NREMT cheat sheet

Adult resting rate 12-20/min; pediatric higher (infant 30-60/min); a rate under 8 or over 30 in an adult signals inadequate ventilation and need for assisted breathing.

Tidal volume formula: 6-8 mL/kg ideal body weight for lung-protective ventilation; a bag-valve-mask delivers roughly 500-600 mL to an adult when squeezed with one hand.

Oropharyngeal airway is measured from the corner of the mouth to the earlobe or angle of the jaw; it is only for patients without a gag reflex.

Nasopharyngeal airway is measured from the nostril tip to the earlobe; it is contraindicated with suspected basilar skull fracture or severe midface trauma.

Signs of inadequate breathing: rate outside normal, shallow depth, absent or minimal chest rise, cyanosis, accessory muscle use, and altered mental status.

Pulse oximetry SpO2 below 94% indicates hypoxemia; 90-94% is a warning zone; below 90% is critical and warrants oxygen and reassessment.

For a patient with inadequate ventilation, positive-pressure ventilation with a BVM is the priority before supplemental oxygen alone; oxygen without ventilation does not correct hypoventilation.

Suctioning should not exceed 10-15 seconds per attempt in an adult; preoxygenate and monitor SpO2 and heart rate during suctioning.

Adult CPR: compression rate 100-120/min, depth at least 2 inches (5 cm) but not more than 2.4 inches (6 cm), full recoil, minimal interruptions.

Adult compression-to-ventilation ratio is 30:2 for one or two rescuers; for pediatric patients with two rescuers it is 15:2.

Defibrillation energy for adult biphasic AED is typically 120-200 J; the device selects the dose; resume compressions immediately after the shock.

AED sequence: power on, attach pads, clear the patient, analyze, shock if advised, then immediately resume CPR for 2 minutes before reanalysis.

Symptomatic bradycardia with a pulse: atropine 1 mg IV every 3-5 minutes, maximum 3 mg; if ineffective, transcutaneous pacing or a dopamine/epinephrine infusion.

For suspected acute coronary syndrome: aspirin 162-325 mg chewed (if no allergy), nitroglycerin for chest pain with systolic BP above 100 mmHg, and oxygen only if SpO2 is below 94%.

Cardiac arrest with shockable rhythm (VF/pulseless VT): defibrillate, then CPR, then epinephrine 1 mg IV/IO every 3-5 minutes; amiodarone after the second or third shock.

A heart rate under 60/min with signs of poor perfusion (hypotension, altered mental status, chest pain) is symptomatic bradycardia requiring treatment, not observation.

Primary survey sequence: catastrophic hemorrhage control, airway, breathing, circulation, disability, exposure (ABC plus hemorrhage control first).

Control life-threatening external bleeding with direct pressure, wound packing, and a tourniquet placed 2-3 inches above the wound, not over a joint.

Signs of tension pneumothorax: unilateral absent breath sounds, tracheal deviation away from the affected side, severe respiratory distress, and hypotension; treat with needle decompression.

Signs of hypovolemic shock: tachycardia, narrow pulse pressure, cool clammy skin, delayed capillary refill, and altered mental status; hypotension is a late sign.

Suspected pelvic fracture: apply a pelvic binder at the level of the greater trochanters; do not repeatedly log-roll the patient.

Suspected spinal injury: maintain manual in-line stabilization and apply a cervical collar; immobilize on a long board or vacuum mattress for transport.

Burns: estimate body surface area with the Rule of Nines (head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%).

Head injury with altered mental status: maintain SpO2 at or above 94% and systolic BP at or above 90 mmHg; avoid hypoxia and hypotension, which worsen outcomes.

Anaphylaxis: epinephrine 0.3-0.5 mg IM (1:1000) in the anterolateral thigh; repeat every 5-15 minutes as needed; adjuncts include antihistamines and albuterol.

Hypoglycemia: check blood glucose; if the patient can swallow, give oral glucose; if not, glucagon IM or IV dextrose per protocol; reassess mental status.

Status epilepticus is a seizure lasting more than 5 minutes or repeated seizures without regaining consciousness; support airway and consider benzodiazepines per protocol.

Opioid overdose: pinpoint pupils, respiratory depression, and altered mental status; give naloxone and support ventilation, since naloxone may not restore breathing alone.

Asthma exacerbation: albuterol by nebulizer or MDI, ipratropium for severe cases, and corticosteroids per protocol; watch for silent chest, which signals impending failure.

