NREMT AEMT cheat sheet

Adult BVM ventilation rate is 10-12 breaths/min (1 breath every 5-6 seconds); with an advanced airway, ventilate at 10 breaths/min (1 breath every 6 seconds).

OPA size: corner of the mouth to the angle of the mandible. NPA size: nostril to the earlobe; avoid NPA with signs of basilar skull fracture.

Adult endotracheal tube depth is about 21-23 cm at the incisors; confirm with continuous waveform capnography, bilateral breath sounds, and chest rise.

Oxygen delivery: nasal cannula 1-6 L/min (24-44%), simple mask 6-10 L/min, nonrebreather 10-15 L/min (up to about 90%), BVM 15 L/min.

Suction limits: 15 seconds adult, 10 seconds child, 5 seconds infant; preoxygenate when possible and monitor SpO2.

Target SpO2 is 94-99%; do not withhold oxygen from hypoperfused or carbon monoxide-poisoned patients based on pulse oximetry alone.

Needle decompression for tension pneumothorax: 2nd intercostal space midclavicular line or 4th-5th intercostal space anterior axillary line.

Signs of inadequate ventilation include accessory muscle use, paradoxical chest movement, absent or decreased breath sounds, altered mental status, and late cyanosis.

Pediatric airway differences: larger tongue, smaller airway diameter, funnel-shaped larynx; avoid excessive hyperextension of the neck.

Adult CPR: 30 compressions to 2 ventilations, 100-120 compressions/min, depth 2-2.4 inches (5-6 cm), full chest recoil, interruptions under 10 seconds.

Two-rescuer child and infant CPR ratio is 15:2; infant compression depth is about 1.5 inches (4 cm), child depth about 2 inches (5 cm).

After an AED shock, resume compressions immediately; do not check a pulse or rhythm first. The AED prompts the next analysis after 2 minutes.

Cardiac arrest epinephrine: 1 mg of 1:10,000 IV/IO every 3-5 minutes.

Refractory VF/pulseless VT: amiodarone 300 mg IV/IO first dose, then 150 mg second dose.

Stable SVT: adenosine 6 mg rapid IV push with flush, then 12 mg if unresolved.

Suspected ACS: aspirin 324 mg chewed (non-enteric coated); nitroglycerin 0.4 mg sublingual every 5 minutes up to 3 doses, holding if SBP is under 90 mm Hg or a PDE5 inhibitor was used recently.

Sudden rise in ETCO2 to 40 mm Hg or more during CPR suggests return of spontaneous circulation; ETCO2 under 10 mm Hg suggests poor compression quality.

Apply a tourniquet 2-3 inches proximal to the wound, not over a joint, and tighten until bleeding stops; record the application time.

Apply a pelvic binder at the level of the greater trochanters, not the iliac crests, for suspected unstable pelvic fracture.

Adult rule of nines: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.

Parkland formula for burns: 4 mL lactated Ringer per kg per %TBSA in 24 hours; give half in the first 8 hours from the time of injury.

Tension pneumothorax signs: unilateral absent breath sounds, distended neck veins, hypotension, and worsening distress; tracheal deviation is late and unreliable.

Head injury: avoid hypoxia and hypotension; a GCS of 8 or less generally requires advanced airway management and ventilation.

Check pulse, motor, and sensory function distal to a fracture before and after splinting.

Prevent hypothermia in trauma: remove wet clothing, cover the patient, and use passive or active warming as available.

Spinal motion restriction: maintain manual stabilization of the head and neck and limit unnecessary movement during packaging and transport.

Anaphylaxis: epinephrine 0.3 mg IM (1:1,000) adult, 0.15 mg IM pediatric, in the lateral thigh; repeat every 5-15 minutes as needed.

Suspected opioid overdose: naloxone 0.4 mg IV/IM or 4 mg intranasal, titrated to adequate respirations rather than full awakening.

Symptomatic hypoglycemia: dextrose 50% 25 g IV; if no IV access, glucagon 1 mg IM.

Bronchospasm: albuterol 2.5 mg nebulized; ipratropium 0.5 mg may be added for severe asthma or COPD exacerbation.

Activated charcoal 1 g/kg (up to 50 g) within 1 hour of certain poisonings only with a protected airway; avoid with caustic and hydrocarbon ingestions.

Cardiogenic pulmonary edema: CPAP plus nitroglycerin if blood pressure allows, with close monitoring for improvement or deterioration.

Organophosphate poisoning: cholinergic signs such as salivation, lacrimation, urination, diarrhea, and bronchoconstriction; treat with atropine and pralidoxime plus decontamination.

Status epilepticus: protect the airway, check glucose, and consider midazolam; do not restrain the patient or place objects in the mouth.

START triage: green (minor) patients can walk; red (immediate) includes respiratory rate above 30, capillary refill over 2 seconds, or inability to follow simple commands.

START categories: red immediate, yellow delayed, green minor, black deceased or expectant.

Helicopter landing zone: at least 100 by 100 feet, clear of debris and power lines, corners marked, and no personnel near the tail rotor.

Hazardous materials: remove patients from the hot zone, decontaminate in the warm zone before transport, and treat in the cold zone with appropriate PPE.

A valid patient refusal requires capacity, informed consent explaining risks, and a signed refusal form; document the patient's statements, vital signs, and witnesses.

Emergency driving: use due regard for public safety, seat belts for all occupants, and a spotter when backing the ambulance.

Handoff communication can use SBAR: situation, background, assessment, recommendation.

Documentation should be objective, timely, and complete, including vital signs, interventions, response to treatment, and any refusal or transfer of care.