NREMT Clinical Judgment Flashcards

Question 1

Rescue device after failed intubation

Accepted Answer

Stop repeated attempts in a desaturating patient → supraglottic airway. Surgical airway only when cannot oxygenate by any means.

Question 2

Pressure overshoots after a trauma bolus and bleeding restarts?

Accepted Answer

Slow fluid to keep-open; the higher pressure broke the clot. Resume only if endpoints are lost.

Question 3

Dialysis patient: bradycardia, weak, wide QRS

Accepted Answer

Assume hyperkalemia. Calcium first to stabilize the membrane; pacing may fail to capture until potassium is addressed. Look for peaked T waves, lost P waves, wide QRS.

Question 4

Glucose corrected but still altered?

Accepted Answer

Look for another cause: stroke, head injury, infection, toxins. More dextrose is not the fix.

Question 5

Why you never slow the breathing in ketoacidosis

Accepted Answer

The deep, fast pattern is respiratory compensation holding the pH up. Blunt it and the acidosis wins. Treat the volume deficit, not the rate.

Question 6

Anterior STEMI + hypotension + crackles

Accepted Answer

Cardiogenic shock. Hold nitrates, avoid large fluid boluses, support oxygenation (CPAP with caution), consider a vasopressor, and notify early for reperfusion.

Question 7

ETCO2 during and after arrest

Accepted Answer

During CPR: <10 → improve compressions. Abrupt sustained rise → probable ROSC. After ROSC: sudden fall → check pulse (re-arrest). Low with fast bagging → hyperventilation.

Question 8

CPAP in pulmonary edema — when to stop

Accepted Answer

Falling mental status, falling respiratory rate or effort, vomiting, or hypotension. CPAP needs the patient's own drive — failure means assisted ventilation.

Question 9

Right diagnosis, incomplete diagnosis

Accepted Answer

The treatment worked and the patient still does not add up? You were right about the finding and wrong about stopping. Ask what produced it — infection behind a hypoglycemia, a stroke behind a corrected glucose.

Question 10

Common stroke mimics

Accepted Answer

Hypoglycemia, postictal (Todd's) paralysis, complex migraine, sepsis/infection, intoxication. Correct the reversible cause, then reassess; a persisting deficit still means stroke workup.

Question 11

Pain that suddenly disappears

Accepted Answer

After hours of severe pain, sudden relief with a rising pulse and cool skin is perforation or dead tissue, not recovery. Read the perfusion findings, not the patient's relief.

Question 12

Low ETCO2 with hypotension, no arrest

Accepted Answer

ETCO2 falls when cardiac output falls: massive PE, hemorrhage, septic shock, as well as hyperventilation. Low ETCO2 plus hypotension is a perfusion warning, not just 'breathing fast'.

Question 13

Anticholinergic vs cholinergic

Accepted Answer

Anticholinergic = DRY, dilated, hot, fast. Cholinergic = WET everywhere, constricted, slow. Mirrors.

Question 14

Postpartum preeclampsia

Accepted Answer

Can appear up to about 6 weeks after delivery. Severe headache + visual change + high BP = seizure risk. Low stimulation, transport.

Question 15

The cue that separates pulmonary embolism from pneumonia

Accepted Answer

Sudden onset, clear lungs, no fever, hypoxia that oxygen barely improves — plus a source such as a swollen calf or recent immobility. Pneumonia builds over days, with fever and focal crackles.

Question 16

Beta-blocker + older trauma patient: HR 76, BP 104?

Accepted Answer

Possible shock — the medicine blunts the rate and 104 may be low for a hypertensive baseline.

Question 17

Anchoring on the dispatch complaint

Accepted Answer

Dispatch is a caller's interpretation over a telephone. Build your impression from your own findings, ask what is different about today, and name the worst condition that fits.

Question 18

Why a hypotensive anaphylaxis patient must not stand or sit up suddenly

Accepted Answer

Blood pools in dilated vessels; sudden upright posture can empty the heart and cause arrest. Keep supine, legs raised, and lift to the stretcher.

Question 19

Exertional heat stroke priority

Accepted Answer

Cool first (cold water immersion), transport second. Sweating does not rule it out.

Question 20

Smoke exposure — oximetry trap

Accepted Answer

Pulse oximeter reads carboxyhemoglobin as oxygenated: falsely normal SpO2. Give high-concentration O2. Altered + hypotensive + tachypneic despite O2 → consider cyanide.

Question 21

Postpartum hemorrhage: blood pressure improves after a bolus — is it fixed?