Stroke: use the Cincinnati Prehospital Stroke Scale (facial droop, arm drift, abnormal speech); note the last known well time and transport to a stroke center.

Suspected sepsis: fever or hypothermia, tachycardia, tachypnea, and altered mental status; provide oxygen, IV fluids per protocol, and rapid transport.

Poisoning or overdose: identify the substance, time, and amount; contact poison control; do not induce vomiting; treat ABCs and specific antidotes per protocol.

Normal labor: contractions every 2-3 minutes lasting 45-60 seconds with urge to push; if the head is crowning, prepare for delivery at the scene.

Delivery sequence: support the perineum, guide the head, check for a nuchal cord and slip it over the head, deliver the shoulders, then the body; dry and warm the newborn.

Newborn assessment: dry, warm, stimulate, and suction only if needed; APGAR scored at 1 and 5 minutes on appearance, pulse, grimace, activity, respiration.

Newborn CPR: compression-to-ventilation ratio 3:1, rate about 100-120 compressions/min, with a compression depth of about one-third of the chest diameter.

Postpartum hemorrhage: uterine massage, fundal pressure, and oxytocin per protocol; a boggy uterus with heavy bleeding is the most common cause.

Eclampsia: seizures in a pregnant patient with hypertension; treat with magnesium sulfate per protocol, protect the airway, and transport rapidly.

Ectopic pregnancy should be suspected in a woman of childbearing age with abdominal pain, missed period, and signs of shock; treat as a hemorrhage emergency.

Prolapsed umbilical cord: place the patient in a knee-chest or Trendelenburg position, keep the cord warm and moist, and do not attempt to push the cord back in.

Scene size-up: identify hazards, number of patients, need for additional resources, and mechanism of injury before patient contact.

Standard precautions: gloves, eye protection, and a mask for any patient with possible blood or body fluid exposure; hand hygiene after every contact.

Triage categories: red (immediate), yellow (delayed), green (minor), black (deceased or expectant); use the START method for mass-casualty incidents.

Radio report structure: identify unit, patient age and sex, chief complaint, vital signs, interventions, and destination or ETA.

Documentation must record objective findings, times, interventions, and patient response; if it was not documented, it is assumed not to have been done.

Vehicle and equipment checks are performed at the start of each shift; defibrillator, oxygen, and suction must be verified functional.

Refusal of care requires the patient to be alert and oriented, informed of risks, and to sign the refusal; document the assessment and the advice given.

Infection control after a needlestick: wash the site with soap and water, report immediately, and follow the exposure control plan for testing and prophylaxis.

Scene size-up, then primary assessment (general impression, mental status, airway, breathing, circulation), then secondary assessment and reassessment.

Vital signs: adults 12-20 breaths/min, pulse 60-100/min, BP about 120/80 mmHg, SpO2 at or above 94%; record the time of each set.

OPQRST for pain: onset, provocation/palliation, quality, region/radiation, severity, time; use it for the chief complaint.

SAMPLE history: signs and symptoms, allergies, medications, past medical history, last oral intake, events leading to the injury or illness.

AVPU mental status: alert, verbal response, painful response, unresponsive; any level below alert is a red flag requiring reassessment.

Reassessment intervals: every 5 minutes for unstable patients and every 15 minutes for stable patients; repeat vital signs and the focused exam.

Focused exam for a medical patient targets the chief complaint; for trauma, perform a rapid head-to-toe scan and look for hidden bleeding.

Pediatric assessment triangle: appearance, work of breathing, and circulation to skin; it is used before touching the child to judge severity quickly.

Treat the patient, not the monitor: if the reading conflicts with the patient's appearance, reassess the patient and the equipment.

Prioritize threats to airway, breathing, and circulation before secondary problems; a patent airway with inadequate breathing still requires ventilation.

When in doubt, transport: a deteriorating patient or one with an unclear presentation should be moved toward definitive care early.

Reassessment after every intervention: confirm the intended effect, watch for adverse effects, and document the response.

Recognize the limits of the scope of practice; request ALS intercept or additional resources when the patient's needs exceed the available equipment or training.

Consider differential diagnoses from mechanism, history, and exam findings; do not anchor on the first impression, and revise as new findings appear.

A patient who is improving may still deteriorate; maintain monitoring and do not downgrade the level of care based on a single normal reading.

Communication with receiving facilities: give a concise report of findings, interventions, and response so the team can prepare before arrival.