Pericardium or Epicardium: Outer layer
“Peri”/”epi” mean “around” or “on top of”

Cardiac Conduction
Intrinsic Rates
Sinoatrial (SA) Node: 60 – 100
Atrioventricular (AV) Node: 40 – 60
Purkinjes: 15 – 40

Cardiac Emergencies
Stable Angina
Unstable Angina
Variant Angina
Left Sided Heart Failure
Right Sided Heart Failure
Cardiac Tamponade
Myocardial Infarction

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 (Variant
Angina).
There are three types of angina and they are primarily categorized by their cause and
duration:
Management:
Relieve anxiety/pain
Place patient in a position of comfort
Administer oxygen
Establish IV access
Obtain a 12 lead EKG
Consider medication administration (MONA)

Oxygen
Aspirin
Nitroglycerin
Morphine (or Fentanyl)

Heart Failure
Primarily, we are concerned with two types of heart failure: left-sided and right-sided.
Knowing the differences between the causes, signs and symptoms, and treatments are
critical to your success on the NREMT!
Causes of Right and Left Heart Failure
Right Heart Failure Left Heart Failure

Left Heart Failure (#1 cause) Pulmonary Edema
Cor Pulmonale (right ventricular hypertrophy) Hypertension
Right Ventricular Infarct Left Ventricle Infarct
Tricuspid Valve Damage Mitral Valve Damage
Pulmonic Valve Damage Aortic Valve Damage
Pulmonary Embolism Cardiomyopathy
Myocardial Infarction (#1 cause)
Signs and Symptoms of Right and Left Heart Failure

JVD Anxiety
Peripheral Edema Tachycardia
Ascites (abdominal swelling) Hypertension
Sacral/Scrotal Edema Pale, Sweaty Skin
Orthopnea Paroxysmal Nocturnal Dyspnea
Hepato-Jugular Reflex Orthopnea
Rales/Crackles
Pink Frothy Sputum (late sign)
Pulsus Paradoxus
Pulsus Alternans

Heart Failure
Primarily, we are concerned with two types of heart failure: left-sided and right-sided.
Knowing the differences between the causes, signs and symptoms, and treatments are
critical to your success on the NREMT!
Treatment of Right and Left Heart Failure

Position of Comfort Position of Comfort
Oxygen Oxygen
12 Lead EKG 12 Lead EKG
Fluid administration (Starling’s Law) Nitroglycerin
**Always monitor lung sounds and abdomen with CPAP
fluid administration“** Furosemide

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
accumulation of fluid that builds up in the pericardial
sac. Because the sac is tough (think leather) it does
not expand well with this excess fluid – this excess
fluid and lack of expansion puts more pressure on
the heart which prevents it from filling and pumping
like it needs to. This causes cardiogenic or Key Signs
obstructive shock (EMS Standards recognize Tamponade
as both forms of shock).
&
Symptoms
Tamponade can be caused by trauma, an MI,
pericarditis, or neoplasms. Hypotension
Management
ABCs Other Signs & Symptoms
Oxygen Chest Pain, Dyspnea, Orthopnea, Narrowing
IV Access Pulse Pressure, Electrical Alternans, Pulsus
Fluid Bolus (20mL/kg) Paradoxus, Altered LOC
Vasopressor

Cardiogenic Shock
Causes:
Impaired myocardial contractility (MI)
Impaired ventricular emptying (left-sided heart failure)
Tension pneumothorax
Cardiac tamponade
Trauma (cardiac contusion)
Signs and Symptoms:

Systolic BP < 80mmHg
Respiratory distress
Chest pain
Weakness
Altered mental status
Hypotension
Tachycardia
Management:
Rapid transport
Position of comfort
Oxygen
Identify and treat underlying problems
IV access/fluid administration*
Consider medications: positive inotropes/vasopressors
Fluid Administration:
Listen to lung sounds first!
If dry: give fluids, 100 – 200mL boluses, (Starling’s Law)
If wet: do not give fluids

Dissecting Aortic Aneurysms

Most common aortic catastrophe  affects three times as many people as “AAA”
Signs and Symptoms:

Syncope
Absent or reduced pulses
Unequal blood pressure readings (right side vs. left side)
Unequal pulse strength (right side vs. left side)
Heart failure
“Tearing” sensation in chest or back (this is a big one!)
Flank pain
Scapular pain
Pain radiating into legs
Management:
Rapid transport to hospital with emergency surgery capabilities

12 Lead EKG Interpretation

To be successful on the NREMT, you must not only know how to interpret a 12 lead EKG
you must also know which vessels are likely occlude to cause the STEMI that you are
interpreting.
Be prepared to not only identify the 12 lead EKG (“Anterior Wall MI”) but also to identify
which vessel would be occluded to cause this (“Left Anterior Descending Artery”).
Lateral Leads: I, aVL, V5, V6 (Left Circumflex)

Inferior Leads: II, III, aVF (Posterior Descending Artery – Right Coronary Artery)
Septal Leads: V1, V2 (Left Anterior Descending)
Anterior Leads: V3, V4 (Left Anterior Descending

Myocardial Infarction
The 12 lead EKG is a great tool in determining if the patient is having an MI, however,
please remember that 50% of myocardial infarctions are STEMIs and 50% of MI’s are
NSTEMIs. So, remember to use your assessment and the patient’s clinical presentation to
best guide the treatment when the 12 lead EKG is unremarkable.
Types of MI:
Subendocardial: The MI extends partially through the thickness of the myocardium. May or
may not produce a pathological Q-wave on future 12 lead EKGs.
Transmural: The MI extends completely through the thickness of the myocardium. Will leave
pathological Q-waves (Q-waves > .04s) on future 12 lead EKGs.
STEMI: What To Look For?
1mm (or more) of ST segment elevation in two or more anatomically contiguous or

numerically consecutive leads.
Anatomically Contiguous Numerically Consecutive

I, aVL, V5, V6 V1 – V2
II, III, aVF V2 – V3
V1, V2 V3 – V4
V3, V4 V4 – V5
V5 – V6
Names of Myocardial Infarctions: Names of Myocardial Infarctions:

ST Segment Elevation (1mm or more) in: ST Segment Elevation (1mm or more) in:
I, aVL, V5, V6 = Lateral Wall MI V2, V3 = Anteroseptal MI
II, III, aVF = Inferior Wall MI V4, V5 = Anterolateral MI
V1, V2 = Septal Wall MI V2, V3, V4, V5 = Extensive Anterior Wall MI
V3, V4 = Anterior Wall MI
58
Right Sided 12 Lead EKG

When an Inferior Wall MI is identified (ST segment elevation in II, III, aVF) complete a right-
sided 12 lead EKG. To do this, move V4 to the right side (same anatomical position as
normal 12 lead, just on the right side of the sternum) and obtain another 12 lead.
When the new 12 lead prints, look specifically in lead V4 for any ST segment elevation of
greater than 1mm. If there is elevation, this is indicative of a Right Ventricular Infarction
(RVI).
So, why do we do this? Well, it’s because of the coronary artery anatomy…let’s take a look!
Look at this picture, the Right Coronary Artery

ultimately supplies the Posterior Descending
Artery and the Right Marginal Artery.
The Posterior Descending Artery supplies the

inferior wall.
The Right Marginal Artery supplies the right B

ventricle.
A
When an Inferior Wall MI is identified, a right-
sided 12 lead occurs in an attempt to identify if
the occlusion is happening in the posterior
descending artery alone (point A) or if it is
happening in the proximal RCA (point B) –
which would cause infarctions of both the
inferior wall and the right ventricle.
When the right ventricle is involved, we are When a RVI is found, use caution with
concerned with preload and nitroglycerin nitroglycerin. Instead, consider a fluid bolus
administration to support preload (Starling’s Law), aspirin,
and oxygen.

Bundle Branch Blocks

There are two main bundle branches in the heart: the right bundle branch and the left bundle
branch. The left bundle branch further divides into the left anterior fascicle and the lest
posterior fascicle. But, we won’t dive too far into the different fascicles of the left bundle
branch.
Bundle branch blocks can be identified on the 12 lead EKG and are important to rule in/rule
out as they can mimic or hide certain 12 lead findings.
There are a few ways to identify a bundle branch block, but we are going to stick with the
turn signal method.
Step 1: In Lead V1 (this is important to remember), look to see if the QRS is wider than .12
(3 small boxes). If it is not, then you can stop. If it is, then proceed to step 2.
Step 2: With a wide QRS in V1, you now need to determine if the QRS complex is deflected
up or down.
Step 3: Picture yourself holding a steering wheel. You are going to

make a right turn so you hit the turn signal lever “up”. A QRS that is
wide and deflected up is a Right Bundle Branch Block.
Now, you are going to make a left turn, so you hit the turn signal lever
“down”. A QRS that is wide and deflected down is a Left Bundle
Branch Block.
LBBB = 12 lead interpretation is a LBBB and then treat your patient’s clinical presentation
RBBB = 12 lead interpretation is whatever you find “with a RBBB”. Treat your patient’s clinical
presentation and 12 lead findings.
Advanced Cardiac Life Support (ACLS)

From our experience, there are few medication dosages that you will be required to know on
the NREMT exam (that doesn’t mean you shouldn’t know them…). But, you can bet your
money that you will be expected to know ACLS and PALS medication dosages. The
medications and their dosages are AHA guidelines and are therefore nationally recognized,
accepted, and practiced.
Most other medications are somewhat protocol driven, so their dosages are not often tested.
But, you are still required to know what the medications are, the indications,
contraindications, etc.
When we teach ACLS, we find it easiest to

breakdown most all cardiac rhythms into a
category: “slow, normal, fast, or dead”.
This approach really makes the lightbulb go off

with our paramedic students. Hopefully it has that
same effect on you!
Let’s get to it!

Slow HR < 60bpm

**Patient must be symptomatic**
Sinus Bradycardia
Junctional Escape
Second Degree Type 1
Third Degree
Idioventricular
Now, let’s divide these rhythms into two different categories based on the treatment that
would be most beneficial (or that they are most likely to respond to).
Sinus Bradycardia
Junctional Escape
1.) Atropine: 1 mg, up to a max of 3mg

2.) Transcutaneous Pacing: 60bpm (AHA
recommendation, increase as needed), 50+ mA until
mechanical (pulse) and electrical (captured
pacer spike) is achieved.
3.) Vasopressor infusion
Dopamine: 5 – 20mcg/kg/minute Second Degree Type 2
Epinephrine: 2 – 10mcg/minute Third Degree
Idioventricular


Dopamine: 5 – 20mcg/kg/minute
Epinephrine: 2 – 10mcg/minute
62
Normal HR 60 - 150
Before we dive into the “Normal” category, we need you to be flexible here. Some of the
rhythms below and the heart rate range above are not necessarily “normal” but if we have a
patient in the back of the medic unit in some of these rhythms at a rate in the range above,
we are not going to do anything for the rhythm specifically (per ACLS).
We will treat their underlying problems, but we aren’t going to speed them up, slow them
down, etc.
Normal Sinus Rhythm

Sinus Tachycardia
Atrial Fibrillation
Atrial Flutter
Accelerated Junctional
Junctional Tachycardia

Fast HR > 150bpm

We further divide “fast” rhythms into “stable” or “unstable”
Supraventricular Tachycardia (SVT)
Ventricular Tachycardia (w/pulse)
Remember, when treating “fast” rhythms, we have to determine if the patient is “stable” or
“unstable”.
Stable  alert and oriented, no significant complaints, hemodynamically stable, “I feel

weak”, lightheadedness
Unstable  disoriented, hemodynamically unstable, chest pain, difficulty breathing
Stable SVT Stable VT
1.) Vagal maneuvers (“bear down”) Amiodarone: 150mg over 10 minutes

2.) Adenosine, 6mg rapid IVP OR
3.) Adenosine, 12mg rapid IVP Procainamide: 25 – 50mg/minute
OR
Sotalol: 100mg (1.5mg/kg) over 5 minutes
Unstable SVT Unstable VT
Synchronized cardioversion Synchronized cardioversion

(50 – 100J, 200J, 300J, 360J…) (50 – 100J, 200J, 300J, 360J…)
**may consider sedation prior to **may consider sedation prior to

cardioversion** cardioversion**

Dead
Asystole/PEA
Ventricular Fibrillation
Pulseless Ventricular Tachycardia
Ventricular Fibrillation Asystole/PEA

NONSHOCKABLE
SHOCKABLE
Immediately begin CPR
Immediately begin CPR (2 minutes/5 cycles for duration of code)
(2 minutes/5 cycles for duration of code)
IV/IO access
Defibrillate when it becomes available
Epinephrine, 1mg, 1:10,000
IV/IO access (every 3 – 5 minutes for duration of code)
Epinephrine, 1mg, 1:10,000 H’s & T’s throughout cardiac arrest

(every 3 – 5 minutes for duration of code)
In refractory VF/pVT
(rhythm sustains after two defibrillations)
Amiodarone, 300mg IVP
Remains refractory…
H’s & T’s throughout cardiac arrest

ACLS Medications:
Adenosine (Adenocard)
Antidysrhythmic  delays conduction through the atrioventricular (AV) node
Used in stable supraventricular tachycardia (SVT)

6mg, 12mg,  18mg (may consider second dose of 12 mg to maximum of 30mg)
Rapid IV push, peripheral IV site, followed by 10 – 20 mL saline flush
**Adenosine has a 10-second half life, so the IV site and flush are critical.
Stable SVT
1.) Vagal maneuvers (“bear down”)

2.) Adenosine, 6mg rapid IVP
3.) Adenosine, 12mg rapid IVP

66
ACLS Medications:
Amiodarone (Cordarone)
Class III Antidysrhythmic  blocks potassium channels, which increases the effective
refractory period. Also blocks sodium channel and has some calcium channel blocking
properties.
Indicated in:
Recurrent Ventricular Fibrillation and Pulseless Ventricular Tachycardia

300mg IVP (first dose), 150mg IVP (second dose)
Stable Ventricular Tachycardia (with a pulse) Ventricular Fibrillation

150mg infused over 10 minutes (minimal) Pulseless Ventricular Tachycardia
SHOCKABLE

IV/IO access


Stable VT
Amiodarone: 150mg over 10 minutes
OR Amiodarone, 150mg IVP
Procainamide: 25 – 50mg/minute H’s & T’s throughout cardiac arrest
OR

ACLS 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 table = 81mg)

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

ACLS Medications:
Atropine
Parasympatholytic & Anticholinergic  inhibits parasympatholytic nervous system; acts on
the vagus nerve (CN X – Cranial Nerve 10).
Used in:
Symptomatic Bradycardia
1mg (max of 3mg cumulative dose)
Push rapid, too slow of administration can cause refractory bradycardia
Organophosphate poisoning
1mg every 3 – 5 minutes to control secretions (SLUDGE)
Sinus Bradycardia
Junctional Escape
1.) Atropine: 1 mg, up to a max of 3mg

Dopamine: 5 – 20mcg/kg/minute
Epinephrine: 2 – 10mcg/minute

ACLS Medications:
Dopamine (Intropin)
Endogenous Catecholamine
.5 – 2mcg/kg/minute  dopaminergic dose  dilates renal and mesenteric arteries
2 – 10mcg/kg/minute  beta dose  beta receptor stimulation  positive inotropy,

chronotropy, dromotropy
10 – 20mcg/kg/minute  alpha dose  alpha receptor stimulation  vasoconstriction

ACLS Medications:
Epinephrine (Adrenalin)
Endogenous Catecholamine & Sympathomimetic
Provides vasoconstriction, chronotropy, inotropy, dromotropy and bronchodilation
Cardiac Arrest dose  used every 3 – 5 minutes for the duration of the cardiac arrest
1mg IV/IO, 1:10,000 concentration
Used in shockable and non-shockable cardiac arrest rhythms
Ventricular Fibrillation
SHOCKABLE

IV/IO access

H’s & T’s throughout cardiac arrest

ACLS Medications:
Lidocaine (Xylocaine)
Antidysrhythmic
Ventricular Fibrillation or Pulseless Ventricular Tachycardia

1 – 1.5mg/kg, IV/IO (first dose)
0.5 – 0.75mg/kg, IV/IO (second dose – if needed, max dose = 3mg/kg)
If conversion  start infusion at 2 – 4mg/minute (1mg higher than converting dose)
Stable Ventricular Tachycardia with Pulse

