Anybody passed NREMT-P lately?

[ArkansasRanger]

I'm interested in how it all swings now?

Like a fool I let my cert lapse in 2008. I've been talking about getting it back since then. I need to undergo a refresher and the psychomotor and written tests. I figure I beat it all once and did pretty well. I just need help on the cardiology part now. I haven't read rhythms in probably two and a half years, and I'm out of the game.

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[Dwindlin]

I'm interested in how it all swings now?

Like a fool I let my cert lapse in 2008. I've been talking about getting it back since then. I need to undergo a refresher and the psychomotor and written tests. I figure I beat it all once and did pretty well. I just need help on the cardiology part now. I haven't read rhythms in probably two and a half years, and I'm out of the game.

I re-certified by exam back in February. I think the thing that surprised me most was some of the anatomy/physio questions. They were MUCH more in-depth than I remember when I first took the test when I first got certified. Honestly there were some that I don't think I would have answered correctly if not for already going through my anatomy block and most of my physio block.

I don't remember what rhythms I had to read specifically, but I do remember thinking as I was leaving how easy and how few there were.

 

[ArkansasRanger]

I re-certified by exam back in February. I think the thing that surprised me most was some of the anatomy/physio questions. They were MUCH more in-depth than I remember when I first took the test when I first got certified. Honestly there were some that I don't think I would have answered correctly if not for already going through my anatomy block and most of my physio block.

I don't remember what rhythms I had to read specifically, but I do remember thinking as I was leaving how easy and how few there were.

Cool enough. You know I actually took undergrad A&P I & II last summer to try to get back on track for the test, and I read a good bit of my medic books. That's as far as I got though. I could go to some CEU classes to get caught up on some things and even a refresher, but I don't know if I could ever get "practiced back up" on my own to being proficient enough to beat dynamic and static cardiology. It's the practicals that have me on edge. Thanks for the heads up though.

 

[malkboy]

I don't remember having many strip interpretations on my national registry. I think I had 1 straight up identification and 1-2 "how would you treat this" type of questions. Its hard to say what your test will look like since it is a CBT but it is bound to focus on your weakness.

The practical portion usually focuses on the "lethal" rhythms.

One thing that I hear consistently from other medics is a focus on amiodarone related questions.

I think A&P is becoming a bigger focus, due to the growing importance for medics to know how something works and why we do it opposed to simply knowing what to do.

 

[sc1085]

I retook the exam about a month ago. I'm a medical student in TN. A lot of the stuff on the exam I had covered in class so I really didn't have to prepare too much. Advice I can give you...I had about four rhythms on the exam. They were not interpretations, but a treatment plan based on what you thought the rhythm was. There was a lot of pathophysiology questions...they would give you a certain disease and ask the underlying mechanism. Know your ACLS protocols COLD! I would study anatomy of the heart and heart sounds (for instance, what each sound represents when listening with a stethescope). You might want to look back over drug calculations, I think I might have had a few of those. The first time I took the exam way back when, I found studying the practical sheets helped me answer a lot of questions (i.e., knowing what happens in the initial assessment as opposed to the scene size up). I'd quickly glance back over acid base abnormalities if I were you. Know the different types of respiration and what they tell you about the patient's condition. This should get you started. PM if you have any more questions. Maybe I can think of some more things you should look into. Good luck.

 

[sc1085]

And yes I did pass, in 78 questions.

 

[Altruist]

Like some of the others, I did the "recert by exam" thing, too, at the beginning of March. It was very different from when I first took the exam in 2004.

I definitely noticed more physiology and pathophysiology type questions, including one about presenting features of Parkinson's disease that could've come from one of my medical school exams. I had to read the question a couple of times because, to be honest, I expected all the questions to be knowledge-based (either you know it or you don't), and that question required stopping and thinking for a moment.

I don't mean that to scare you; most of the exam wasn't bad. I don't remember any wacky rhythm strips or anything like that--that part of it was straightforward.

For dynamic and static cardiology in the practical, unless they've started putting 12-leads on there since I took it, an ACLS review book might be all you need.

 

[ArkansasRanger]

Sweet. Thanks, guys.