Accepted Answer

No. Fluid buys time but does not contract the uterus. Continue fundal massage, encourage breastfeeding and transport.

Question 22

Early warning of respiratory failure in ascending neuromuscular weakness

Accepted Answer

Weak cough, short single-breath count, weak voice, rising end-tidal CO2. SpO2 stays normal until late — do not let it reassure you.

Question 23

ROSC achieved: oxygen, CO2 and pressure goals

Accepted Answer

SpO2 92–98% (avoid hypoxia and hyperoxia), ETCO2 35–45, SBP at least 90 and MAP at least 65, 12-lead ECG, check glucose, treat the cause. Avoid hyperventilation.

Question 24

Low SpO2 but normal ETCO2 in a dyspneic patient

Accepted Answer

An oxygenation problem, not a ventilation one: V/Q mismatch or shunt (pneumonia, edema, PE). High ETCO2 would point to ventilatory failure needing assisted breaths.

Question 25

Rising CO2 with falling consciousness

Accepted Answer

Ventilatory failure. Oxygen cannot fix it — assist ventilations.

Question 26

Sepsis in the older adult

Accepted Answer

Fever may be absent; hypothermia is possible. New confusion + tachypnea + soft BP = screen positive. Isotonic boluses with reassessment; pressor if hypotension persists (paramedic).

Question 27

Head injury, no herniation signs, ETCO2 27?

Accepted Answer

Overventilated. Slow the rate to a normal ETCO2 — low CO2 cuts cerebral blood flow.

Question 28

Compensated shock in a child

Accepted Answer

Normal blood pressure is EXPECTED until compensation fails, then it falls suddenly. Treat the rate, the refill and the mottling you already have.

Question 29

Search satisficing

Accepted Answer

Stopping the search once one explanation turns up. Fix: finish the full exam even after the first finding.

Question 30

What Clinical Judgment items actually test

Accepted Answer

The facts are given and not in dispute. The question is which cue changes the impression, which problem is treated first, and whether the intervention addresses the cause or the number.

Question 31

Kussmaul breathing in DKA

Accepted Answer

Compensation for acidosis. Never coach it slower; if ventilating, match the patient's high rate.

Question 32

Signs an IO has infiltrated — and what to do

Accepted Answer

Swelling and firmness around the site, slowed flow. Stop the infusion, remove the needle and use a different bone (never the same bone again).

Question 33

Anaphylaxis relapse

Accepted Answer

Return of symptoms = repeat epinephrine + isotonic fluid. Refractory = epinephrine infusion (paramedic). Biphasic reaction can occur hours later without re-exposure.

Question 34

Fluid target in hemorrhage without head injury

Accepted Answer

Titrate isotonic crystalloid to a palpable radial pulse and improved mentation, not a normal BP.

Question 35

Last known well vs time of discovery

Accepted Answer

Stroke onset is the last moment the patient was seen normal. Wake-up stroke = bedtime, not discovery. Never average or guess; report exactly what is known.

Question 36

CPAP contraindications

Accepted Answer

Hypotension · vomiting · can't follow commands/protect airway · suspected pneumothorax · apnea or inadequate drive · facial trauma preventing a seal.

Question 37

Heat stroke cooling endpoint?

Accepted Answer

Stop active cooling near 39°C (102°F) to avoid overshoot. Cool first, transport second.

Question 38

Hypoglycemia on an oral sulfonylurea

Accepted Answer

Long-acting drug: glucose may drop again hours after correction. Strongly encourage transport; recurrent hypoglycemia is a real risk and not a safe refusal.

Question 39

How late after delivery can eclampsia occur?

Accepted Answer

Up to about six weeks postpartum, most often in the first days. Headache, visual change or a seizure in a recent mother = eclampsia until proven otherwise.

Question 40

Closed loop: the three steps of an order

Accepted Answer

Sender gives the order → receiver repeats it back → receiver reports when it is done.

Question 41

When the monitor and the patient disagree

Accepted Answer

The patient wins. A rhythm that cannot hold a conversation is not the rhythm a talking patient is in — check the leads and the pulse before you treat a tracing.

Question 42

Contraindications to an IO site

Accepted Answer

Fracture of that bone (or the bone above), a prior IO in that bone, infection or burn over the site, and a nearby joint replacement.

Question 43

Wheezing stops but the asthmatic is worse

Accepted Answer

A 'silent chest' means almost no air movement: impending arrest. Expect rising ETCO2, fatigue and altered mentation. Assist ventilation with slow rate and long exhalation.

Question 44

Potassium in DKA on the monitor

Accepted Answer

Acidosis shifts K+ out of cells: serum high, total body low. Peaked T/wide QRS = hyperkalemia; flat T/U waves = hypokalemia as treatment moves K+ back in.

Question 45

Eclampsia — agent and toxicity

Accepted Answer

Magnesium sulfate stops and prevents eclamptic seizures. Toxicity: lost reflexes → sedation → respiratory depression. Stop infusion, ventilate, calcium is the antagonist.

Question 46

Symptomatic bradycardia — what makes it 'symptomatic'?

Accepted Answer

Hypoperfusion caused by the slow rate: hypotension, altered mental status, ischemic chest pain, acute heart failure or shock. A slow rate without these is watched, not treated.

Question 47

Older adult — hidden emergencies

Accepted Answer

Beta-blockers mask tachycardia. Sepsis often afebrile, presents as acute confusion. Pain out of proportion + AF → mesenteric ischemia. Ask why they fell.

Question 48

Capnography waveform suddenly flat after moving a patient with a supraglottic airway

Accepted Answer

Suspect displacement or disconnection first: check the device, connections and chest rise at once, then a pulse.

Question 49

Why a 99% saturation can mislead

Accepted Answer

It measures oxygenation, not ventilation. On oxygen, CO2 can climb while the number stays perfect.

Question 50

Lethal triad of trauma

Accepted Answer

Hypothermia + acidosis + coagulopathy. Interrupt: control bleeding, keep warm, warmed fluid only as needed, avoid large crystalloid volumes.

Question 51

Hyperactive delirium red flag

Accepted Answer

Extreme agitation + hyperthermia: sudden calm or quiet may precede arrest. Sedate, cool, keep supine never prone, and check breathing and pulse at once.

Question 52

Assisting a patient who is still breathing with a bag-valve mask

Accepted Answer

Squeeze as the patient begins to inhale; add breaths between theirs if effort is inadequate. Each breath over about one second, just to visible chest rise.

Question 53

When the cuff and the patient disagree

Accepted Answer

Confirm by a second method before acting. A machine reading that contradicts warm skin, a strong radial pulse and clear mentation is a measurement problem until a manual pressure agrees.

Question 54

Fast sinus rhythm: treat the rhythm or the cause?

Accepted Answer

Sinus tachycardia matching fever, pain, hypovolemia or hypoxia is compensation. Treat the cause; never cardiovert it. A narrow rate well above 150 with no variability favors SVT.

Question 55

Sudden ETCO2 jump during compressions

Accepted Answer

An abrupt, sustained rise suggests ROSC. Finish the cycle and confirm with a pulse check at the next planned pause rather than interrupting compressions early.

Question 56

Refractory anaphylaxis on a beta-blocker

Accepted Answer

Epinephrine blunted at the receptor → glucagon (acts via its own receptor, raises cardiac output).

Question 57

Ventilated patient: bag stiffens, one side silent, BP falling — AEMT action?

Accepted Answer

Tension pneumothorax. Expedite transport and get paramedic decompression; do not speed ventilation.

Question 58

Cushing's triad

Accepted Answer

Hypertension (widening pulse pressure) + bradycardia + irregular respirations = herniation. Late, ominous sign of rising intracranial pressure.

Question 59

Decision-making capacity

Accepted Answer

Understand · appreciate · reason · express a stable choice. Decision-specific, reassessed. Disagreeing with you ≠ incapacity. Orientation alone ≠ capacity.

Question 60

Opioid overdose: order of care

Accepted Answer

Airway and BVM ventilation first; antagonist after oxygenation. Watch for re-sedation because the antagonist often wears off before the opioid.

Question 61

Glucagon did not work — why, and what next?

Accepted Answer

Liver glycogen is depleted (chronic alcohol use, malnutrition, prolonged illness). Give IV or IO dextrose.

Question 62

The history that arrives at minute eight

Accepted Answer

A working impression is a hypothesis, and late information is what overturns one. A new medicine, a missed daily drug, an ingestion an hour ago — take it and rebuild, do not defend the plan.

Question 63

Hypothermic patient stops shivering and grows confused?

Accepted Answer

Worsening hypothermia, not recovery. Handle gently, horizontal; warm the trunk.

Question 64

Why is permissive hypotension not used in a significant head injury?

Accepted Answer

The injured brain cannot autoregulate; even brief hypotension worsens secondary brain injury, so hypotension is avoided and a higher pressure defended.

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