1 – 1.5mg/kg, IV/IO (first dose)
0.5 – 0.75mg/kg, IV/IO (second dose – if needed; max dose = 3mg/kg)
If conversion  give 0.5mg/kg, IV/IO, in 10 minute increments (two times)

ACLS Medications:
Nitroglycerin
Potent Vasodilator
Indications:
Chest Pain  obtain 12 lead first and establish IV access
Pulmonary Edema  Administer with CPAP to help with evacuating fluid from the alveoli
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)
*Obtain IV access prior to administration when possible, always obtain 12 lead

prior to administration to rule in/out RVI
Nitro-Bid is the paste form of nitroglycerin and is applied in a 1” circle (15mg TD) to upper left
chest area

ACLS Medications:
Procainamide (Pronestyl)
Antidysrhythmic  Blocks influx of sodium, slows conduction (decreases both atrial and
ventricular rates)
Considered in stable tachycardic rhythms (> 150bpm; SVT/VT/A-Fib)
25 – 50mg/minute
Stable VT

OR
Procainamide: 25 – 50mg/minute
OR

74
ACLS Medications:
Sodium Bicarbonate
Alkalinizing agent
Cardiac arrest for known dialysis patients or prolonged down time

1mEq/kg, IV/IO
Tricyclic Antidepressant (TCA) overdoses

1mEq/kg, IV/IO
**May cause transient increase in capnography

75
ACLS Medications:
Sotalol (BetaPace)
Antidysrhythmic
Considered in stable tachycardic rhythms (> 150bpm; SVT/VT/A-Fib)
100mg (1.5mg/kg) over 5 minutes
Stable VT

OR
Procainamide: 25 – 50mg/minute
OR
Sotalol: 100mg (1.5mg/kg) over 5
minutes

Review Questions
1.) The innermost layer of the heart is the: _________________
2.) The muscles that protrude from the endocardium and assist with valve closure are called the:
_______________ muscles.
3.) The intrinsic rate of the AV node is ____ to ____ beats per minute.
4.) When treating a suspected heart failure patient with JVD, ascites, and clear lung sounds, that he or she
is experiencing left / right (circle one) sided heart failure.
5.) The number one cause of right-sided heart failure is ____________________________.
6.) The number one cause of left-sided heart failure is _____________________________.
7.) Jugular vein distention, muffled heart sounds, and hypotension collectively describe _______________
Triad; which is specific to ______________ _____________.
8.) If left untreated, a myocardial infarction and cardiac tamponade will lead to ________________ shock.
9.) A subendocardial / transmural (circle one) MI will always produce a pathological Q wave on future 12
leads.
10.) Leads I, aVL, V5, V6 look at the _________ Wall and are supplied by the ____________________
artery.
11.) To determine if the EKG has a bundle branch block, you should look in lead ____ to determine if the
QRS complex is > 0.12 seconds.
12.) The initial dose of Atropine in the symptomatic bradycardia rhythm is ____mg.
13.) In an unstable SVT patient, what treatment should be the first line? _______________________
14.) In a recurrent Ventricular Fibrillation cardiac arrest, how much Amiodarone is initially administered?
______mg.
15.) Which medication is a potent vasodilator? _________________
16.) Which coronary artery supplies leads V1 and V2?
17.) Leads II, III, and aVF collectively look at the ________ Wall.
18.) Sotalol can be administered to a stable Ventricular Tachycardia – what is the dose? _____mg.

Want more
Cardiology review?
Check out our Paramedic Cardiology Study Guide
or our Cardiology Review Lecture for more in-
depth information!
78
5
CHAPTER 5
Neurology

Chapter 5: Neurology
The Nervous System

Body’s principal control system
Network of cells, tissues, and organs regulate bodily functions via electrical impulses
transmitted through nerves
Endocrine system: related to the nervous system, exerts control via hormones
Circulatory system: assists in regulatory functions by distributing hormones and chemical

messengers
Dendrites:
Receive chemical
messages from other
neurons – messages Soma: Central cell body
then converted into
impulses
Axon: Sends messages (impulses) to

other neurons
Synapse: Connects here
Synapse: Small gaps that

separate neurons (between axon
of one neuron and the dendrites
of the other) Axon Terminal: Buds at end of axon
from which chemical messages
(impulses) are sent

CNS Anatomy
The spine has 33 vertebrae

Cervical Spine: 7 vertebrae
Thoracic Spine: 12 vertebrae
Lumbar Spine: 5 vertebrae
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”)

Cranial Nerves
CN I: Olfactory: Smell
CN II: Optic: Vision
CN III: Oculomotor: eye movement,

pupillary constriction
CN IV: Trochlear: down and inward eye

movement
CN V: Trigeminal: jaw movement
CN VI: Abducens: lateral eye movement
CN VII: Facial: facial movement
CN VIII: Vestibulocochlear: hearing and

equilibrium
CN IX: Glossopharyngeal: swallow,

phonation
CN X: Vagus: parasympathetic nervous

system
CN XI: Accessory: shoulder shrug
CN XII: Hypoglossal: tongue movement
“On Occasion Our Trusty Truck Acts Funny Very Good Vehicle
Any How”

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
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
AEIOU TIPS: Mnemonic to rule in/rule out Severity of AMS: DERM
reasons for altered mental status and/or Depth of coma
unconsciousness Eyes
Respiratory pattern
Alcohol Motor function
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

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 seizures Simple or Complex

Tonic-clonic = “grand mal seizure”
Generalized motor seizure Simple:
Produces loss of consciousness Focal motor, sensory, Jacksonian seizures
Chaotic movement or dysfunction of one
Specific progression of events: area of the body
Aura No loss of consciousness
Complex:
Loss of consciousness Temporal lobe or psychomotor seizures
Distinctive auras:
Tonic phase, hypertonic phase Unusual smell, taste, sound
Metallic taste in mouth is common
Clonic phase Status Epilepticus
Two or more generalized motor seizures

Post seizure without intervening return of
consciousness
Management:
Postictal
Move objects from around patient
Petit-Mal/Absence Seizures Oxygen
Brief, generalized seizure IV access
10 to 30 second loss of consciousness or Benzodiazepine administration
awareness
Eye or muscle fluttering #1 cause of seizure activity is non-
Occasional loss of muscle tone compliance with medications
Obtain BGL on all seizure patients

Syncope & Headaches

Syncope
Sudden, temporary loss of consciousness caused by insufficient blood flow to the brain.
Regains consciousness when lying supine.
Potential Causes:
Cardiovascular conditions
Hypovolemia
Non-cardiovascular disease
Idiopathic (unknown cause)
Headaches
Acute (sudden)
Chronic (constant or recurring)
Generalized (all over)

Localized (specific area)
Range from mild to severe
Migraines
Vascular Lasts minutes to hours to days
Migraines & Cluster Headaches
Usually very intense, throbbing pain
Significant percentage are tension
headaches Photosensitivity
Continuous throbbing headache with fever, Nausea/Vomiting

confusion, and/or nuchal rigidity = think
meningitis Often unilateral
Occur commonly in women

CNS Conditions
Bells Palsy
Sudden, unilateral weakness or paralysis of the facial muscles
Occurs due to dysfunction of seventh cranial nerve (facial nerve)
Often follows viral infection
Herpes Simplex Virus can also be a cause
Trigeminal Neuralgia
Also called “Tic Doloureux”
Extremely painful, affects 5th cranial nerve (trigeminal nerve)
Electrical shock type spasms and pain
Tends to be chronic
Antiseizure medications used as treatment
Alzheimer’s and Pick’s

Results from death and disappearance of nerve cells in cerebral cortex.
Marked atrophy of the brain
Pick’s  permanent form of dementia similar to Alzheimer’s disease

Tends to affect only certain areas of the brain, rare condition
Huntington’s & Creutzfeldt-Jakob

Huntington’s Disease  Genetic defect in chromosome 4
Adult onset and early onset types
Creutzfeldt-Jakob  Form of brain damage

Rapid decrease in mental function and movement, results from protein called “prion”
No treatment

