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Study for the EMT-Basic Exam

Updated on January 11, 2015
Morgan leFae profile image

Elizabeth has been an EMT for a year, a writer for 10 years, and an artist all her life. She pulls inspiration from her favorite authors.

The Exam

The NREMT (National Registry of Emergency Medical Technicians) exam for EMT-Basic is anywhere for 70 to 120 questions, computer adaptive, and timed. It covers Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical & Obstetrics/Gynecology; and EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). I had to take the exam twice, as many people do, and have plenty of tips, tricks, and study material for you!

The first thing to know and truly understand about the Registry exam is what computer adaptive means. The basic idea is that you get one question at a time. If you answer correctly, the next question is a little harder, while if you answer incorrectly, the next question is a little easier. The computer uses this method to get an accurate idea of your abilities, and it may result in you seeing similar questions multiple times. The trick to this is to figure out exactly which topics you are worst at, and studying them the most.

Of course, do not neglect the things you are best at, no matter what exam you study for it's always a good idea to have a well-rounded study strategy.

Developing a Study Strategy

Everyone studies and learns differently, but there are some factors that every study strategy should incorporate.

  1. Whether you study with friends or alone, avoid distractions. If your friends are the type to get off topic to talk about other things or goof off, you might consider skipping the study sessions.
  2. Gather all of your class materials (textbook, notes, flashcards, charts, highlighters, pencils, worksheets, old quizzes and tests) in a comfortable area for studying. If you need a computer for online tests like MedicTests.com, either bring a laptop or study where your desktop is. The library is also a good choice. Note: Do NOT bring anything you don't need.
  3. Figure out and make sure you have just the right level of background noise. For me, I put on a TV show I've already seen a million times. I don't have to watch it or even completely listen to know what's going on. So it provides comfort and background noise to my studying without being too much of a distraction. A lot of people find it hard to properly concentrate in complete silence, just like it's hard to study with too much distraction.
  4. Review the things you are best at first, maybe include a quick quiz.
  5. Move on to the things you are unsure of and need more time with. Re-read the chapters, review your notes, make flashcards, find quizzes, make charts for visual reference.
  6. At the end, review the things you are good at again quickly.
  7. Try not to study more than a couple hours at a time. Don't cram, and don't overdo it. Make sure you take a break to do something you like and then come back to studying later.

Study Material

My advice to you is to study specific conditions, like pulmonary embolisms, and OB/GYN. Not only are these the subjects that more people have trouble with, its very easy to overlook the details of individual conditions when you are focused on definitions and basics. So below you will find some of my notes from class, charts and tables, videos and pictures that you may peruse to help you study.

Normal Vital Signs

Age
Pulse
Respirations
Blood Pressure (systolic)
Blood Pressure (Diastolic)
Neonates (1-28 days old)
120-160
40-60
Greater than 60
 
Infants (1-12 months old)
100-120
25-50
70-95
 
Children (1-8 years old)
80-100
15-30
80-110
 
Adults
60-100
12-20
90-140
60-90
*Normal O2 sat is 95%-100% *If you have no pulse ox available, check the capillary refill. If its less than 2 seconds, the patient's pulse is normal, breath sounds are clear and equal, and the patient's skin is dry and pink, its fairly safe to say th

APGAR Score Determination

Category
0 Points
1 Point
2 Points
Heart Rate
Absent
Less than 100
Greater than 100
Respiratory Effort
Absent
Slow or irregular
Strong Cry
Muscle Tone
Flaccid
Some flexion
Active motion
Irritability
No response
Some
Vigorous
Color
Blue/pale
Body pink, but extremities blue/pale
Fully Pink
*Score should be measured at 1 minute after birth and again at 4 minutes after birth **Infants with scores of 7-10 usually require supportive care only ***A score of 4-6 shows moderate depression ****Infants with scores of 3 or less require aggressiv

Glascow Coma Scale

(click column header to sort results)
Eye Opening  
Score  
Spontaneously
4
To Command (to speech for infants)
3
To Pain
2
No Response
1
Best Verbal Response
Score
Oriented (infants coo/babble)
5
Confused (infants irritable cries)
4
Inappropriate words (infants cry to pain)
3
Incomprehensible (infants moan or grunt)
2
No response
1
Best Motor Response
Score
Obeys Commands (infants spontaneous movement)
6
Localizes pain
5
Withdraws from pain
4
Flexion
3
Extension
2
No response
1

Ob/gyn

Childbirth

Get a detailed history of present concern.

