4. Pediatric Respiratory Compromise
A. Verbalize or take appropriate PPE precautions
B. Verbalize general impression of patient from a distance before approaching or touching the patient
C. Determine level of consciousness (LOC)
D. Assess the airway – look for secretions and signs of foreign body airway obstruction, listen for audible noises and voice sounds
E. Assess breathing – check rate, rhythm, chest excursion, audible noises
F. Attach pulse oximeter and evaluate SpO2 reading (Examiner will verbalize Pulse oximeter shows a saturation of 82%.)
G. Select proper delivery device and attach to oxygen
H. Administer oxygen at proper flow rate [blow-by oxygen, non-rebreather mask]
I. Check pulse
J. Evaluate perfusion – skin color, temperature, condition; capillary refill
K. Obtain baseline vital signs (Examiner will verbalize that patient begins to develop decreasing SpO2, decreasing pulse rate, see-saw respirations, head bobbing, drowsiness, etc.)
L. Place patient supine and pad appropriately to maintain a sniffing position
M. Manually open airway
N. Consider airway adjunct insertion based upon patient presentation [oropharyngeal or nasopharyngeal airway]
O. Insert airway adjunct properly and positions head and neck for ventilation
Select appropriate BVM and attaches reservoir to oxygen flowing at 12 – 15 L/minute (Examiner will inform candidate no gag reflex is present and patient accepts airway adjunct. The patient’s respiratory rate is now 20/minute.)
P. Assure tight mask seal to face
Q. Assist ventilations at a rate of 12 – 20/minute (1 ventilation every 3 – 5 seconds) and with correct volume to cause visible chest rise
R. Ventilate at proper rate and volume while observing changes in capnometry/capnography, pulse oximeter, pulse rate, level of responsiveness (Examiner will ask the candidate, How would you know if you are ventilating the patient properly?)
S. Call for immediate transport of patient.
Station 4 – At this station the candidate will be evaluated on their ability to manage a cardiac arrest situation with 1-rescuer CPR and the proper use of an AED.
5. Cardiac Arrest Management / AED
A. Verbalize or take the appropriate PPE precautions
B. Determine the scene and situation is safe
C. Attempt to question any bystanders about events related to the arrest
D.
Check patient responsiveness.
E. Check pulse and breathing simultaneously:
a. Check patient for signs of breathing by observing for absence of breathing or abnormal breathing (gasping or agonal respirations)
b. Check carotid pulse
F. Begin immediate chest compressions with adequate depth and rate (Allow the chest to recoil completely)
G. Request additional EMS Response
H. Perform high-quality 1 Rescuer Adult CPR for 2 minutes:
a. Correct depth and rate
b. Compression to ventilation ratio is correct
c. Allow chest to recoil completely
d. Adequate volume for each breath
e. Minimal interruptions of no more than 10 seconds throughout CPR.
NOTE: After 2 minutes or around 5 cycles of CPR the candidate should assess the patient and a second rescuer will resume compressions while the candidate operates the AED.
I. Turn power on to AED
J. Follow AED prompts and correctly attach the AED to the patient
K. Stop CPR and make sure all rescuers are clear of the patient during rhythm analysis
L. Ensure everyone is clear of patient and deliver shock from AED
M. Immediately direct rescuer to resume chest compressions.
Station 5 – This station will be testing two skills. First, the candidate will be required to establish a patent IV on a manikin arm in accordance with a given scenario for the Intravenous Therapy skill. After successfully establishing a patient IV line, the candidate must administer an IV bolus of medication in accordance with a given scenario for the Intravenous Bolus Medications skill.
