INTRODUCTION

The purpose of this course is to prepare you for the National Registry of Emergency Medical

Technicians (NREMT) Paramedic Examination—the test that must be taken as part of the paramedic certification process. This course includes clinical and nonclinical information you must know in order to pass the test, with an emphasis on clinical care in the practice of EMS. The test is the most advanced examination taken by emergency medicine personnel, which is reflected in an increased complexity over other NREMT examinations.

Chapter one focuses on normal cell physiology, normal acid-base physiology, and acid base

disorders. Understanding cell physiology as an EMT-Paramedic is necessary because cells are the building blocks of the body and make up every physiological response that happens in the

body. An example of this is acid base disorders. This chapter discusses acid-base physiology and disorders involving acids, bases, and the pH of the blood.

Chapter two involves a discussion about shock. While shock is considered a situation of low

blood pressure for various reasons, including sepsis and hypovolemia, it is actually a great deal more than that. Shock decreases the tissue perfusion to major organs, leading to metabolic

acidosis and acute end-organ failure. The treatment of shock must take place as soon as it is identified in order to prevent tissue hypoxia, permanent end organ damage, and death from multiple organ failure.

The subjects of chapter three are the drugs used by paramedics in the EMS system, which can be given by any number of routes, as well as intravenous and intraosseous lines. What’s unique to paramedics versus other EMS personnel is that the paramedic can give a wide variety of medications, including medications given intravenously. The paramedic must know the basics of starting an intravenous line, the different types of intravenous fluids given, and the purpose of an intraosseous line. These things are all covered in this chapter.

Chapter four is about airway management, which is one of the most important aspects of EMS. This is because the assessment and management of the patient’s airway is paramount to their survival. Without adequate evaluation and treatment of airway concerns, few other aspects of patient care will help the patient survive. The chapter discusses airway evaluation, ventilation concerns, airway adjuncts used by EMS, and procedures for intubating patients who require total airway support.

Dyspnea or “shortness of breath” and its management is the topic of chapter five. This is a common complaint, affecting about eight percent of all patients seen in the emergency department. In half of these situations, dyspnea is the patient’s primary concern. For this reason, it is important to know the differential diagnosis of dyspnea as well as some common interventional strategies the paramedic needs to implement for those patients presenting with this symptom.

The focus of chapter six is the evaluation of chest pain and the management of acute coronary syndrome. These are things that the paramedic commonly encounters in the EMS setting. The

chapter covers the evaluation of chest pain in general (as not all chest pain is cardiac in nature) as well as the management of acute coronary syndrome (ACS), which is a medical emergency for which the interventions begin in the field by the paramedic and EMS team.

Chapter seven talks about the management of cardiac arrhythmias in EMS practice. Individuals will present with cardiac arrhythmias as the primary complaint with a variety of presentations. As a prehospital provider, the paramedic should be able to recognize the different arrhythmias and their presentations and should be able to initiate interventional strategies in keeping with current Advanced Cardiac Life Support (ACLS) protocols.

The subject of chapter eight is medical emergencies. A paramedic handles emergencies from all

areas of medicine on a daily basis. This chapter focuses mainly on internal medicine emergencies, from neurological disorders that present emergently to things like endocrine,

immunologic, infectious disease, and toxicologic emergencies, among others. Each of these is

important to cover because of the numerous possible medical presentations that can await the paramedic as part of their everyday job.

Chapter nine covers several different gynecological emergencies a paramedic might encounter.

These include early pregnancy complications, such as ectopic pregnancy and miscarriage, as well as the general topic of vaginal bleeding. Sexual assault represents a special kind of gynecological emergency in which there are medical, psychosocial, and legal concerns. The paramedic who handles sensitive cases related to female gynecological emergencies needs to manage these women on multiple levels of care.

The focus of chapter ten is the emergency medical technician’s care of the pregnant patient, including pre-delivery obstetrical emergencies, the normal delivery process, and obstetrical emergencies. When caring for the pregnant patient, particularly one who delivers in the EMS setting, there are two patients to manage. For this reason, the process of newborn resuscitation is also covered in this chapter.

Chapter eleven covers mass casualty incidents, triage, and incident management. All paramedics are likely to train for and be prepared for a mass casualty incident, in which the resources available cannot keep up with the number of casualties. In such a situation, triage is important in order to care for the greatest number of patients with the fewest resources, keeping in mind that the sickest or most injured patients often are not treated first. Incident management involves what the EMS system does in the aftermath of significant or traumatic incidents to help maintain the health and wellbeing of the EMS worker.

Chapter twelve discusses the paramedic and trauma management. In a trauma situation, there may be a single area of the body affected, such as head or chest trauma; however, many times, the patient will have multiple body areas at the same time at risk for trauma. This chapter covers the different areas where trauma might be experienced as well as the management of burns that can affect any area of the body.

The focus of chapter thirteen is the care of special populations. Not all patients a paramedic

will care for are adults so the special needs of infants and children care are covered, including

the important differences in vital signs and medical management of children versus adults. The geriatric population deserves special attention as well. Older adults have complex medical histories and some do not want aggressive care should they suffer medical decompensation.