  1. How far apart are the contractions?
  2. Is this her first pregnancy? First live birth?
  3. Does she have the urge to push or move her bowels?
  4. Is she on any medications?
  5. Has the amniotic sac ruptured?
  6. Has the patient previously had a c-section?

IF POSSIBLE, transport immediately if there is an abnormal presentation, patient has history of c-section, known multiple births, excessive bleeding, or if pregnancy is not full-term. Remember, THERE IS NO DYING OR MULTIPLYING IN THE MOVING AMBULANCE. If birth is imminent, remain on scene to deliver and call for second unit.

Cephalic presentation - normal, head-first presentation. Occurs in 97% of deliveries.

Breech presentation - when the buttocks present first, occasionally the feet or knees present first. Occurs in about 3% of births.

Shoulder presentation - Shoulder, arm, or trunk may present first. Occurs in less than 1% of births.

Cord presentation - umbilical cord presents, sometimes sticking out of vaginal opening.

Steps for normal Birth (Cephalic presentation)

If birth is imminent, you may have to deliver the baby in the field. Here are the steps for a cephalic presentation childbirth:

  1. Place mother on her back, knees up and apart. She will push better if she is able to sit up more while doing so, but should be able to lay her head down completely when necessary.
  2. Using a gloved hand, use gentle pressure on the presenting head to guide it out and prevent explosive delivery. Remember the anatomy of an infants head and avoid using too much pressure
  3. AS SOON AS MOUTH DELIVERS, suction mouth. The infant will begin breathing immediately, through the mouth first. Suction nose second before continuing with delivery
  4. Guide down to deliver first shoulder, up to deliver second shoulder.
  5. Once infant is full delivered, keep it level with perineum
  6. Clamp umbilical cord (or tie off - use what you have in the field!) in TWO places close together, ideally about 8-10 inches from the infant
  7. Wait for cord to stop pulsing, cut between the two clamps.
  8. Warm and dry the infant, stimulating it by drying with a towel. Make sure respirations are adequate and remember to calculate APGAR score.
  9. Check for excessive post-partum bleeding, treat for shock if necessary, massage uterus to aide contractions. Have mother nurse infant.

Breech Presentation

Contact on-line medical control. If head won't deliver, consider applying gentle pressure to mother's abdomen. If unsuccessful, insert two gloved fingers in vagina between infant's face and vaginal wall to create an airway. RAPID TRANSPORT.

Cord Presentation

Contact on-line medical control. Put mother in trendelenburg and knee to chest position. Hold pressure on baby's head to relieve pressure on the cord. Check pulses in cord, keep the cord moist with saline dressing. Provide O2, RAPID TRANSPORT.

Foot or Leg Presents

Contact on-line medical control. Support the presenting part and put mother in trendelenburg/knee to chest position and provide O2. RAPID TRANSPORT.

Cord around Neck

Unwrap cord from around neck and deliver normally, keep face clear and suction mouth and nose. In some areas, the protocol is to insert two gloved fingers between the cord and infants neck to relieve pressure, trendelenburg the mother, and rapid transport. Consult med control and your protocols.

If the infant is not breathing, suction mouth and nose, stimulate with towel, rub back, and flick soles of feet. Ventilate with BVM if necessary. If heart rate is below 60, begin chest compressions. Assess lung sounds and contact med control. RAPID TRANSPORT.