CNS Conditions
Muscular Dystrophy
Genetic disease
Progressive muscle weakness
Degeneration of skeletal or voluntary muscle fibers
Multiple Sclerosis
Unpredictable disease of CNS
Inflammation of nerve cells
Demyelination or destruction of myelin sheath – protective covering of nerve body
Nerves unable to conduct impulses properly
Duchenne Dystrophy
Most common childhood muscular dystrophy
Onset by age 6
Symmetrical weakness/wasting
Progresses to death
Guillain-Barre Syndrome
Serious disorder
Body’s immune system mistakenly attacks peripheral nerves
Leads to nerve inflammation that causes muscle weakness
Parkinson’s Disease
Degenerative changes in basal ganglia due to dopamine deficiency
Rhythmical muscular tremors
Rigidity of movement
Droopy posture
Usually occurs after 40 years of age
Leading cause of neuro disability > 60

CNS Conditions
Amyotrophic Lateral Sclerosis (ALS)
“Lou Gehrig’s Disease”
Progressive motor neuron disease
Disease of the motor tracts of the lateral columns and anterior horns of the spinal cord
Results in progress muscular atrophy, increased reflexes, spastic irritability of muscles
No cure
Spina Bifida
Neural tube defect
Failure of one or more of fetal vertebrae to close in utero
Nerve damage is permanent
No cure
Poliomyelitis (Polio)
Infectious, inflammatory viral disease of CNS
May result in permanent paralysis
New cases are rare

Review Questions
1.) What is the middle layer of the meninges? ________________ ______________
2.) When a patient’s pupils are unable to constrict or dilate, you would suspect an injury to the
____________ cranial nerve.
3.) Which cranial nerve does parasympathetic nervous system primarily function on? ___________
4.) Which system is responsible for maintaining consciousness? ________________________
5.) True or False: We want to be aggressive with oxygen therapy in the suspected stroke patient, aiming for
oxygen saturation levels of 100%.
6.) The number one cause of seizures in the adult patient is: ________________________________
7.) Parkinson’s Disease is caused by a lack of ______________.
8.) Bell’s Palsy occurs due to a dysfunction of the ___________ cranial nerve.
9.) Two or more generalized motor seizures without intervening return of consciousness is called
___________ ___________.
10.) Temporary interference with blood supply to the brain that may last minutes to hours is called a
________________________________________.
11.) Which type of stroke is the most common? ______________________
12.) The cervical spine has a total of ____ vertebrae.
13.) The thoracic spine has a total of ____ vertebrae.
14.) The lumbar spine has a total of ____ vertebrae.
15.) The outermost layer of the meninges is called the ___________ ___________.
16.) _____________ receive chemical messages from other neurons and then convert those messages into
impulses.
17.) The brain consumes ______% of the body’s glucose.
18.) What should be obtained on all seizure patients? _______________

Want more Neurology

review?
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our Neurology Review Lecture for more in-depth
information!
6
CHAPTER 6
Toxicology &
Pharmacology

Chapter 6: Toxicology & Pharmacology
Toxicology
“Good to Know” Antidotes Alcohol Use Disorder (AUD)
Benzodiazepines = Flumazenil (Romazicon) Nutrition deficiencies  mainly Thiamine

Beta Blockers = Glucagon
Calcium Channel Blockers = Calcium Wernicke Encephalopathy:
Cyanide = Hydroxocabalamin Develops sudden with ataxia, nystagmus,
Opioids = Narcan speech disturbances, signs of neuropathy,
Tricyclic Antidepressants = Sodium stupor, coma
Bicarbonate
Dystonic Reaction = Benadryl Korsakoff’s Psychosis:
Mental disorder found with Wernicke
Encephalopathy
Cholinergic
Apathy, poor memory, retrograde amnesia,
confabulation (story telling), dementia
Pesticides (organophosphates, carbamates)
Usually considered irreversible
Nerve agents (sarin, soman)
Permanently handicapped by memory loss
Signs & Symptoms:
Hypoglycemia in the Alcoholic Patient:
“SLUDGE”
Administer Thiamine (100mg slow IV or IM)
Salivation
along with glucose
Lacrimation
Urination
**Unable to metabolize glucose without
Defecation
adequate thiamine
GI Upset
Emesis
Cirrhosis of the Liver:
Alcoholics are prone to cirrhosis (scarring of
Headache, Dizziness, Weakness,
the liver)
Bradycardia, Nausea
Cirrhosis is the #1 cause of esophageal varices
Management:
ABCs, Decon
Esophageal Varices:
Atropine (1mg IVP q 3 – 5 minutes until
Swollen veins in the esophagus
symptoms go away)
Often rupture and hemorrhage
Pralidoxime
35% mortality rate with hemorrhage
Diazepam or Lorazepam for seizures
94
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, IV access, extremity  immobilize in neutral position,
do not use ice packs or tourniquets

Pharmacology Key Terms

Pharmacology: Pharmacodynamics:
The science of drugs used to The study of how a drug acts on
prevent, diagnose, and treat. a living organism.
Pharmacokinetics:
The study of how the body handles a drug over a
period of time, including the processes of absorption,
distribution, biotransformation, and excretion.

96
Pharmacology Key Terms

Affinity: Efficacy:
Drug’s desire to attach to a receptor Drug’s ability to create an action once
it has attached itself to a receptor
Oxygen vs. CO
Agonist:
Antagonist:
A drug with both affinity and efficacy
A drug that inhibits other drugs from
that attaches a receptor and causes
attaching to a given receptor site
some effect to occur

Drugs: Their Name and Source

Official Name: The name that appears in the United States Pharmacopeia (USP) or the
National Formulary (NF). Most often, the official name is the same as the generic name and
is not capitalized.
Generic Name: nonproprietary – furosemide
Trade Name: proprietary - Lasix
Pharmacognosy: Natural drug sources of medications
Plant Sources:
Atropine Sulfate  Atropa Belladona Plant
Morphine Sulfate  Opium Plant
Digitalis  Purple Foxglove
Mineral Sources:
Sodium Bicarbonate
Calcium Chloride
Animal Sources:
Insulin  swine and cows
Oxytocin  swine
Synthetic (man-made) Sources:

Lidocaine (Xylocaine)
Diazepam (Valium)
Midazolam (Versed)

Medication Administration
Right Medication
Right Dose
Right Time
Right Route
Right Patient
Right Documentation
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 …
Therapeutic Index
Represents the relative safety of a drug
Determined by two factors:
Lethal Dose 50 (LD50)  dose that kills 50% of the animals the drug is given to.
Effective Dose 50 (ED50)  dose that provides therapeutic effects in 50% of a given
population
Therapeutic Index Formula: LD50 / ED50

The closer that ratio is to 1, the more dangerous the drug is.

99
Fluids, Fluids, Fluids!

Colloids: Contain molecules (usually protein = Albumin) that are too large to pass through
the capillary membrane.
Blood
Packed Red Blood Cells
Blood Plasma
Plasma Substitutes  Hetastarch
Crystalloids: Do not contain large molecules (protein).
Can be divided into three groups:

Hypertonic: Any solution that is greater than Hypotonic: Any solution that is less than an
the isotonic concentration of 0.9%. Living isotonic concentration of 0.9%. Living cell is
cell is placed in a solution that has a higher placed in a solution that has a lower solute
solute concentration (and a lower water concentration (and a higher water
concentration) than that inside the cell. concentration) than that inside the cell.
Water exits the cell and enters the solution, Too much water can enter the cell and cause
causes cell to dehydrate (crenate) and it to burse (lyse).
possibly die.
Isotonic: Any solution that is equal to a concentration of 0.9%. Living cell is placed in a
solution that has the same solute and water concentrations as the solution inside the cell.

Autonomic Nervous System

Pharmacology
Peripheral Nervous System: Provides nearly every organ with a double set of nerve fibers.
Sympathetic: Adrenergic, fibers exit from thoracic and lumbar regions of spinal cord.
Parasympathetic: Cholinergic, fibers exit from cranial and sacral portions of spinal cord.
Parasympathetic Nervous System: Sympathetic Nervous System:

Also called: Cholinergic System / Also called: Adrenergic
Craniosacral System System/Thoracolumbar System
Function: Maintain vegetative state, normal Function: “Fight or Flight”, increase body
body activity system activities
Neurotransmitter: Acetylcholine Neurotransmitter: Norepinephrine
Major Nerves: Vagus Nerves (CN X) Deactivating Enzymes:

Monoamine Oxidase (MAO)
Deactivating Enzyme: Acetylcholinesterase Catechol-o-methytransferase (COMT)
“Para Aces in Vagus”

Parasympatholytic: Sympathomimetic:
Blocks the effects of the parasympathetic Mimics the effects of the sympathetic
nervous system (Atropine) nervous system (epinephrine)
“Lytic”  blocks “Mimetic”  Mimics

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

Review Questions
1.) You are treating a patient who has overdosed on amitriptyline, what is the antidote?
________________________
2.) What mnemonic is often paired with cholinergic poisoning? __________________
3.) The #1 cause of esophageal varices is ______________.
4.) What medication should be considered in the hypoglycemic chronic alcohol patient? _________
5.) What is the medical term for “scarring of the liver”? __________________
6.) Glucagon is the antidote for which type of medication overdose? __________________
7.) When treating a patient with suspected cyanide poisoning, what medication should be considered?
____________________________
8.) True or False: A venomous snake bite should have constricting bands placed above and below the bite.
9.) The drug’s desire to attach to a receptor. __________________
10.) A drug that inhibits other drugs from attaching to a given receptor site. _________________
11.) Atropine Sulfate is derived from the ___________ _____________ plant.
12.) After _____ half-lives have passed, the drug is considered fully eliminated.
13.) The therapeutic index is calculated by dividing ______ by ______. The closer that ratio is to 1, the more
dangerous the drug is.
14.) What is the common protein found in colloid solutions? ________________
15.) A hypertonic solution will cause the cell to ________.
16.) A hypotonic solution will cause the cell to ________.
17.) What is the neurotransmitter of the parasympathetic nervous system? ____________________
18.) What is the neurotransmitter of the sympathetic nervous system? _____________________
19.) What is a common parasympatholytic administered in the prehospital setting? _____________
20.) Beta 1 receptors work on the _________ and Beta 2 receptors work on the __________.

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7
CHAPTER 7
Trauma

Chapter 7: 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

106
Chapter 7: 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
Fracture of clavicle, ribs, or pelvis crashes
Pulmonary contusion Rollover: ejection, may have several types of
injuries
Ruptured liver or spleen
(depending on side involved) Car Crash: Rear End Impact
Head and neck injury Vehicle struck from behind – back and neck
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 7: 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
Parkland Formula:
4mL X kg X %TBSA burned = 24 hour infusion
1st half over first 8 hours, 2nd half over next 16 hours
>20% TBSA, 2nd and 3rd degree burns only

Rule of 9s – Adult
Rule of 9s – Pediatric

Chapter 7: 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, singed 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 7: Trauma
Head, Face, & Neck Trauma

Le Fort Fractures Types of Amnesia:
Retrograde Amnesia: no recall of events before
the injury.
Antegrade Amnesia: in ability to create new

memories; exists after recovery of
consciousness
https://www.aao.org/oculoplastics-center/le-fort-fractures
Types of Head Bleeds
Increased Intracranial Pressure

“Cushing’s Triad” = MUST KNOW
Normal ICP range = 10 – 15mmHg or less
Treatment:
SPO2 > 94%
Capnography monitoring of 35 – 40mmHg
Treatment (Evidence of Herniation):
Hyperventilation to yield ETCO2 of 30 – 35mmHg Cushing’s
Evidence of Herniation: Cushing’s Triad OR unresponsive patient Triad
with bilateral, dilated pupils AND decerebrate posturing with no
motor response to a painful stimuli
Systolic Blood Pressure
110
Chapter 7: Trauma
Spinal Cord Injuries

Axial Loading: Vertical compression of the spine results when direct forces are sent down
the spinal column. Compression fracture or crushed vertebral bodies  T12 to L2
Central Cord Syndrome: Hyperextension cervical injuries  greater impairment of the

upper extremities than of the lower extremities, paralysis of arms, sacral sparing
(preservation of sensory or voluntary motor function of the perineum, buttocks, scrotum, or
anus)
Anterior Cord Syndrome: Usually seen in flexion injuries – decreased sensation of pain
and temperature below level of lesion, intact light touch and position sensation, paralysis
below the level of the lesion.
Brown-Sequard Syndrome: Hemitransection of the spinal cord – weakness or paralysis

of the extremities on the same side (ipsilateral) of the injury with loss of pain and
temperature sensation on the opposite side (contralateral)
Hemitransection, simply put,

means “half” the cord has
been transected. An easy
way to remember this is the
“-” between Brown &
Sequard. Think of the hyphen
as being a “half” transection.
https://www.sciencedirect.com/topics/medicine-and-dentistry/dermatome

Chapter 7: 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)
Needle Decompression:
10 – 16 gauge IV needed, at least 3.25” in length
Insert needle above rib (to avoid nerves and vasculature that run under rib)
Historically: 2nd intercostal space, mid clavicular
Updated Evidence: 5th intercostal space, anterior axillary

Chapter 7: 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
Consider intubation (as needed)
Traumatic Asphyxia
“Severe crushing injury to the chest and abdomen, results
in increased intrathoracic pressure”
Forces blood from the right side of the heart to the upper
thorax, neck and face.
Face will have a purple/red appearance
Management
ABC’s & hypovolemia/shock management
https://intjem.biomedcentral.com/articles/10.1007/s12245-010-0204-x
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 7: Trauma

Diaphragmatic Rupture Cardiac Tamponade
Sudden compression of abdomen results in
increased intra-abdominal pressure See “Cardiac Tamponade” in “Chapter 4:
Cardiology” for detailed information.
Signs and Symptoms
Evisceration
Abdominal pain, shortness of breath,
Protrusion of an internal organ(s) or the
decreased breath sounds, bowel sounds heard
peritoneal contents through a wound
over thorax
Management
Management
Cover eviscerated contents with moist,
Oxygen/ventilatory support
sterile dressing
Fluids
Cover moist dressing with dry dress to
Rapid transport
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 blunt
abdominal organ trauma
Mortality rate = 54%
Abdominal Trauma Treatment
Spleen
Left upper quadrant Stabilize the patient & rapid transport
40% of patients have no
symptoms…immediately Oxygen
Pain in left shoulder (Kehr’s Sign) Permissive hypotension = 80 – 90mmHg
Check for other injuries
Reassess every 5 minutes

114
Chapter 7: 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)

115
Chapter 7: Trauma
Types of Shock
Commonly Associated with Trauma
20mL/kg boluses, PRN

100 – 200mL boluses, PRN
Stages of Shock

Chapter 7: Trauma
SCUBA Diving Emergencies

Diving Gas Laws:
Boyle’s Law: if temperature remains constant, volume of a given mass of gas is inversely
proportional to the absolute pressure.
When pressure is doubled, the volume of gas in halved. Popping or squeezing sensation in
ears.
Dalton’s Law: pressure exerted by each gas in a mixture of gases is the same pressure that
gas would exert if it alone occupied the same volume.
Henry’s Law: at a constant temperature, the solubility of a gas in a liquid solution is

proportionate to the partial pressure of gas.
Descent Diving Injuries

“The Squeeze”  Results from the compression of
gas in an enclosed space as the ambient pressure
increase with descent under water.
Pain
Sensation of “fullness”
Headache
Disorientation
Vertigo
Nausea
Bleeding from nose or ears (think eustachian tubes)

Chapter 7: Trauma
SCUBA Diving Emergencies

Ascent Injuries
Air Embolism: most serious complication of pulmonary barotrauma  major cause of death
and disability among divers.
Occurs when ascending too quickly or holding breath while ascending to surface. Diver loses
consciousness immediately after resurfacing.
Signs and Symptoms: Difficulty breathing, stroke-like symptoms (vertigo, confusion, visual
disturbances, focal neurologic deficits)
Management:
Oxygenation and airway protection
Transport in left lateral recumbent position
Hyperbaric oxygen therapy (“recompression”)
Decompression Sickness (“the bends, diver’s paralysis, caisson disease, dysbarism”):

Multisystem disorder that results when nitrogen in compressed air converts back from solution
to gas  results in formation of bubbles in the tissues and blood. (Henry’s Law).
Signs and Symptoms: Joint pain, rashes, itching, “bubbles under the skin”, chest pain, cough
,shortness of breath
Management:
Oxygenation and airway protection
Transport in left lateral recumbent position
Hyperbaric oxygen therapy (“recompression”)
Nitrogen Narcosis (“rapture of the deep”): nitrogen becomes dissolved in the blood and
crosses the blood-brain barrier. Causes CNS depression effects similar to alcohol which can
seriously impair the diver’s thinking and lead to lethal errors. Usually becomes evident at
depths of 75 – 100’.

