Medics some stuff to consider for the NREMTP

May see some of this on the National!

1) Pathophysiology of opioid overdose in the brain

Primary problem: opioids stimulate µ-opioid receptors in the CNS → depress the brainstem respiratory centers (medulla) and blunt the CO₂ drive.

↓ respiratory rate + ↓ tidal volume → hypoventilation
CO₂ rises (hypercapnia) + O₂ falls (hypoxemia) → respiratory acidosis
Hypoxia → altered mental status → seizures/arrest (late)
Also causes CNS sedation + loss of airway tone → obstruction/aspiration risk

High-yield triad: CNS depression + respiratory depression + miosis (miosis can be absent in mixed OD).

2) Why you might need to repeat naloxone (Narcan)

Repeat dosing is needed when opioid effect outlasts naloxone or the dose is overwhelming.

Common reasons:

Long-acting opioids (methadone, ER formulations)
High potency / large load (e.g., fentanyl analog exposure)
Re-sedation after initial response (short naloxone duration)
Co-ingestants (benzos/EtOH) → patient remains altered even if RR improves (narcan won’t fix benzos)
Inadequate initial dose / wrong route / poor absorption
Delayed GI absorption (body packing, bezoar)

Test pearl: Naloxone’s job is ventilation, not “make them awake.” Titrate to adequate RR/ETCO₂.

3) Causes of erythematous skin

Erythema = vasodilation/inflammation. On exams, they love pattern recognition:

Big buckets:

Infectious: cellulitis, erysipelas, scarlet fever, meningococcemia (may start as erythema), viral exanthems
Allergic/immune: urticaria, anaphylaxis, contact dermatitis, drug eruptions
Heat/vasodilatory: heat illness, fever/flushing, sunburn
Toxicologic: CO exposure (classically “cherry red” is unreliable), niacin flush, anticholinergic vs sympathomimetic syndromes (often flushed)
Shock/inflammatory states: early sepsis (warm, flushed), cytokine reactions
Autoimmune: lupus rash, dermatomyositis, vasculitis

Pearl: Erythema + hypotension/wheeze/angioedema = anaphylaxis until proven otherwise.

4) RBBB/LBBB — which interferes with evaluating ST elevation?

LBBB is the classic one that masks/complicates STEMI interpretation because of “secondary” ST-T changes that come with LBBB.

LBBB can make STEMI hard to diagnose

RBBB can still allow STEMI evaluation more often, but it can confuse V1–V3 interpretation.

High-yield one-liner:

LBBB = major STEMI confounder.
New/unknown LBBB + ischemic symptoms is high risk (STEMI equivalent thinking in the right clinical context).

5) Lightning strike, multiple victims — who first?

Lightning MCIs use reverse triage:

Treat apneic/pulseless first because many arrests are respiratory-driven and rapidly reversible with immediate ventilation/CPR/defib.
“Black tag” in lightning is not the same as routine trauma triage.

Your choice (pulseless patient first) is exactly the classic lightning triage principle.

6) Leukemia causes enlargement of what organ?

Most classically: spleen (splenomegaly), often also liver (hepatomegaly) and lymph nodes.

Mechanism: malignant cell infiltration + extramedullary hematopoiesis.

Exam phrasing: “Enlarged LUQ organ” → spleen.

7) “Warfan’s syndrome” patients predisposed to what condition?

This is almost certainly Marfan syndrome (common mis-hear/misspelling).

Marfan predispositions (high yield):

Aortic root dilation → aortic aneurysm/dissection
Mitral valve prolapse
Possible spontaneous pneumothorax risk due to connective tissue issues

(When a Marfan-looking patient has sudden tearing chest/back pain = treat as dissection until proven otherwise.)

8) Deer ticks

The big diseases they test:

Lyme disease (Borrelia)
Babesiosis (malaria-like hemolysis, fevers, fatigue)
Anaplasmosis (fever, headache, leukopenia/thrombocytopenia patterns)

Field teaching pearl: tick exposure + fever + low platelets/leukopenia = think anaplasma/ehrlichia bucket.

9) Neonatal SpO₂ levels (2 questions)

They usually mean preductal (right hand) target saturations after birth (NRP concept). Typical targets by minute (preductal) include:

1 min: ~60–65%
2 min: ~65–70%
3 min: ~70–75%
4 min: ~75–80%
5 min: ~80–85%
≥10 min: ~85–95%

This is why “90% at 1 minute” is generally not expected in a normal transition.