Medications

Medication
Dose
Route
Indication
Contraindications
Side Effects
Form
Special Considerations
Desired Effect
Epinephrine Auto-Injector
Adult: 0.3mg, Peds*: 0.15mg
Intramuscular, thigh
Moderate to severe allergic reaction with respiratory distress or mild allergic reaction with history of life threatening allergic reaction. Pediatric patient with severe asthma
NONE in the presence of anaphylaxis. If given for asthma, contraindicated if patient can take a sufficient breath to use inhaler instead
Tachycardia, Angina, Headache, Nausea/Vomiting, Dizziness, Hypertension, Nervousness or Anxiety, Tremors
Liquid/metered dose injector
Consult med control for cardia, pregnant, or adult asthma patients, or for extra doses
Vasoconstrictor, Bronchodilator
Albuterol
Adult: 2 doses (4 puffs), Peds: 1 dose (2 puffs). Given within the same 30 minutes
Inhaled
Respiratory distress, Bronchospasm/wheezing associated with asthma, chronic bronchitis, emphysema, anaphylaxis
Inhaler not prescribed to patient, patient already exceeded dose, unknown # of puffs already taken
Tachycardia, Hypertension, Angina, Nervousness and Anxiety, Tremors, Dizziness, Headache, sweating, sore throat, Nausea/vomiting
Fine powder
Warm and inspect cannister before administering to patient. More doses can be given after consult
Bronchodilater
Glucose Paste
10-15 grams between the gum and cheek. Consider 2nd dose after 10 mins if patient has not improved.
Oral
Altered mental status with known diabetic history, unconscious for an unknown reason
None
None
Paste/gel
None
Raises blood sugar level
Nitroglycerin
Adult: 1 tablet or spray, repeat 3-5 mins if chest pains persist, maximum of 3 doses total. Not indicated for pediatric patients
Sublingually
Chest pain
Systolic BP below 90, Pulse under 60, Medication is not prescribed to patient, patient is under 12 years old, Patient has taken an erectile dysfunction drug in the last 48 hours
Hypotension, Headache, Dizziness, Tachycardia
Spray or tablet
Must be individual white tablets, additional doses after consult
Vasodilater
Activated Charcoal
1 gram per kg of body weight
Oral
Poisoning by mouth
Altered mental status, patients who have already received an emetic.
Vomiting and nausea
Suspention
If the poison burned going down, it will burn coming up. Consult with med control and poison control before administering
Absorbant
Aspirin
324 or 325mg (4 baby aspirin = 324mg)
Oral
Chest pain with suspected AMI
Known allergy
Heartburn, nausea/vomiting, wheezing, GI bleed/upset
chewable tablet
none
Platelet inhibitor, Anti-inflammatory
Acetominophen
160mg/5mL = 1 dose. 3-5 years old, 1 dose. 6-9 years old, 2 doses. 10 and up, 4 doses/
Oral
Patients over 3 in mild to moderate discomfort
Head injury, Hypotension, taken acetaminophen in the last 4 hours, inability to swallow or take meds by mouth, respiratory distress, persistent vomiting, known or suspected liver disease, recent alcohol ingestion, known allergy
none
Liquid
significantly underweight or overweight patients, consult med control for dosage
pain relief
*Pediatric patient with medications is a patient under THREE years of age. **Common ED drugs are Viagra, Adcirca, Revatio, Levitra, and Cialis.

Specific Conditions

COPD - chronic obstructive pulmonary disorder. This is a blanket term to describe several diseases and disorders including:

  • Emphysema - Walls of the alveoli break down, and the surface area for gas exchange is reduced. Lungs lose elasticity. Stale air with CO2 is trapped in the lungs and effectiveness of normal breathing efforts is decreased.
  • Chronic Bronchitis - bronchiole lining is inflamed and mucus is formed. Cilia in the cells of bronchioles are damaged or destroyed and cannot clear out obstructions as normal
  • Black Lung - coal-worker's pneumoconiosis. Coal dust builds up in the lungs and is unable to be cleared by the body. Can also be caused by the effects of long term use of tobacco cigarettes. Inflammation, fibrosis, and even necrosis can occur

Asthma - usually there are episodic flare ups. Asthma does not result in a hypoxic drive. The small bronchioles that lead to the alveoli become narrowed and there is an overproduction of thick mucus. Air can get in but then gets trapped in the lungs and becomes stale (the patient has to exhale forcefully, creating wheezing sounds). Steroid inhalers are prescribed for everyday prevention, but albuterol is used in rescue inhalers during attacks. Attacks can be caused by a variety of factors:

  • Insect stings
  • Air contaminants or pollutants
  • Infection
  • Strenuous exercise
  • Emotional stress

Pulmonary Edema - Common in patients with congestive heart failure. Abnormal accumulation of fluid in the lungs, typically because the left side of the heart has been damaged. The damage makes it difficult to pump blood out, and it backs up into the pulmonary veins and lungs, accumulating in the alveoli. With fluid occupying the space, oxygen cannot get in easily = dyspnea.

  • These patients often also have right-sided heart failure - results in pedal or sacral edema, JVD and fluid in the abdominal cavity.
  • Patients may complain of a feeling of drowning.

