# NREMT- advice?



## almorajo25 (Feb 3, 2015)

I took my NREMT exam in November of last year. I actually thought I did well but I ended up failing the exam. I had near passing for most of them but I failed in the airway management section. I don't know if I'm overstudying or not studying enough. I want to retake the exam soon so any advice would be very helpful.

PS: I was wondering when is it appropriate to use nasal cannula, nonrebreather mask, and BVM depending on the situation? On the exam they don't give much details.


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## LMEMT (Feb 3, 2015)

Are you talking about the written or the practical exam? 

With the nasal cannula vs. the nonrebreather mask, on the exam, we were always told to go better safe than sorry. A nonrebreather is always good for someone that is keeping up their rate and quality of breathing and can maintain their own airway. If the exam notes that a nonerebreather mask is not tolerated by the patient, then a nasal cannula is always the next best thing. 

A BVM should only be used if the patient is not keeping up their rate and quality of breathing. For example, if they have shallow respiration or extremely slow respiration.  In the event that they can not maintain their own airway, an airway adjunct should be used.

Best of luck on retaking your test!


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## almorajo25 (Feb 3, 2015)

This is for the written exam. So if they said that the respiration rate is 12 or 28, you would use BVM? If the patient has trouble breathing, you would use BVM and if the patient is in the high/low ranges of respiratory rate but the quality of breathing is ok, then you would use nonrebreather right?  
Thanks!


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## LMEMT (Feb 3, 2015)

Just making sure ^^ The practical for Wisconsin was very different from the practicals I've seen for other states, so I didn't want to mess you up. But the written is the same all around.

If the respiration rate is less than 12 or more than 28, it should specify how they're breathing. The number we were always told would necessitate a BVM was 8. Trouble breathing would, mainly depend on the quality of breathing, but if they have trouble breathing and it has become shallow or what have you, then they're becoming exhausted. Therefore, they need help (bvm). If the quality is good and they need oxygen, then nonrebreather is the way to go, yes.


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## almorajo25 (Feb 4, 2015)

Yeah I was told that too that use BVM if respiration rate was 8. So if I understand this correctly, BVM is mostly used for hypoventilation but what about   hyperventilation? When the respiration rates are too high? SOrry for asking a bunch of questions. This is the section I failed so I just want to make sure I'm understanding this right >__<


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## chaz90 (Feb 4, 2015)

First rule of EMS is as follows. Patients don't learn numbers or rules that your textbook teaches you. 

No one, and I mean no one, should be trying to use a BVM on a patient with a RR of 12 or 28 as was mentioned earlier in this thread. Respiratory rates vary much, much more than the "12-20" for adults taught in EMT school. 8 can be plenty with adequate tidal volume in some people at rest, and 30 is simply a minor asthma attack or anxiety most of the time. 

Hypoventilating patients in need of assistance with a BVM will be abundantly obvious most of the time. Cardiac arrests with agonal or absent respiration are obvious times to use a BVM, as is the hypoxic opiate OD that will typically present with RR between 0-4ish. 

Conscious, hyperventilating patients are rarely going to allow you to use a BVM on them. If you're a BLS unit with a conscious patient in severe respiratory distress and a dramatically elevated RR, a non-rebreather (better yet CPAP if local protocols allow) will be the best choice the vast majority of the time. I've run a lot of critical respiratory patients, and I've yet to use a BVM on someone who is conscious and tachypneic. Experiences may vary from other posters. 

If you're trying to learn the various indications for the written test, don't overthink it. NREMT loves to overemphasize NRB usage, but keep in mind most patients don't need one at all. Mildly hypoxic patients with minor respiratory distress are often fine with a nasal cannula, moderate to severe distress consider NRB at the BLS level, and for apneic and severely hypoventilating unconscious/semi conscious patients, use a BVM. If a test question wants you to choose BVM on a conscious and hyperventilating patient (again, extremely rare in real life), it will likely describe the respirations as extremely rapid, inadequate, and shallow. Follow these cue words and you should be fine. Good luck, and I recommend asking your instructor for further clarification.


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## LMEMT (Feb 4, 2015)

Thanks for the clarification and sharing your knowledge and experience, Chaz. What I was talking about was the test, sorry for not clarifying, but thank you.


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## ecphotoman (Feb 9, 2015)

almorajo25 said:


> This is for the written exam. So if they said that the respiration rate is 12 or 28, you would use BVM? If the patient has trouble breathing, you would use BVM and if the patient is in the high/low ranges of respiratory rate but the quality of breathing is ok, then you would use nonrebreather right?
> Thanks!


You want to reserve the BVM for apneic patients. People that have uneven chest rise or are non responsive IMO and or low RR of <10. If the patient is responsive and on the high range I would always go NRB@15lpm. Hope that helps, check cliffs notes cram plan it helped me a lot.


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## almorajo25 (Feb 20, 2015)

Thanks everyone! That was really helpful 
I was wondering if anyone has ever used JB learning? I heard its good but it costs like $55. I'm considering in purchasing it but I would like to know what are your guys input not it


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## machestnut (Feb 24, 2015)

yeah same here.  I took my NREMT last Friday and was shocked that I failed the airway mgmt portion of the NREMT.  I believe that it was mostly due to the BVM vs NRB questions.  I am going to retake it in a couple of weeks, signed up for emtprep.com and studying more to pass it.


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## machestnut (Feb 24, 2015)

chaz90 said:


> First rule of EMS is as follows. Patients don't learn numbers or rules that your textbook teaches you.
> 
> No one, and I mean no one, should be trying to use a BVM on a patient with a RR of 12 or 28 as was mentioned earlier in this thread. Respiratory rates vary much, much more than the "12-20" for adults taught in EMT school. 8 can be plenty with adequate tidal volume in some people at rest, and 30 is simply a minor asthma attack or anxiety most of the time.
> 
> ...




Thank you,,,this breaks it down nicely.  I was totally over thinking the NREMT exam questions.


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