 

[malkboy]

I would also brush up on basic 12-lead interpretation, as in elevation/depression plus the leads that correlate with specific areas of the heart and treatment plan for specific AMIs (e.g. inferior opposed to anteroseptal).

Edit: I would also guarantee that a question on coronary artery circulation will be on the exam.

 

[ArkansasRanger]

I would also brush up on basic 12-lead interpretation, as in elevation/depression plus the leads that correlate with specific areas of the heart and treatment plan for specific AMIs (e.g. inferior opposed to anteroseptal).

Edit: I would also guarantee that a question on coronary artery circulation will be on the exam.

I was actually never taught 12 lead, and when it manifested on the truck I stuck with leads 1-3. I got halfway through Dale Dubin once, but.....yeah.

 

[Dwindlin]

I was actually never taught 12 lead, and when it manifested on the truck I stuck with leads 1-3. I got halfway through Dale Dubin once, but.....yeah.

Whoa. How long ago were you certified? I feel like this would have come up sometime before your card lapsed in '08.

 

[deleted6669]

when did field 12 leads start in widespread use? 2000 or so? I know some places like seattle have used them longer.
I knew 12 lead through self study but it wasn't covered when I was in medic school in 1991.
I worked in 2 states( ca and pa) as a medic and never had to take the natl registry exam but did take state exams for both states. when I was in pa they went to lifetime paramedic certification which is pretty sweet. I have a pa medic cert card that says expiration: none.
to actually go back there and work now I would have to demonstrate to a medical director that I was still proficient in acls, pals, and btls/phtls and do 10 als calls. probably take me a shift or 2. for ca they require a 48 hr refrresher + the state test+ 10 als calls last time I checked.

 

[ArkansasRanger]

Whoa. How long ago were you certified? I feel like this would have come up sometime before your card lapsed in '08.

It wasn't that long ago, but Arkansas EMS is always about ten years behind EMS in the rest of the country. I believe I did the course in 2001 and certified in 2002. Unfortunately, I don't think 12 lead was actually taught until about the 2005 class or so. I never picked up any CEUs on it since, even then, 12-lead was still rare in the field. Back then Arkansas required a 48 hour refresher and 24 hours of CEUs every two years to recertify. Now, it's 72 hours of CEUs or what I mentioned above. Now, 12 lead is more commonplace. I'd like to know it for sure. Ok, I feel my blood pressure going up from reflecting on 2008 when my boss wouldn't let me get off for the refresher so I'm getting off this topic for now, lol.

 

[Dwindlin]

when did field 12 leads start in widespread use? 2000 or so? I know some places like seattle have used them longer.
I knew 12 lead through self study but it wasn't covered when I was in medic school in 1991.
I worked in 2 states( ca and pa) as a medic and never had to take the natl registry exam but did take state exams for both states. when I was in pa they went to lifetime paramedic certification which is pretty sweet. I have a pa medic cert card that says expiration: none.
to actually go back there and work now I would have to demonstrate to a medical director that I was still proficient in acls, pals, and btls/phtls and do 10 als calls. probably take me a shift or 2. for ca they require a 48 hr refrresher + the state test+ 10 als calls last time I checked.

I'll admit I didn't really get into the profession until '04, but I thought pre-hospital 12-lead was more prevalent much earlier than that.

ArkansasRanger, sorry to bring up a sore subject, it was nothing personal against you, I was just a little surprised to hear 12-lead ECG's were something of a recent development.

 

[ArkansasRanger]

I'll admit I didn't really get into the profession until '04, but I thought pre-hospital 12-lead was more prevalent much earlier than that.

ArkansasRanger, sorry to bring up a sore subject, it was nothing personal against you, I was just a little surprised to hear 12-lead ECG's were something of a recent development.

LOL No, it's nothing any of you did.

I only did EMS as a part-time adventure, and when I got the full-time job in 2008 that I've got now (my second law enforcement position) I was the new guy and couldn't take off the days I needed to go to the refresher. That's what I'm still sore about. Because of that I'm no longer a medic. Now, Arkansas is even a licensed, rather than certified, state, PLUS we can do all CEUs now rather than refreshers only. All that came into play after my cert lapsed. Now, I'd be licensed and never have to take refreshers again. Oh, well, another day in AR's life.