Common signs an symptoms include:

  1. Complaining of feeling worse and worse over the last several nights
  2. Weight gain of a few pounds over a few days
  3. Anxiety
  4. Pale, sweaty skin
  5. Tachycardia
  6. Hypertension
  7. Rapid and labored breathing
  8. Low oxygen saturation
  9. Gurgling sounds in lungs, either easily audible or on auscultation

Pneumonia - infection of one or both lungs caused by bacteria, viruses, or fungi. Inhalation of microbes causes inflammation. Patients with respiratory diseases are more likely to get pneumonia, as well as people with chronic health problems. Signs and symptoms include:

  1. Productive cough with green, yellow, or even bloody mucus
  2. Fever
  3. Chest pain, usually described as sharp and pleuritic, worse with inhalation
  4. Severe chills
  5. Shortness of breath
  6. Headache
  7. Pale, sweaty skin
  8. Fatigue
  9. Confusion - seen especially in the elderly

Spontaneous pneumothorax - when a lung collapses without injury or any other obvious cause. Usually the result of the rupture of a weak section of the lung. The lung collapses and air leaks into the thorax. Tall, thin people are more likely to have a weak spot that can rupture with just a cough. Smoking destroys the lung tissue and puts a person at higher risk. Signs and symptoms include:

  1. Sharp, pleuritic chest pain
  2. Shortness of breath
  3. Tires easily
  4. Tachycardia
  5. Tachypnea
  6. Low oxygen saturation
  7. Cyanosis
  8. Patient may have decreased or absent breath sounds on the collapsed side.

Pulmonary Embolism - when something that is not blood enters the blood stream and attempts to travel through blood vessels. Gets stuck and blocks an artery in the lungs. The most common is a blood clot, often one that originates in the leg or pelvic region in a vein. This is also called deep vein thrombosis. Increased risk factors:

  • Limb immobility
  • local trauma to an extremity
  • abnormally fast blood clotting
  • women on birth control pills
  • patients with cancer
  • Patients with lower extremity injuries
  • Anyone who is in the same position for an extended period of time (transcontinental air travelers, bedbound patients)

Signs and symptoms include:

  1. Sudden onset sharp pleuritic pain
  2. Shortness of breath
  3. Anxiety
  4. Cough (sometimes with bloody sputum)
  5. Sweaty skin, pale or cyanotic
  6. Tachycardia
  7. Tachypnea
  8. Light-headedness or dizziness
  9. Pain or swelling in one or both legs
  10. Wheezing
  11. If clot is large, may become hypotensive and go into cardiac arrest

Epiglottitis - when an infection inflames the area around and above the epiglottis, and the tissue swells. Can occlude or close off the airway. This used to be more common in children, but recent developments in vaccinations have made it much more common in adults and nearly eradicated in children. Signs and symptoms include:

  1. Sore throat
  2. painful/difficult swallowing
  3. sick appearance
  4. muffled voice
  5. fever
  6. drooling
  7. Stridor - more alarming sign, which indicates the upper airway is already significantly obstructed.

Cystic Fibrosis - disease that typically appears in childhood. Thick, sticky mucus that accumulates in the lungs and digestive system. Can cause severe life-threatening lung infections and problems with digestion. Friends and family will be able to tell you how the disease specifically affects the patient, especially in children. There is no known way to prevent the disease, but patients are now living longer. Signs and symptoms include:

  1. Coughing with large amounts of mucus
  2. Fatigue
  3. Frequent occurrences of pneumonia with worse symptoms than normal
  4. Abdominal pain and distention
  5. Coughing up blood
  6. Nausea
  7. Weight loss

Aneurysm - dilation/ballooning of a weakened section of an artery. If a major artery ruptures, death from hemorrhagic shock can occur very quickly. The rupture of any vessel at all produces internal bleeding and the lack of oxygen in other tissues in the surrounding area. Most common aneurysms are Aortic (as in a AAA. The aorta is the largest artery in the body and caries oxygenated blood from the heart away to the body) or Brain (the rupture of brain aneurysms results in hemorrhagic stroke).

Hypoglycemia vs. Hyperglycemia

Hypo
Hyper
sudden onset
gradual onset
Blood pressure goes up
Blood pressure drops
Pulse, respirations go up
Pulse, respirations go up
Confusion
Ketone breathe-off
Stupor
Profound altered mental status
Unconsciousness
Dehydration
Seizures
hypovolemic shock

Practice Quiz

view quiz statistics

Rule of 9s for Burn Injuries

References

www.medictests.com

www.emsworld.com

www.jems.com

Emergency Care 12th Edition (Person publication, Limmer and O'Keefe)

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