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EMT-Basic NREMT Exam Study Guide

Key concepts, definitions, and exam tips organized by topic.

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Medical Emergencies – EMT-Basic NREMT Exam Study Guide


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Overview


This study guide covers the core medical emergency categories tested on the NREMT EMT-Basic examination, including neurological, metabolic, respiratory, cardiac, anaphylaxis, toxicological, and abdominal emergencies. Mastery of these topics requires understanding not just isolated facts, but the clinical reasoning behind assessment findings and treatment priorities. Each section emphasizes the patient presentations, key interventions, and critical decision points an EMT will encounter in the field and on the exam.


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Altered Mental Status & Neurological Emergencies


Overview

Altered mental status (AMS) is one of the most common and clinically challenging presentations in EMS. The EMT must quickly identify life-threatening causes and prioritize interventions accordingly.


Key Concepts


AEIOU-TIPS Mnemonic – The framework for identifying causes of AMS:

  • • A – Alcohol
  • • E – Epilepsy
  • • I – Insulin (hypoglycemia/hyperglycemia)
  • • O – Opiates
  • • U – Uremia (kidney failure)
  • • T – Trauma
  • • I – Infection
  • • P – Psychiatric
  • • S – Stroke/Seizure

    • Stroke Assessment


    Cincinnati Prehospital Stroke Scale (CPSS) evaluates three components:

    1. Facial Droop – Ask patient to smile; one side drooping is abnormal

    2. Arm Drift – Arms extended forward with eyes closed; one arm drifting downward is abnormal

    3. Abnormal Speech – Slurred, incorrect words, or inability to speak


    > Any single abnormal finding = suspect stroke


    Priority Action for Stroke:

  • • Perform rapid stroke assessment
  • • Establish exact time of symptom onset (critical for thrombolytic eligibility)
  • • Transport immediately to a designated stroke center
  • • Do NOT delay transport for on-scene interventions

    • Seizure Management


    | Phase | EMT Action |

    |---|---|

    | Active tonic-clonic | Protect from injury, move hard objects, maintain airway, O₂ |

    | Postictal | Place in recovery position, monitor airway, reassess |

    | Status epilepticus | Rapid transport, continuous airway management |


    Key Definitions:

  • • Postictal State – Period of decreased responsiveness, confusion, and exhaustion following a seizure; typically lasts minutes to 30 minutes
  • • Status Epilepticus – Seizure lasting >30 minutes OR two or more seizures without return to full consciousness between them

    • Key Terms

  • • Hemiplegia – Paralysis on one side of the body
  • • Aphasia – Impaired ability to speak or understand language
  • • Tonic-clonic – Seizure phase with muscle rigidity followed by rhythmic jerking
  • • Postictal – Post-seizure recovery phase
  • • Thrombolytic therapy – Clot-dissolving medication; time-sensitive for stroke treatment

    • ⚠️ Watch Out For

  • • Never place anything in a seizing patient's mouth – this is a classic wrong-answer trap
  • • Never restrain a seizing patient – guide limbs away from hazards only
  • • Do not assume AMS is "just intoxication" – always rule out other causes (glucose, trauma, stroke)
  • • Time of stroke symptom onset = when patient was last known well, not when found

    • ---


    Diabetic & Metabolic Emergencies


    Overview

    Diabetic emergencies are extremely common in the field and heavily tested on the NREMT. The EMT must distinguish between hypoglycemia and hyperglycemia, as their presentations and treatments differ significantly.


    Hypoglycemia vs. Hyperglycemia


    | Feature | Hypoglycemia | Hyperglycemia/DKA |

    |---|---|---|

    | Onset | Rapid (minutes) | Slow (hours to days) |

    | Skin | Pale, cool, diaphoretic | Warm, dry, flushed |

    | Breathing | Normal | Kussmaul (deep, rapid) |

    | Breath odor | Normal | Fruity/acetone |

    | Mental status | Confused, anxious, combative | Lethargic, gradual decline |

    | Blood glucose | <70 mg/dL | >200–300+ mg/dL |

    | Other signs | Shakiness, hunger | Polydipsia, polyuria |


    Oral Glucose Administration


    Three criteria must ALL be met:

    1. Patient has a history of diabetes

    2. Patient is conscious with an intact gag reflex

    3. Patient is able to swallow


    > Never administer oral glucose to an unconscious or unresponsive patient – aspiration risk


    Diabetic Ketoacidosis (DKA)


  • • Occurs primarily in Type 1 diabetes
  • • Caused by insulin deficiency leading to ketone buildup and metabolic acidosis
  • • Hallmark breathing: Kussmaul respirations – deep, rapid, labored breathing as the body attempts to blow off CO₂ to compensate for acidosis
  • • EMT treatment: supportive care, high-flow O₂, rapid transport