Remember, Arkansas is literally a decade behind proactive EMS agencies around the country. New innovations occuring for you right now will be seen here in the year 2020. I recall about when RSI was being "considered" for flight medics here. They can do it now, but ground units can't even with the same agency (having both flight and ground service). There are other issues like that. Honestly, I don't know if adult IOs have been approved or not. When I did my last refresher in 2006 we were playing with them, and the instructor said "these are out there on the horizon." Then again, I don't know if RSI or adult IOs are in practice for ground medics anywhere outside Arkansas either.

 

[malkboy]

Then again, I don't know if RSI or adult IOs are in practice for ground medics anywhere outside Arkansas either.

I would say RSI/PAI are fairly prevalent within Texas EMS systems. As far IO, it is become an essential tool for us (similar to an AED) to gain quick vascular access in emergent or difficult situations. We utilize the EZIO, partly because our medical director, Dr. Larry Miller, was the inventor and I believe it is easier to us than the BIG or jamshidi. We have made great progress with IO use and routinely favor humeral head insertion (studies show better flow) opposed to the tibia, however the paramedic can use his/her discretion when choosing a site just as with IVs.


I recomend viewing http://www.youtube.com/watch?v=ADu7ghcjIQ4 in order to have an overview of 12 leads. There are 7 parts to the series.

 

[Altruist]

When I started working, we still had LP12's with a "built-in modem" feature. I never used it, but I assume it faxed your 12-lead to the hospital.

The problem being (according to folks who'd tried using it) the cell phone network couldn't handle that kind of thing at the time, so transmitting an EKG meant leaving your partner to care for the patient while you hunted around for a phone jack so you could plug in the monitor. Effect: No one ever transmitted a 12-lead.

I remember hearing about Arkansas' little turf wars from an ER nurse who worked on a helicopter down in your area. RSI is pretty widely spread on ground ambulances, probably more so than the evidence supports. It's not everywhere, but it's pretty common. My old medical director still won't go for it; but a very low-volume county service where I use to moonlight had had it for 10 years. Go figure.

 

[malkboy]

I think there was a big push to transmit 12-leads in order to prevent false activation of the cath lab. But, as you stated transmitting is often easier said then done. Different systems utilize different monitors/suites which leads to increasing costs. I see the general trend going to towards better education for medics so they can contribute to early identification and triage of AMIs. The hard part is deciding weather the cath lab can be activated from the field and what an acceptable false activation rate is. I'm sure POC testing for cardiac markers in the field will become the standard soon just as 12-leads are now the standard for EKGs.

 

[Dwindlin]

We transmit in this area for "cardiac alerts." We usually only end up transmitting pretty text book STEMI's because those are the only ones that the hospital will activate the cath lab based solely on pre-hospital 12-lead and HPI. The few times I have sent in a questionable 12-lead with a good story its always "ok, bring them on in to the ED for further work up" so I just stopped doing it.

 

[ArkansasRanger]

Ha. The only lead transmission I've ever heard of/seen before was on Emergency via the "biophone." I still bet that's nonexistent in Arkansas. It's cool, and I like the idea. If that is in place here it's going to be in urban systems, and it would've popped up within the last year or so.

 

[Altruist]

Ha. The only lead transmission I've ever heard of/seen before was on Emergency via the "biophone." I still bet that's nonexistent in Arkansas. It's cool, and I like the idea. If that is in place here it's going to be in urban systems, and it would've popped up within the last year or so.

Single-lead radio telemetry. They really didn't trust their medics back then, did they?

My old boss had the great idea of updating our system when we bought new monitors a couple years ago, and Zoll was happy to have us trial their finest bluetooth-enabled monitors that would email our 12-lead to the ER... where the unit coordinator would not notice it, or would forget to print it out, or would print it out but not find the doc to show him/her before we got to the ER, or one of a million other things would go wrong.

So again, after a burst of excitement... we stopped transmitting them.

Technology, man. It's awesome!

 

[ArkansasRanger]

Technology, man. It's awesome!

I know. I'm still finding new features on my three year old Motorola Razr phone. LOL.