Nremt-p Orals

[Asysin2leads]

Its been a few years now since I took my NREMT-P exams, but I just started this year as an evaluator so maybe I can help.

Candidates seem to worry most about the oral stations, but surprisingly enough it isn't the station most often failed. That honor belongs to - believe it or not - the BLS station: long spine board or KED. ...So don't forget to review that stuff as well, even if you are sure you've got it down.

The orals seem like a big deal but most people once they get in there are able to fall into the routine that they normally do. It might help to know that you will not fail if you miss little things. You fail for missing big things. Check the blood sugar on the altered mental status. Do a thorough airway assessment right away on the trauma. Don't give drugs to the hypothermic patient. These are the things you want to remember. People fail these stations tend to rush through stuff (particularly the airway) and miss something obvious that they would have definitely remembered had they slowed down and thought about each step.

Just go slow, take a breath, and relax. You'll be fine.

Advanced Cardiac Life Support manual, page 46-47

"For a cardiac arrest patinet in VF/VT who has hypothermia and a body temperature of <30 degree C (<86 degree F), a single defibrillation attempt is appropriate. If the patient fails to respond to the initial defibrillation attempt, defer subsequent defibrillation attempts and drug therapy until the core temperature rises above 30 degree C (86 degree F)... in cardiac arrest in the hospital should be aimed at rapid core rewarming. Got it. Shock once, rapid transport. Now how about active rewarming? Warm IV fluids or maintain body temperature en route? Decisions, decisions.

Actually, the BLS is also the thing that scares me. Actually what scares me is the KED. In over 12 years of testing for EMS, I still can't get the damn thing to work when I'm being evaluated. I know all about it. Invented for rapid extrication of test pilots. My baby looks hot tonight. Middle bottom legs head top. Check neurologic status before and after application, I know how to feed the straps. I know how to roll the shoulders. I know how to place padding to prevent femoral artery occlusion. What I don't know is why, every single goddamn time I think I have the leg straps tight, when I move the patient, it all falls apart. I can only assume that God hates me. I fear the backboard because I know how I put the straps on, but that might not be acceptable to the tester. I fear bleeding control because I might sneeze and fail the sterility part. We're still at direct pressure, elevation, pressure point, and tourniquet, right? Hard to screw that up? But I think I might. I once had a traumatic arrest packaged, intubated, two large bore IVs, needle decompression, and transport initiated in 6 minutes and 37 seconds. I've treated bilateral above knee amputations, shootings and eviscerations, and MVA's and even a couple of helicopter crashes, and still, the thing I fear most is basic BLS skills evaluation. I think it says more about the tests than me. There has to be a better way. God help me if I get the 20 year EMT with the light bar and the tattoos who is looking to conclusively prove that book learnin' ain't what its about. God help me if I forget to fold something the right way. I wish the future of my career rested on more than a 1 page checklist. But it doesn't. Of the things I hate about this job the most, this is one of them.

[fiznat]

I wouldn't worry about active rewarming. Just do the basic stuff and you'll be fine.

Chill out! haha

[CharleeFoxtrot]

First off...relax! You know you know this stuff, and getting yourself all knotted up won't do you any good. As far as the oral stations, the best advice I can give you is to use the paper they provide to your advantage. Write down the time you start the scenario-that's where I messed up when I tested a month ago. I went over time allowed on one of them because I didn't pay attention, and wasn't writing down my interventions so I couldn't even extrapolate the timed elapsed to the hospital. So, I had to do it over. In my program, part of the requirements for graduation was a nice sit down with the head Doc from Med Control/head of ER for one of the hospitals. Talk about getting run through the wringer! It was two hours of questions and thinking off the top of your head. This interview included scenarios, and we used to attack them the same way all the time in practice so we wouldn't freeze. Take your paper and draw two lines, one up and down in the middle and the other across to make 4 squares to write info in. The top left was your scene info...who what where-note the environment of the call. The bottom left was your SAMPLE, OPQRST, etc. and physical exam findings. The top right was for your interventions, bottom right was for vitals and trends. Setting up the squares I wrote "SAMPLE" and filled stuff in as it was given to me. For the vitals I wrote BP HR RESP P/OX etc so I didn't forget to ask the questions and then I could trend vitals by writing them in a column to keep track of them.

I had three scenarios: peds asthma, active MI (the one I went 2 minutes over time on) and the retest was a hypothermia. Keep yourself focused, and start with the basics ABC always! Remember rapid transport vs. stay and play, and keep your mind on what can happen next. After each intervention reassess. Overwhelm the proctor with correct info, which shows him/her you do indeed know what you are talking about. The proctors do take nerves into account, and at least when I tested where really great about making you feel that they weren't out to get you.

Go over your basic skills, practice them if you can. Remember to look at the autofails and the points. No reason to give points away, repetitive practice of the entire evolution will help with that. Don't have the equipment to practice? Use a friend and a pillow as your patient for the longboard/KED and pantomime it. Sounds stupid, but it does work. Someone else posted up to check youtube, there are some videos there on the practicals, but they are a bit out of date. Watch them anyway, using your checksheets (you can get them if you don't have them already on the NREMT website) and think how you would have done things.

A few days before...and this is important...STOP STUDYING. Give your mind a rest, and go into the practicals with a clear mind. If you keep going over and over and over things, all you'll do is get burnt out and doubting yourself.

Good luck!

[Arizonaffcep]

My thoughts have already been said here as far as practical testing...so I will only say GOOD LUCK! I'm sure you'll have no troubles! Afterwards...go get a beer!

[cookiemonka]

Anyone taken the NREMT-P practical lately? I'm having stress-induced GI problems over it. My biggest problem is that where I am testing is no where near me, so I'll be doing it with strange people in a place I've never worked, and I am really afraid of tripping up over some idiosyncracy. Any one have any tips? Better yet, anyone know where I can find some practice materials so I at least have some heads up with what I'm facing? I have pretty much everything printed out from the NREMT possible, but I could always use more. Thanks for anything that helps.

I took the practicals a little over a year ago. As long as you know your cardiac and the NREMT printoffs, you will do fine. Stay relaxed and just act as if you would in real life. I was really stressed, but they ended up being quite a bit easier than I was expecting. If you have paid attention in class, you will be fine. Good luck and let us know how it goes!

[Asysin2leads]

Hey everyone, just got back from the NREMT practical. I actually did fine on the orals. Knocked them out of the park. I did them like I did a call and all was well with the world.

That doesn't mean I passed completely. I have to retest on the pediatric IO, pediatric ventilation, and adult ventilatory management. Now, you may pause and ask yourself, "Is asysin2leads really such a doofus that after being a paramedic for five years that he still can't figure out how to intubate and how to do an IO?" The answer, I assure you, is NO. The other answer is yes, I did study the skill sheets. Approximately 8 hours a day for the past three weeks I have been reviewing. I am not sure why they failed me on the stations. I know it is nothing in any text-book, skill sheet, or CME I could get my hands on that I missed. I do know that the reason I failed the KED station the first time (told ya), is because I put the middle strap on first and not the top strap. Yeah, apparently in their neck of the woods, they put the top strap on first, not the middle strap, and that's reason enough to fail your sorry ass on the random basic skill if you put the middle strap on first. Yes, I know the manufacturers instructions actually say there's not really any order to put the straps on, but what can I say. Given that experience, I can only assume their was some BS local idiosyncracy that I wasn't doing on the other stations that failed me. I would also like to take this time to voice my opinion that if the goal of the NREMT is to provide a standardization of EMS throughout the country, they are not doing particularly well, as their skills testing still allows too much wiggle room for the testers to throw their own little interjections into the testing. For instance, if on your skill sheet, the criteria simply states "Secures the torso properly" and you never spell out what "securing the torso properly" really means, then it is up to the local testing agency to decide what that means. Now, if you are the paramedic student who has been training with said testers for the duration of their curriculum, knowing exactly what they want is not a particularly difficult goal to achieve. However, for the paramedic who comes in from a different area to do your testing, it presents a bit of a challenge to psychically mind read the testers to know exactly what they want. Yes, I am a little annoyed. Just a little. A smidgen.

[reaper]

Hey everyone, just got back from the NREMT practical. I actually did fine on the orals. Knocked them out of the park. I did them like I did a call and all was well with the world.

That doesn't mean I passed completely. I have to retest on the pediatric IO, pediatric ventilation, and adult ventilatory management. Now, you may pause and ask yourself, "Is asysin2leads really such a doofus that after being a paramedic for five years that he still can't figure out how to intubate and how to do an IO?" The answer, I assure you, is NO. The other answer is yes, I did study the skill sheets. Approximately 8 hours a day for the past three weeks I have been reviewing. I am not sure why they failed me on the stations. I know it is nothing in any text-book, skill sheet, or CME I could get my hands on that I missed. I do know that the reason I failed the KED station the first time (told ya), is because I put the middle strap on first and not the top strap. Yeah, apparently in their neck of the woods, they put the top strap on first, not the middle strap, and that's reason enough to fail your sorry ass on the random basic skill if you put the middle strap on first. Yes, I know the manufacturers instructions actually say there's not really any order to put the straps on, but what can I say. Given that experience, I can only assume their was some BS local idiosyncracy that I wasn't doing on the other stations that failed me. I would also like to take this time to voice my opinion that if the goal of the NREMT is to provide a standardization of EMS throughout the country, they are not doing particularly well, as their skills testing still allows too much wiggle room for the testers to throw their own little interjections into the testing. For instance, if on your skill sheet, the criteria simply states "Secures the torso properly" and you never spell out what "securing the torso properly" really means, then it is up to the local testing agency to decide what that means. Now, if you are the paramedic student who has been training with said testers for the duration of their curriculum, knowing exactly what they want is not a particularly difficult goal to achieve. However, for the paramedic who comes in from a different area to do your testing, it presents a bit of a challenge to psychically mind read the testers to know exactly what they want. Yes, I am a little annoyed. Just a little. A smidgen.

I feel for you man!

I did mine last year, after letting it laps years ago. It could use a lot of improvement on how it is set up and ran.

I failed Adult airway the first time. For all things of forgetting the "BSI". I was not happy. Had to drive 6 hours to retake one station. They would not do retake that day, because the NREMT rep had to leave. Even though we finished 3 hours early!

Just retest those stations, get it out of the way and never let it expire!