Chapter 7: Trauma
Environmental Emergencies
Hypothermia
Core body temp (CBT) of less than 95 degrees  lose the ability to shiver
Osborn wave (“J wave”) may be present at junction of the QRS and ST segment
https://www.grepmed.com/images/3297/hypothermia
Mild hypothermia: 89.8 – 95 32 1 35
Moderate hypothermia: 82.5 – 89.7 28 32
Severe hypothermia: < 82.4 28
-cardiology-clinical-osborn-jwave-ekg-ecg
Increased risk of enter Ventricular Fibrillation
Management:
Handle with care
Move to warm environment and start rewarming process
Remove wet/cold clothing Heat Stroke
CBT > 104
Heat Exhaustion
740
Signs & Symptoms
CBT up to 103 Confusion/irrational behavior
39 Coma
Signs & Symptoms Flushed skin
Severe cramps Pulmonary edema
Dizziness Dysrhythmias
Nausea GI bleeding
Profuse sweating Clotting disorders
Headache Reduced renal function
Hepatic injury
Management: Electrolyte abnormalities
Move to cool environment **Sweating may be absent**
Administer replacement fluids
Management:
Cool patient with a cool water spray
Move to cool environment
Cool by fanning, keep the skin wet
Administer fluids
Administer benzodiazepines for seizures

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.) This type of EKG finding is characteristic in the hypothermic patient. ____________________
4.) When calculating the Parkland Formula, only ____ and ____ burns are calculated.
5.) After calculating the Parkland Formula, the first half of fluid should be given during the first _____ hours.
6.) Carbon monoxide has an affinity for hemoglobin that is _____ times greater than that of oxygen.
7.) _____________ skin is a late finding in high carbon monoxide levels.
8.) This type of inhalation burn has the greater likelihood of reaching the lower airways. _____________
9.) This type of burn causes liquefaction necrosis. ________________
10.) This type of burn causes coagulation. _______________
11.) Bradycardia, irregular respirations, and an increasing blood pressure collectively form ___________
_______.
12.) This type of head bleed is arterial in nature and most commonly involves the middle meningeal artery.
______________
13.) The inability to create new memories. ___________________
14.) This type of head bleed is venous in nature and is more common than epidural bleeds. ___________
15.) A hemitransection of the spinal cord is called _________- ________ __________.
16.) What is a major difference between a hemothorax and a tension pneumothorax? ____________
17.) What is the preferred site of needle decompression? _______________________
18.) Blunt chest trauma, timed during the upstroke of the T-wave that produces ventricular fibrillation.
___________________________________
19.) The most common type of fracture in the pediatric patient. ___________________
20.) Left untreated, a tension pneumothorax will develop into ______________ shock.

Want more Trauma

review?
Check out our Paramedic Trauma Study Guide or
our Trauma Review Lectures for more in-depth
information!
121
8
CHAPTER 8
Medical
Emergencies

Chapter 8: Medical Emergencies
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
Ovarian Cyst: Thin walled, fluid-filled sac on the
surface of the ovary
May result in significant hemorrhage
Abdominal pain may be caused by rapid

expansion, torsion or acute rupture
Vaginal bleeding or a late/missed period at time

of rupture
Localized, one-sided lower abdominal pain

https://www.completewomencare.com/ovarian-cysts/
Management
IV & fluids
Pain management
Rapid transport
Ectopic Pregnancy: pregnancy that develops

Normal
outside of the uterus (fallopian tube or ovary)
Third leading cause of maternal death; typically

found at 8 – 12 weeks’ gestation
2 3 months
Vaginal bleeding, crampy abdominal pain, spotting
Rigid, stiff, board-like abdomen
After rupture, severe abdominal pain, vaginal
spotting, internal hemorrhage, sepsis, and shock
Ectopic
Management
IV & fluids
Pain management
RAPID TRANSPORT

124

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 months 442
Occurs in about 5/1000 deliveries Occurs in about 1% of all pregnancies;
Signs and Symptoms results in fetal death in about 15% of cases
Third-trimester pain (aching) Signs & Symptoms
Third-trimester pain (stabbing)
Painless
Painful
Bright Red Bleeding
Dark Red Bleeding
Strongly associated with # of previous C-
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 Left lateral recumbent positioning
Impaired liver function Oxygen
Renal insufficiency IV access
Pulmonary edema Magnesium Sulfate  4g over 10 – 20
Visual or cerebral disturbances mins
Can consider benzodiazepines
Severe HTN characterized by systolic > 160
and diastolic > 110 Each seizure increases fetal mortality by
10%
IV, oxygen (PRN), calm transport Can occur up to 4 weeks postpartum, rare


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, administer oxytocin (10U/1L, infuse at 20 – 30
drops/minute)
Amniotic Fluid Embolism

Amniotic fluid enters maternal circulation during labor, delivery, or immediately after through
lacerations of endocervical veins, lower uterine segment, or uterine veins.
Occurs in 6 – 15 per 100,000 deliveries
Maternal mortality rate is high
Signs and symptoms mimic that of a pulmonary embolism (PE)

see “Chapter 3: Respiratory & Airway”
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, IV access, 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, consider anti-contraction
medication


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!
https://fineartamerica.com/art/umbilical+cord

129
Pediatrics
Age Awake Rate Sleeping Respiratory Blood
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-Aged 75 – 118 58 – 90 18 – 25 80 + (2 x age*)
Adolescent 60 - 100 50 – 90 12 – 20 80 + (2 x age*)
*age in years
Adenosine: 0.1mg/kg (max 6mg), second dose 0.2mg/kg (max 12mg)
Amiodarone: 5mg/kg (max 300mg)
Atropine: 0.02mg/kg (max 0.5mg single dose)
Calcium Chloride: 20mg/kg (0.2mL/kg)
Dextrose: 0.5 – 1g/kg
Epinephrine:
0.01mg/kg (0.1mL/kg of 0.1mg/mL concentration)  PEA/ symptomatic bradycardia
0.1mg/kg (0.1mL/kg of the 1mg/mL concentration)  PEA/symptomatic bradycardia
0.15mg (junior autoinjector) to 0.30mg (autoinjector)
.25 - .5mL racemic solution (2.25%) mixed in 3mL normal saline via inhalation
Lidocaine: 1mg/kg
Magnesium Sulfate: 25 – 50mg/kg
Naloxone: 0.1mg/kg Fluid Resuscitation:
Sodium Bicarbonate: 1mEq/kg 10mL/kg for neonates (< 1 month)
20mL/kg for > 1 month

Pediatrics
Respiratory Differentiation
40C
7400
Meningitis
Petechiae
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  dark purple lesions

Purpura
Life threatening  Protect yourself with N95 mask!

Endocrinology
Endocrine Glands Exocrine Glands
Ductless Release chemical products through ducts
Secrete hormones directly into circulation Have localized effects
Widespread effects
Act on distant tissues
Hormones…
Just read the names to determine their effect/role
“Growth hormone releasing hormone (GHRH)”

Releases growth hormone
“Growth hormone inhibiting hormone (GHIH)”

Inhibits growth hormone release
Terms:
Anabolism: Build up, uses energy
Catabolism: Breakdown, no energy required

132
Endocrine Anatomy
Hypothalamus: Located deep within the cerebrum of the brain.
Hypothalamic cells – nerve cells or neurons, receive messages from
ANS and detect internal conditions. Gland cells produce and release
hormones.
Pituitary Gland: “Master Gland”. Size of a pea, broken into “anterior”

and “posterior” glands.
Anterior responds to hypothalamic hormones.
Posterior responds to nerve impulses from hypothalamus.
Has direct impact on endocrine glands throughout body.
Anterior Pituitary Gland Posterior Pituitary Gland
Adrenocorticotropic hormone (ACTH) Antidiuretic hormone (ADH)

Adrenal cortexes Retention of water
Thyroid stimulating hormone (TSH) Oxytocin

Thyroid Uterine contraction
Lactation
Follicle stimulating hormone (FSH)
Gonads or sex organs Diabetes Insipidus
Large volumes of urine
Luteinizing hormone (LH) Inadequate ADH secretion
Gonads
Prolactin (PRL)
Female mammary glands