10) What are tocolytics used for?

Tocolytics = medications used to suppress uterine contractions to delay preterm labor (usually to buy time for steroids/transport to higher level care).

Example

terbutaline

11) Heat exhaustion vs heat stroke (3 questions)

Heat exhaustion

Core temp typically < 40°C (104°F)
Sweating present, pale/clammy
Weakness, dizziness, nausea, headache
Mental status: usually intact (maybe mildly confused)

Heat stroke = true emergency

Core temp typically ≥ 40°C (104°F)
CNS dysfunction is the discriminator: confusion, delirium, seizures, coma
Skin can be hot; may be dry OR sweating (exertional heat stroke often still sweats)
Can progress to rhabdo, DIC, hepatic injury

Pearl: If they have AMS + heat exposure → call it heat stroke and cool aggressively.

12) Hyponatremia symptoms

Symptoms are mostly neurologic due to cerebral edema:

Headache, nausea/vomiting
Confusion, lethargy
Seizures
Coma (severe)
Muscle cramps/weakness can occur

Trap: Severity depends on how fast it developed, not just the number.

13) Most effective in killing C. difficile

C. diff forms spores → alcohol hand gel does not reliably kill spores.

For environmental killing:

Bleach (sodium hypochlorite) at sporicidal concentration is a mainstay; CDC notes bleach (about 5,000 ppm chlorine) can inactivate C. diff spores with appropriate contact time.
Use an EPA-registered sporicidal disinfectant (“spore-killing” products).

14) Abdominal pain: diagnosing + treating (high-yield framework)

National Registry loves location + red flags + “can’t miss.”

“Can’t miss” abdominal diagnoses

AAA: older, hypotension, back pain, pulsatile mass (don’t be fooled by “GI symptoms”)
Ectopic pregnancy: any reproductive-age female + pain/bleeding/syncope
Appendicitis: periumbilical → RLQ migration, fever, anorexia
Cholecystitis: RUQ, after fatty meal, fever, Murphy sign
Pancreatitis: epigastric to back, vomiting, worse supine
Mesenteric ischemia: “pain out of proportion,” AFib history
Bowel obstruction: distention, vomiting, obstipation
Peritonitis/perf: rigid abdomen, rebound/guarding
GI bleed: melena/hematemesis, shock signs
Renal colic: flank to groin, hematuria, writhing

EMS approach (what they test)

ABCs, O₂ as needed, IV access
Treat shock: fluids judiciously
Pain control + antiemetic
Don’t miss pregnancy test logic (conceptually)
Rapid transport for peritoneal signs, hypotension, GI bleed, suspected AAA/ectopic

15) Woodpile bite, 2 tiny marks, severe abdominal pain + spasms → benzos

That presentation screams black widow (Latrodectus): envenomation can cause severe muscle cramping/spasms, abdominal rigidity/pain, diaphoresis, hypertension/tachycardia.

Benzodiazepines for muscle spasm + analgesia is a classic treatment direction.

Your answer choice (benzos) matches the classic management concept.

16) DVT questions: who’s predisposed?

Think Virchow’s triad:

Stasis: immobility, long travel, hospitalization
Endothelial injury: surgery/trauma
Hypercoagulability: cancer, pregnancy/postpartum, OCPs, inherited thrombophilias

Also common: prior DVT/PE, smoking (risk modifier), obesity.

17) CHF-heavy question set (how they usually test it)

They typically hammer:

Left vs right failure findings
Flash pulmonary edema vs pneumonia/COPD
Med errors: nitrates with RV infarct/hypotension; fluid overload; missing CPAP
Mechanics: increased preload/afterload, decreased contractility
Treatments: CPAP, nitrates (if BP allows), diuretics (system-dependent), cautious fluids depending on scenario

Exam pearl: “Pink frothy sputum + tripod + HTN” → think acute pulmonary edema; CPAP + nitrates are high-yield (BP permitting).

18) Meperidine is an opiate (opioid)

Yes—meperidine (Demerol) is an opioid analgesic. They test this to see if you recognize “older” opioids and can connect it to: