NREMT Paramedic cheat sheet

Oropharyngeal airways require an absent gag reflex; nasopharyngeal airways are preferred in the semiconscious patient but are avoided with suspected basilar skull fracture or severe midface trauma.

A bag-valve-mask without a reservoir delivers about 21% oxygen; adding a reservoir with 15 L/min flow raises delivered oxygen to nearly 100%.

Nasal cannula at 1-6 L/min delivers roughly 24-44% oxygen; a nonrebreather at 10-15 L/min delivers 90-100%.

Ventilate an adult with an advanced airway once every 6 seconds (10/min); without an advanced airway use 30:2 for adults and 15:2 for two-rescuer child and infant CPR.

Target tidal volume is 6-7 mL/kg with visible chest rise; excessive volume causes gastric insufflation and raises intrathoracic pressure, reducing venous return.

Waveform capnography is the confirmation standard for endotracheal placement; normal ETCO2 is 35-45 mmHg, and a reading near zero suggests esophageal intubation or dislodgement.

Limit each intubation attempt to 30 seconds and stop if SpO2 falls below 90%; resume bag-valve-mask oxygenation between attempts.

CPAP is indicated for respiratory distress with adequate mental status and blood pressure; it is contraindicated in hypotension, altered mental status, facial trauma, and pneumothorax.

Adult CPR: rate 100-120 per minute, depth 5-6 cm (2-2.4 in), full chest recoil, and interruptions kept under 10 seconds.

Compression-to-ventilation ratio is 30:2 for a single rescuer of any age and for two-rescuer adults; it is 15:2 for two-rescuer child and infant resuscitation.

Defibrillation energy: biphasic 120-200 J per manufacturer recommendation, monophasic 360 J; resume compressions immediately after the shock without a pulse check.

Cardiac arrest pharmacology: epinephrine 1 mg IV/IO of 1:10,000 every 3-5 minutes; amiodarone 300 mg then 150 mg for VF or pulseless VT refractory to shocks.

Adenosine 6 mg rapid IV push followed by 12 mg for stable narrow-complex SVT; avoid in asthma, wide-complex rhythms, and irregular rhythms.

Atropine 1 mg IV every 3-5 minutes to a maximum of 3 mg for symptomatic bradycardia; proceed to transcutaneous pacing if atropine fails.

STEMI criteria: at least 1 mm ST elevation in two contiguous limb leads or at least 2 mm in two contiguous precordial leads; II/III/aVF is inferior, V1-V4 anterior, I/aVL lateral.

Post-ROSC care: titrate oxygen to SpO2 90-98%, target ETCO2 35-45 mmHg, obtain a 12-lead ECG, and provide targeted temperature management at 32-36 C.

Hypotension in a trauma patient is hemorrhagic shock until proven otherwise; control major external bleeding before secondary assessment.

Hemorrhage classes by estimated blood volume loss: I under 15%, II 15-30%, III 30-40%, IV over 40%; class III adds marked hypotension and altered mental status.

Tension pneumothorax is treated with needle decompression at the second intercostal space in the midclavicular line or the fifth intercostal space at the anterior axillary line.

Beck triad of hypotension, distended neck veins, and muffled heart sounds suggests cardiac tamponade; management is rapid transport with cautious fluid resuscitation.

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

Parkland formula: 4 mL x body weight in kg x percent total body surface area burned, with half given in the first 8 hours from the time of injury and the remainder over 16 hours.

Tourniquet placement is 2-3 inches proximal to the wound, never directly over a joint, tightened until hemorrhage stops, with the application time recorded.

Flail chest and open chest wounds: apply a vented occlusive dressing, support ventilation, and reassess frequently for developing tension pneumothorax.

Symptomatic hypoglycemia is a blood glucose below 70 mg/dL; give oral glucose if the patient can swallow, otherwise dextrose IV/IO or glucagon IM.

Anaphylaxis: epinephrine 0.3 mg IM of 1:1000 for adults and 0.15 mg for children in the anterolateral thigh, repeated every 5-15 minutes as needed.

Status epilepticus is continuous seizure activity or repeated seizures without regaining consciousness lasting more than 5 minutes; benzodiazepines are first line.

Stroke: document the last known well time; IV thrombolysis may be given up to 4.5 hours, and transport to the nearest appropriate stroke center.

Cincinnati Prehospital Stroke Scale tests facial droop, arm drift, and abnormal speech; any single abnormal finding makes stroke likely.

Naloxone 2 mg intranasal or 0.4-2 mg IV/IO for opioid-associated respiratory depression, titrated to adequate ventilation rather than full arousal.

Eclamptic seizures in pregnancy are treated with magnesium sulfate IV/IO; monitor for respiratory depression and loss of deep tendon reflexes.

Sepsis is suspected infection with two or more SIRS criteria plus hypotension or elevated lactate; treat with oxygen, IV fluids, and rapid transport.

START triage sorts patients by ability to walk, breathing, perfusion (radial pulse and capillary refill), and mental status, targeting under 30 seconds per patient.

Triage categories: red immediate, yellow delayed, green minor or walking wounded, black deceased or expectant.

Hazmat zones: the hot zone requires chemical protective clothing and specific training; the warm zone is the decontamination corridor; the cold zone is safe for support operations.

ICS span of control is roughly 3-7 subordinates per supervisor; when exceeded, the organization is divided into additional sections or divisions.

Helicopter landing zone: at least 100 by 100 feet, flat, free of debris and overhead wires, and secured from bystanders and vehicles.

Emergency vehicle operation falls under due regard statutes; lights and sirens do not exempt the driver from liability for reckless operation.

A patient refusal requires documented decision-making capacity, an informed consent discussion including risks, and a signed refusal; contact online medical direction when capacity is questionable.

NIMS/ICS principles include unity of command, accountability, and a formal transfer-of-command briefing when leadership changes.