Endocrine Anatomy
Thyroid: Two lobes, butterfly shaped, located in neck anterior and
inferior to larynx.
Produces three hormones:
Thyroxine (T4)  stimulates cell metabolism
Triiodothyronine (T3)  stimulates cell metabolism
Calcitonin  lowers blood calcium levels
Parathyroid: Four small glands located on posterior lateral surfaces

of thyroid.
Secretes parathyroid hormone (PTH)  increases blood calcium

levels
PTH is antagonist of calcitonin; balance of PTH and calcitonin

determines level of blood calcium
Thymus: In mediastinum, just behind the sternum. During childhood,

it secretes thymosin  maturation of “T” lymphocytes responsible for
cell-mediated immunity. The “T” of “T” lymphocytes (or “T” cells)
stands for “thymus”.
Disappears after childhood – cannot be seen on chest x-ray
Pancreas: Located in LUQ, retroperitoneal behind stomach. Has

both endocrine and exocrine tissues.
Endocrine tissue known as “Islets of Langherns”

Alpha: Glucagon  raises blood sugar Glycogenolysis  Glucagon
Beta: Insulin  lowers blood sugar stimulates breakdown of
Delta: Somatostatin glycogen
Exocrine tissues secrete digestive enzymes. Gluconeogenesis  New

glucose from non-sugar
sources
Endocrine Anatomy
Pineal Gland: Located in roof of thalamus in brain. Releases
hormone melatonin in response to changes in light. Melatonin may
affect mood.
Adrenal Gland: Subdivided into “Adrenal Cortex” and “Adrenal

Medulla”
Adrenal Cortex Posterior Pituitary Gland
Outermost layer Middle layer
Steroids Catecholamines
Glucocorticoids  increase BGL Adrenal Medulla
Nerve cells and gland cells
Mineralocorticoids  salt/fluid balance Secretes epinephrine (adrenalin)
Norepinephrine
Androgenic hormones  same effect as
secreted by gonads
Female Gonads Male Gonads

Ovaries produce eggs Tests produce sperm cells
Sexual maturation  puberty and Sexual maturation  puberty and

subsequent reproduction subsequent reproduction
Ovaries (female gonads) Testes (male gonads)

Paired organs about size of almond Located outside abdominal cavity in
Located in pelvis on either side of uterus scrotum
Produce estrogen and progesterone
Testosterone  secondary male sexual
characteristics and sperm development

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
Very low production of insulin (if any) Non-insulin-dependent diabetes mellitus
(NIDDM)
Insulin-Dependent Diabetes Mellitus (IDDM) 
requires insulin injections for homeostasis Some patients may require insulin
Less common than Type II, but more serious Heredity and obesity play a role
Accounts for most diabetes-related deaths
Far more common than Type I
If untreated, blood glucose levels rise because
cells cannot take up circulating sugar Untreated presents with lower level of
hyperglycemia and fewer major signs of
BGL of 300 – 500 not uncommon metabolic disruption
Constant thirst (polydipsia), excessive urination May proceed to hyperglycemic hyperosmolar
(polyuria), ravenous appetite (polyphagia), non-ketotic syndrome (HHNK)
weakness, weight loss
Ketosis result of fat catabolism

Hyperglycemic Hyperosmolar Non-Ketotic
May proceed to diabetic ketoacidosis 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 Treatment  give fluids and transport
Ketones on breath
BGL ~> 500mg/dL Hypoglycemia
BGL < 60, treat with oral sugar (if conscious),
Treatment  give fluids and transport IV Dextrose, or IM glucagon

Thyroid Disorders
Thyrotoxicosis (Hyperthyroid)
“Thyroid Storm”
Mild form of hyperthyroidism

Hypothyroidism
Low levels of thyroid hormones produced,
Brought on by infection, stress, or surgical
cold intolerant
manipulation of thyroid
Often associated with Grave’s Disease

Hyperthyroidism
Goiter (enlarged thyroid) Excessive levels of thyroid hormones
produced, heat intolerant
Exophthalmos (protruding eyes)
Severe tachycardia, heart failure, dysrhythmias,

shock, hyperthermia, agitation, coma, delirium
Myxedema
Graves Disease
Form of hypothyroid  may be associated
Type of excessive thyroid activity characterized with inflammation of thyroid gland
by a goiter and protruding eyes (Hashimoto’s)
Most often occurs in young women Thickening of the skin, most notably the lips,
nose, and throat
May arise as a result of an autoimmune process
in which an antibody stimulates the thyroid cells Coma is rare, precipitated by exposure to
cold, infection, heart failure, trauma, drugs,
stroke, hypoxia, and hypoglycemia
Characterized by hypothermia and decreased

LOC

Adrenal Disorders
Cushing Syndrome
High Cortisol & Aldosterone Levels
Mainly affects women 30 – 50 years old
May be caused by adrenal gland tumor,

adrenal gland enlargement or long-term
administration of corticosteroid drugs
(prednisone, dexamethasone or
methylprednisolone)
Low Cortisol &
Signs and Symptoms Aldosterone
Face appears to be round (“moon face”) and
red
Addison’s Disease
Weight gain, muscle atrophy of arms/legs Low Cortisol & Aldosterone Levels
Purple stretch marks on abdomen, thighs, and Caused by any disease process that destroys
breasts (“striae”) the adrenal cortices
Increased facial hair, buffalo hump on back, Most common cause is shrinking the adrenal
hypertension, insomnia, depression, diabetes tissue
Progressive weakness, weight loss, and

High Cortisol & anorexia
Aldosterone Skin hyperpigmentation (redness/pinkness)
Hypotension
Hyponatremia
Hyperkalemia
GI disturbances (nausea, vomiting, diarrhea)

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

139
GI Bleeds
GI Bleed Treatment:
ABCs
Left lateral recumbent/high semi-fowler’s position (protect airway)
Oxygenation via non-rebreather mask
IV access
Antiemetic for nausea/vomiting
Fluid replacement as needed
Mallory Weiss Tear (Upper GI Bleed):

Laceration of the esophagus caused by excessive “retching” and vomiting - associated
with bulimia. Tear does not extend through entire esophagus
Boerhaave Syndrome (Upper GI Bleed): Rupture of esophagus from prolonged

“retching” and vomiting. Tear travels entirely through the esophageal wall.
Allows for passage of blood, air, and food out of the esophagus and into the
mediastinum.
90% mortality rate in 48 hours if untreated

Abdominal & GI
Acute Gastroenteritis: Inflammation of the stomach and intestines with sudden
vomiting and diarrhea.
Causes: ETOH and tobacco use, NSAID use, chemotherapeutic agents, alkalotic/acidic
ingestion.
Treatment  airway management & hydration
Chronic Gastroenteritis: Long-term mucosal changes or permanent mucosal damage.
Causes: microbial (H-Pylori  fecal/oral route or through contaminate food or water)
Peptic Ulcers: #1 cause of upper GI bleeds. Erosions cause by gastric acid – may occur
anywhere in the GI tract. Duodenal ulcers occur in proximal portion of the duodenum.
Occurs more in males than females.
Causes: NSAIDS, nicotine, ETOH, H-Pylori
Signs and Symptoms: nausea and vomiting, massive hemorrhage is possible
Treatment  Antacids and bleeding control
Zollinger-Ellison Syndrome: Acid secreting tumor provokes ulcerations – chronic ulcers

may result in anemia
Ulcerative Colitis: Unknown cause, occurs in the rectum and large intestine, bloody
diarrhea/ stool with mucus.
Signs and Symptoms: nausea, vomiting, fever, weight loss

Abdominal & GI
Crohn’s Disease: Can occur anywhere in the GI tract
Who/Why  familial link, white females, high stress, Jewish population
What  GI bleeding, weight loss, intermittent abdominal cramping/pain,

nausea/vomiting/diarrhea, fever
RAPID ONSET
Diverticulosis: #1 cause of lower GI bleed – outpouchings of tissue that push through

intestinal wall
Diverticulitis: Inflammation of diverticula due to infection
Signs and Symptoms: lower left-sided pain, fever, elevated WBCs, nausea/vomiting,
tenderness on palpation
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:

Metabolic = alcoholism
Mechanical = gallstones 30 – 40% Mortality
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

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
Consider early intubation
IV with fluids
Oxygen is 1st line medication
Epinephrine 1:1,000  0.3 – 0.5mg IM every 15 – 20 minutes (adult)
Epinephrine 1:10,000  0.1mg IVP over 5 minutes
Benadryl, Steroids, Albuterol
Vasopressors as needed

144
Distributive Shock
Anaphylaxis will eventually lead into “Anaphylactic Shock” which is a subset of “Distributive
Shock”
For all subsets of distributive shock, see below!