    • Key Terms

  • • Hypoglycemia – Blood glucose <70 mg/dL
  • • Hyperglycemia – Elevated blood glucose
  • • DKA (Diabetic Ketoacidosis) – Life-threatening acidosis from insulin deficiency and ketone accumulation
  • • Kussmaul respirations – Deep, rapid, labored breathing pattern associated with metabolic acidosis
  • • Gag reflex – Protective reflex that prevents aspiration; must be intact before giving oral glucose

    • ⚠️ Watch Out For

  • • A diabetic patient who is combative or altered may be hypoglycemic – check glucose before assuming psychiatric cause
  • • Fruity breath + Kussmaul respirations = DKA (hyperglycemia), NOT hypoglycemia
  • • Oral glucose is contraindicated even in a patient with depressed mental status, even if they have a history of diabetes

    • ---


    Respiratory Emergencies


    Overview

    Respiratory emergencies range from mild bronchospasm to complete airway failure. The EMT must rapidly distinguish upper from lower airway problems and recognize signs of impending respiratory failure.


    Breath Sound Differentiation


    | Sound | Timing | Location | Cause |

    |---|---|---|---|

    | Wheezing | Expiratory | Lower airways | Asthma, bronchospasm, COPD |

    | Stridor | Inspiratory | Upper airway | Croup, foreign body, epiglottitis, anaphylaxis |

    | Crackles/Rales | Inspiratory | Alveoli | Pulmonary edema, pneumonia |

    | Absent ("silent chest") | None | Throughout | Severe asthma – critical finding |


    Spontaneous Pneumothorax

  • • Definition: Accumulation of air in the pleural space without trauma, causing lung collapse
  • • Classic patient: Tall, thin young male; or patients with COPD/emphysema
  • • Signs: Sudden chest pain, decreased breath sounds on affected side, respiratory distress

    • COPD and Oxygen Administration

  • • The hypoxic drive concern (fear of suppressing respirations with O₂ in COPD patients) is often overemphasized
  • • Priority is always correcting hypoxia – a hypoxic patient needs oxygen
  • • Target SpO₂: 94–98% – titrate and monitor closely
  • • Never withhold oxygen from a patient in respiratory distress

    • Metered-Dose Inhaler (MDI) Assistance


    Steps for assisting with MDI:

    1. Confirm prescription belongs to this patient

    2. Obtain medical direction per local protocol

    3. Shake the inhaler well

    4. Have patient exhale fully

    5. Patient takes slow, deep inhalation while actuating the inhaler

    6. Patient holds breath for 10 seconds

    7. Reassess breath sounds and SpO₂


    Signs of Severe Asthma / Impending Respiratory Failure


  • • Silent chest (absent breath sounds) – most ominous sign
  • • Inability to speak in full sentences
  • • Cyanosis
  • • SpO₂ < 90%
  • • Severe accessory muscle use
  • • Altered mental status

    • Key Terms

  • • Wheezing – Lower airway obstruction sound
  • • Stridor – Upper airway obstruction sound
  • • Pneumothorax – Air in the pleural space
  • • SpO₂ – Oxygen saturation measured by pulse oximetry
  • • Silent chest – Absent breath sounds in asthma; indicates air trapping and critical status
  • • Accessory muscle use – Use of neck and intercostal muscles to breathe; indicates increased work of breathing

    • ⚠️ Watch Out For

  • • Stridor = upper airway problem (think neck/throat); Wheezing = lower airway (think lungs/bronchi)
  • • A silent chest in an asthma patient is NOT reassuring – it means air is trapped and the patient is exhausted
  • • MDI assistance requires medical direction and confirmation the medication belongs to the patient
  • • Do not confuse spontaneous pneumothorax (no trauma) with tension pneumothorax (traumatic, with tracheal deviation and JVD)

    • ---


    Cardiac Emergencies


    Overview

    Cardiac emergencies are a leading cause of death and a major focus of NREMT testing. EMTs must recognize AMI presentations (including atypical ones), understand AED use, and know when and how to assist with aspirin administration.


    Acute Myocardial Infarction (AMI)


    Classic Presentation:

  • • Crushing/squeezing chest pain
  • • Radiation to left arm, jaw, or shoulder
  • • Diaphoresis, nausea, dyspnea, anxiety

    • Atypical Presentations (commonly tested):

  • • Women: fatigue, jaw pain, nausea, epigastric pain
  • • Diabetics: may have silent MI (no chest pain) due to neuropathy
  • • Elderly: weakness, shortness of breath

    • Aspirin Administration


  • • Dose: 160–325 mg chewed (not swallowed whole) for rapid antiplatelet effect
  • • Contraindications:

    • - Known aspirin allergy

    - Active GI bleeding

    - Unable to swallow


    Cardiogenic Shock


    Definition: Circulatory failure from the heart's inability to pump adequately


    Distinguishing Features (the "wet" shock):

  • • JVD (jugular venous distension) – backed-up blood
  • • Pulmonary edema – wet, crackly lungs
  • • Hypotension – despite adequate volume
  • • Contrast with hypovolemic shock which has flat neck veins and dry lungs

    • AED Use – Modifications and Contraindications


    | Situation | Action |

    |---|---|

    | Patient <1 year old | Do NOT use AED |

    | Ages 1–8 | Use pediatric pads/attenuator if available |

    | Medication patch present | Remove patch, wipe skin, then apply pads |

    | Standing water | Move patient to dry area first |

    | Pacemaker/ICD implant site | Place pads at least 1 inch away from device |


    Pulseless Electrical Activity (PEA)


  • • Definition: Organized cardiac rhythm on monitor + no palpable pulse
  • • Why no defibrillation? Electrical system is functioning; problem is mechanical pump failure
  • • Treatment: High-quality CPR + identify and treat reversible causes (H's and T's)

    • H's and T's (Reversible Causes of Cardiac Arrest):


    | H's | T's |

    |---|---|

    | Hypovolemia | Tension pneumothorax |

    | Hypoxia | Tamponade (cardiac) |

    | Hydrogen ion (acidosis) | Toxins |

    | Hypo/Hyperkalemia | Thrombosis (pulmonary) |

    | Hypothermia | Thrombosis (coronary/AMI) |


    Key Terms

  • • AMI – Acute Myocardial Infarction; heart attack
  • • Cardiogenic shock – Shock from pump failure
  • • JVD – Jugular venous distension; sign of right heart failure or tamponade
  • • PEA – Pulseless Electrical Activity
  • • Defibrillation – Delivery of shock to terminate shockable rhythms (V-fib, pulseless V-tach)
  • • AED – Automated External Defibrillator

    • ⚠️ Watch Out For

  • • Atypical AMI presentations are a common test trap – especially in women and diabetics
  • • Aspirin must be chewed, not swallowed whole, for rapid antiplatelet effect
  • • PEA does NOT respond to defibrillation – recognizing this is critical
  • • JVD + hypotension + absent breath sounds = tension pneumothorax (not cardiogenic shock)
  • • JVD + hypotension + muffled heart sounds = cardiac tamponade (Beck's Triad)

    • ---


    Anaphylaxis & Allergic Reactions


    Overview

    Anaphylaxis is a rapidly progressive, life-threatening systemic allergic reaction. Early recognition and immediate epinephrine administration are lifesaving. The distinction between a severe allergic reaction and true anaphylaxis is clinically and legally important.


    Allergic Reaction vs. Anaphylaxis


    | Feature | Allergic Reaction | Anaphylaxis |

    |---|---|---|

    | Airway | Intact | Stridor, swelling, bronchospasm |

    | Circulation | Stable | Hypotension, shock |

    | Systemic involvement | Local/limited | Multi-system, life-threatening |

    | Epinephrine required? | No (unless progressing) | Yes – immediately |


    > Anaphylaxis = airway compromise AND/OR circulatory collapse


    Epinephrine Mechanism of Action


    | Receptor | Effect | Clinical Benefit |

    |---|---|---|

    | Alpha-1 | Vasoconstriction | Reverses hypotension |

    | Beta-2 | Bronchodilation | Relieves bronchospasm |

    | Also | Stabilizes mast cells | Reduces histamine release |


    Epinephrine Auto-Injector Administration


  • • Adult dose: 0.3 mg epinephrine 1:1,000
  • • Pediatric dose (<30 kg): 0.15 mg
  • • Site: Anterolateral (outer mid-) thigh
  • • Can be administered through clothing
  • • Hold in place per manufacturer instructions (~10 seconds)
  • • Reassess and repeat per protocol if no improvement

    • Clinical Scenario – Throat Tightness After Bee Sting


    > Hives + throat tightness = anaphylaxis (throat tightness = impending airway compromise)


    Treatment priority:

    1. Administer epinephrine auto-injector immediately

    2. High-flow oxygen

    3. Position appropriately (supine if hypotensive)

    4. Rapid transport


    Key Terms

  • • Anaphylaxis – Systemic life-threatening allergic reaction with airway or circulatory involvement
  • • Epinephrine – First-line treatment for anaphylaxis
  • • Urticaria – Hives; localized allergic skin response
  • • Bronchospasm – Constriction of bronchial smooth muscle causing wheezing
  • • Mast cell degranulation – Release of histamine and other mediators triggering allergic response

    • ⚠️ Watch Out For

  • • Throat tightness alone = anaphylaxis – do not wait for wheezing or hypotension to develop
  • • Epinephrine is given in the outer thigh, not the arm or buttocks
  • • Do not withhold epinephrine because the patient "only has hives" if any airway involvement exists
  • • Epinephrine's effects are temporary – these patients must be transported even if they feel better

    • ---


    Poisoning & Overdose


    Overview

    Toxicological emergencies require the EMT to recognize toxidromes (clusters of signs/symptoms associated with specific substance classes), prioritize airway management, and contact Poison Control or medical direction.


    Opioid Overdose


    Classic Triad:

    1. Pinpoint pupils (miosis)

    2. **

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