6. Intravenous (IV) Therapy
A. Checks selected IV fluid for: Proper fluid, Clarity and Expiration date
B. Select correct catheter
C. Select correct administration set
D. Connect IV tubing to the IV bag
E. Prepare administration set – fill drip chamber and flush tubing
F. Cuts or tears tape – can be done at any time before venipuncture
G. Take or verbalize appropriate PPE precautions prior to venipuncture
H. Apply tourniquet
I. Palpate suitable vein
J. Clean site appropriately
K. Perform venipuncture: Insert stylette, Note or verbalize flashback, Occlude vein proximal to catheter, Remove stylette, and Connect IV tubing to catheter
L. Dispose of or verbalize proper disposal of needle in proper container
M. Release tourniquet
N. Run IV briefly to assure the line is patent
O. Secure catheter by actually taping or verbalizing
P. Adjust to appropriate flow rate
7. Intravenous Bolus Medications
A. Ask patient for any known allergies
B. Select correct medication
C. Assure correct concentration of medication
D. Assemble prefilled syringe correctly and dispel air
E. Continue to take or verbalize PPE precautions
F. Identify and clean injection site closest to the patient [Y-port or hub]
G. Reaffirm medication
H. Stop IV flow
I. Administer correct dose at proper push rate
J. Dispose or verbalize proper disposal of syringe and needle in proper container
K. Turn IV on and adjust drip rate to TKO/KVO
L. Verbalize the need to observe patient for desired effect and/or adverse side effects
Station 6 – Candidate is required to establish an intraosseous line in a pediatric IO manikin. (Manual insertion with a Jamshidi® needle or battery-powered drill-type devices is permitted.)
8. Pediatric Intraosseous Infusion
A. Check selected IV fluid for: Correct fluid, Clarity and Expiration date
B. Selects appropriate equipment to include: IO needle, Syringe, Saline and Extension set or 3-way stopcock
C. Select correct administration set
D. Connect administration set to bag
E. Prepare administration set and fill drip chamber and flush tubing
F. Prepare syringe and extension tubing or 3-way stopcock
G. Cut or tear tape can be done at any time before IO puncture
H. Take or verbalize appropriate PPE precautions prior to IO puncture
I. Identify proper anatomical site for IO puncture
J. Clean site correctly
K. Perform IO puncture:
a. Stabilizes tibia without placing hand under puncture site and “cupping” leg
b. Insert needle at proper angle
c. Advance needle with twisting motion until “pop” is felt or notices sudden lack of resistance and
d. Removes stylette
L. Dispose of or verbalize proper disposal of needle in proper container
M. Attach syringe and extension set to IO needle and aspirate; or attach 3-way stopcock between administration set and IO needle and aspirate; or attach extension set to IO needle [aspiration is not required for any of these as many IO sticks are “dry” sticks]
N. Slowly inject saline to ensure proper needle placement
O. Adjust flow rate/bolus as appropriate
P. Secure needle and support with bulky dressing, taping securely or verbalizing to secure it.
Station 7 – At this NREMT exam station, the candidate is required to immobilize an adult patient who is found supine. The patient is found with a suspected unstable spine and candidate will immobilize using a long spine immobilization device. An EMT assistant will be provided, but the candidate is responsible for communicating with and directing the EMT assistant.
9. Spinal Immobilization (Supine Patient)
A. Take or verbalize appropriate PPE precautions
B. Direct assistant to place/maintain head in the neutral, in-line position
C. Direct assistant to maintain manual immobilization of the head
D. Reassess circulatory, motor, and sensory function in each extremity
E. Apply appropriately sized extrication collar
F. Position the immobilization device appropriately
G. Direct movement of the patient onto the device without compromising the integrity of the spine
H. Apply padding to voids between the torso and the device as necessary
I. Immobilize the patient’s torso to the device
J. Evaluate and pad behind the patient’s head as necessary
K. Immobilize the patient’s head to the device
L. Secure the patient’s legs to the device
M. Secure the patient’s arms to the device
N. Reassess circulatory, motor, and sensory function in each extremity
Station 8 – This station tests on one randomly selected EMT skill. The candidate will be evaluated on one of the following four Basic EMT skills. To see the testing guidelines for these four skills, scroll up to the National Registry of EMT Psychomotor Exam heading on this page and you will find 10 Basic EMT skills discussed.
(Candidate will be tested on one of these four EMT-B skills)
• Long Bone Immobilization
• Joint Immobilization
• Bleeding Control/ Shock Management
• Spinal Immobilization (Seated Patient)
Scroll up to National Registry of EMT Psychomotor Exam section to find these skills discussed in the area for EMT Basic candidates.
For information on the NREMT exam for Paramedics, see our National Registry Paramedic page.
Check out our other posts for more EMT Topics:
→ 7 Tips to Pass the Psychomotor Exam