10 - 20mL/kg boluses, PRN
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.

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.) Which medication should be considered for the eclamptic seizure? ____________________
6.) A postpartum hemorrhage is defined as blood loss of greater than _______mL within first 24 hours after
delivery.
7.) What are two ways to help control postpartum hemorrhage? ____________________________
8.) Twenty minutes after delivering a healthy newborn, the mother is experiencing a sudden onset of difficulty
breathing. What do you suspect? ___________________
9.) An APGAR score should be assigned at ____ and ____ minutes after birth.
10.) When a newborn’s head is too large to pass through the birth canal. ______________________
11.) When the umbilical cord is wrapped around the fetus’ neck during delivery, it is termed:
_____________________.
12.) What is the appropriate fluid bolus dose for a 2 week old newborn? _____________
13.) Petechiae and purpura are characteristic findings of _______________.
14.) This respiratory condition typically occurs in kids between 6 months and 4 years of age and produces a
stridorous sound.
15.) Laryngotracheobronchitis is another term for __________.
16.) Endocrine glands are __________ and secrete hormones directly into circulation.
17.) The Beta cells of the pancreas secrete ________.
18.) Type I Diabetes can develop into which hyperglycemic condition? ______________________
19.) Which is more common, Type I or Type II diabetes? _________________
20.) Which thyroid condition is associated with cold intolerance? ______________

Review Questions
21.) The overproduction of cortisol and aldosterone can lead to ___________________.
22.) Hyperpigmentation of the skin is often associated with what adrenal disorder? _____________
23.) What is the number one cause of upper GI bleeds? _____________
24.) What is the number one cause of lower GI bleeds? ______________
25.) A partial laceration of the esophagus caused by excessive “retching” and vomiting, often associated with
bulimia. ___________________________
26.) The most common surgical emergency seen in the field that starts as periumbilical pain.
________________
27.) What is the first line medication in the anaphylactic patient? _____________
28.) Left untreated, anaphylaxis will develop into anaphylactic shock. What major shock category is
anaphylactic shock apart of? __________________

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9
CHAPTER 9
Special
Populations

Chapter 9: Special Populations
Special Populations
Cerebral Palsy: General term for non-progressive disorders of movement and posture
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
Huntington Disease: Genetically programmed degeneration of neurons in the brain.
Causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance.
Management:
Incurable, supportive care in the prehospital setting
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

Special Populations
Guillain-Barre Syndrome: Acute or subacute type of progress polyneuropathy
Prominent weakness with some sensory changes  begins in legs and spreads upward
to arms and body. Causes total or near-total paralysis over time.
Patients often require mechanical ventilation
Most patients do recover from GBS, some may have persistent weakness
GBS can last days to weeks, follows symptoms of a respiratory or GI viral
infection
Parkinson Disease: Degeneration of nerve cells in the basal ganglia of the brain. This
degeneration causes a lack of dopamine.
Results in muscles becoming overly tense  tremors, joint rigidity, and slow movement.
Typically begins in one hand/arm and progresses over time
**Leading cause of neurologic disability in people older than 60 years
Amyotrophic Lateral Sclerosis (ALS)  “Lou Gehrig's Disease”

Motor neuron disease  nerve fibers in the brain and spinal cord degenerate.
Weakness is first noticed in the hands and arms; accompanied by fasciculations.

Progresses to involve muscles of all four extremities and those involved in respiration
and swallowing.
In final stages, patients are unable to speak, swallow, or move.
Management: Supportive care, airway management

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.
Administer fluids and analgesics
Normal RBC Sickle Cell – RBC

Irregularly shaped RBC

152
10
CHAPTER 10
EMS Operations

Chapter 10: 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

155
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

Incident Command
C-FLOP
C: Command
F: Finance/administration
L: Logistics
O: Operations
P: Planning
Incident Commander (IC)

Must be clearly identified
Must be familiar with ICS
Should be the person best able to manage the emergency scene
Command can be transferred
Typically occurs face-to-face
This must be communicated with all personnel, incoming units, and dispatch
First arriving unit should establish command

When two or more units are responding
Large scale incident
Not necessary for an isolated ambulance call, only with multiple units/agencies
Span of Control
Number of people or tasks the IC can control
Range is 3 – 7, however 5 is optimal
With large incident and lots of personnel, separate divisions should be utilized to oversee
personnel on the scene
Incident priorities (in order)

Life safety
Top priority, protect yourself and rescuers
Then, attend to patients
Incident stabilization
Property conservation

Hazardous Materials
Formerly called “Material Safety Data Sheets”
Required by OSHA for each chemical produced, stored, or used in the US
Supplied by manufacturer
Contain information for emergencies and exposures
International Hazardous Materials Classification

Class 1  Explosives
Class 2  Gases
Class 3  Flammable and combustible liquids
Class 4  Flammable solids
Class 5  Oxidizers and organic peroxides
Class 6  Poisonous and infectious materials
Class 7  Radioactive materials
Class 8  Corrosives
Class 9  Miscellaneous
Types of Radiation
Alpha radiation – Large radioactive particles with minimal penetrating ability. Stopped
with thin sheets of paper.
Beta radiation – Small radioactive particles that can penetrate skin, be ingested or
inhaled. Stopped with respiratory protection and/or protective clothing.
Gamma radiation – Most dangerous form of penetrating radiation, can produce internal
and external hazards. Stopped with large sections of concrete.
Self Protection
Time, Distance, Shielding
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, etc.) Nuclear
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. _______________________

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Operations review?
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information!
162
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 150
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.
 20 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.
Need help preparing for the Paramedic

NREMT Psychomotor Exam? Check out
our 1-hour review lecture!
Found at bottom of “Paramedic NREMT

Prep Lectures” page on website

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Prepared exclusively for Ali Alquraini Transaction: PWP3586 No one other than the individual above should access

or use this study guide. Contents are copyrighted.

Copyright 2021 - Pass with PASS, LLC 1

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

He completed his paramedic education at the University of

Copyright 2021 - Pass with PASS, LLC 2

All procedures listed in the study guide should only be performed

Medication dosages may differ across the country, any medication

Copyright © 2021 by Pass with PASS, LLC. All rights reserved.

Reference herein to any specific commercial product, process, or

Although we make every effort to ensure that the material

Copyright 2021 - Pass with PASS, LLC 3

2 Medical Terminology Page 7

3 Respiratory & Airway Page 19

6 Toxicology & Pharmacology Page 93

7 Trauma Page 105

8 Medical Page 122

9 Special Populations Page 149

10 EMS Operations Page 152

Copyright 2021 - Pass with PASS, LLC 4

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Chapter 1: The NREMT Exam

The NREMT Exam

Topic Area Percentage of Questions

Cardiology & Resuscitation 22 – 26%

EMS Operations 10 – 14%

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Chapter 2: Medical Terminology

By the way, it was “C – Anaphylaxis”

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Chapter 2: Medical Terminology

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.

Anion  an ion with a negative charge.

Aphasia  inability or difficulty in speaking.

Apnea  the cessation of spontaneous respirations.

Ascites  abnormal accumulation of fluid in the abdomen.

Ataxia  failure of muscle coordination.

Atrophy  shrinkage of a cell or muscle.

Bile  secreted by the liver, stored in gallbladder.

Bruit  an abnormal sound or murmur due to a narrowing of the vessel.

Copyright 2021 - Pass with PASS, LLC 9

Chapter 2: Medical Terminology

Cartilage  smooth and firm connective tissue.

Cation  an ion with a positive charge.

Cell  basic unit of life.

Cerumen  ear wax found in external ear canal.

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.

Demarcation  line or visible mark between living and necrotic tissues.

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

Dyskinesia  disorder related to involuntary muscle movements.

Copyright 2021 - Pass with PASS, LLC

Chapter 2: Medical Terminology

Dysplasia  abnormal growth of a cell.

Dysphagia  difficulty in swallowing.

Dysuria  difficult or painful urination.

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