# NREMT and CPR



## juxtin1987 (Nov 1, 2009)

Hey all, just stumbled upon this site and it looks like a lot of you have some good insight on what exactly i'm getting  myself into. I'm just about to wrap up my EMT class and register for NREMT-B test. 

My question is, what is the protocol's for CPR on National Registry?

What i mean by this is that i was trained to do cpr two fignerbreaths above xiphoid etc at a depth of 1 1/2 - 2" etc. I was told by my future employer that this curriculum of CPR is outdated and it is now mid nipple line accross the board as well as a depth of 1/3'rd body. Any insight appreciated.

Thanks,
Justin


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## Lifeguards For Life (Nov 1, 2009)

juxtin1987 said:


> Hey all, just stumbled upon this site and it looks like a lot of you have some good insight on what exactly i'm getting  myself into. I'm just about to wrap up my EMT class and register for NREMT-B test.
> 
> My question is, what is the protocol's for CPR on National Registry?
> 
> ...



2-3 finger widths above the xiphoid process is about on the nip line on most patints(give or take a small amount). also on a normal adult 1.5-2 inches is roughly 1/3 of the body depth.
As long as you are not compressing ON the xiphoid process you should be allright(pressing on the xipoid itself can induce vomiting)


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## juxtin1987 (Nov 1, 2009)

Lifeguards For Life said:


> 2-3 finger widths above the xiphoid process is about on the nip line on most patints(give or take a small amount). also on a normal adult 1.5-2 inches is roughly 1/3 of the body depth.
> As long as you are not compressing ON the xiphoid process you should be allright(pressing on the xipoid itself can induce vomiting)



Thanks for the response, i'm more so wondering if i get a question on registry that says for example: 
What's the appropriate depth for CPR on an adult patient?
a) 1 1/2 - 2"
b) 1/3'rd the body depth
c) Random Answer
d) Random Answer

Im just not wanting to miss a question because i wasn't properly informed is all.


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## Shishkabob (Nov 1, 2009)

NR "follows" the current AHA guidelines, which are as of right now the 2005 guidelines.  2010 will be out real soon though.


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## Lifeguards For Life (Nov 1, 2009)

juxtin1987 said:


> Thanks for the response, i'm more so wondering if i get a question on registry that says for example:
> What's the appropriate depth for CPR on an adult patient?
> a) 1 1/2 - 2"
> b) 1/3'rd the body depth
> ...



haha. i dont remember any cpr based questions on my exam. in this case i would go with 1/3 body depth. that answer is not as specific, and allows more room for adaption if the patient is a 100 pounds or 400 pounds. compressing 2 inches on a 100 pounder is not the same as compressing 2 inches on a 400 lb pt.


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## Lifeguards For Life (Nov 1, 2009)

Linuss said:


> NR "follows" the current AHA guidelines, which are as of right now the 2005 guidelines.  2010 will be out real soon though.



you know, i don't think i've ever actually seen the actual AHA guidelines. even when we recertified the first day of paramedic school


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## juxtin1987 (Nov 1, 2009)

Thanks Fellas


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## Onceamedic (Nov 1, 2009)

Lifeguards For Life said:


> (pressing on the xipoid itself can induce vomiting)



Not to mention fracturing it and lacerating a liver - not good


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## juxtin1987 (Nov 1, 2009)

Lifeguards For Life said:


> you know, i don't think i've ever actually seen the actual AHA guidelines. even when we recertified the first day of paramedic school



2005 AHA is 1 1/2 - 2" for adult and 1/3rd to half body mass for children and infants (though my class was trained 1-1.5" and 0.5-1" respectively), the 2010 AHA standards is 1/3rd body mass for all Pt's. Hopefully I don't encounter a direct question such as that I previously mentioned. I don't think i will but i guess you never know. Everyone of my proctors has said that if you pass this class i'm in currently that i'll have no problem on registry and i missed 2 out of 50 on midterm so i'm confident that i'll pass. 

Thanks again for the help!

P.S. I don't imagine lacerating a liver is considered helpful to the situation.


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## Lifeguards For Life (Nov 1, 2009)

juxtin1987 said:


> 2005 AHA is 1 1/2 - 2" for adult and 1/3rd to half body mass for children and infants (though my class was trained 1-1.5" and 0.5-1" respectively), the 2010 AHA standards is 1/3rd body mass for all Pt's. Hopefully I don't encounter a direct question such as that I previously mentioned. I don't think i will but i guess you never know. Everyone of my proctors has said that if you pass this class i'm in currently that i'll have no problem on registry and i missed 2 out of 50 on midterm so i'm confident that i'll pass.
> 
> Thanks again for the help!
> 
> P.S. I don't imagine lacerating a liver is considered helpful to the situation.



there are a ton of inconsistencies in this field. i would bet there are CPR instructors out there who haven't read any updates since the 90's.


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## nemedic (Nov 1, 2009)

juxtin1987 said:


> Hopefully I don't encounter a direct question such as that I previously mentioned. I don't think i will but i guess you never know.



I took it last wednesday, and can't remember having anything on the "technique" of performing CPR, though I do remember one or two scenarios that asked about if/when CPR would be initiated. I realize it's a vague answer, but don't want to give out too much info and violate the rule on posting questions. I can say that there seemed to be a LOT of OB questions on there, so I would reccomend definitely keying in on that chapter when you study.


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## Onceamedic (Nov 1, 2009)

The National Registry test is an example of computerized adaptive testing or CAT.

CAT successively selects questions so as to maximize the precision of the exam based on what is known about the examinee from previous questions. From the examinee's perspective, the difficulty of the exam seems to tailor itself to his or her level of ability. For example, if an examinee performs well on an item of intermediate difficulty, he will then be presented with a more difficult question. Or, if he performed poorly, he would be presented with a simpler question. 

The basic computer-adaptive testing method is an iterative algorithm with the following steps:

   1. The pool of available items is searched for the optimal item, based on the current estimate of the examinee's ability
   2. The chosen item is presented to the examinee, who then answers it correctly or incorrectly
   3. The ability estimate is updated, based upon all prior answers
   4. Steps 1–3 are repeated until a termination criterion is met

Nothing is known about the examinee prior to the administration of the first item, so the algorithm is generally started by selecting an item of medium, or medium-easy, difficulty as the first item.

As a result of adaptive administration, different examinees receive quite different tests. 

You got a lot of OB questions because it took a while to determine your level of competence in OB, not unusual because that is traditionally a weak area for paramedics and EMTs.

Your (or anyone's) advice as to what to study is meaningless because your individual strengths and weaknesses are not someone else's.

The correct answer when someone asks you what they should study is "everything".


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## juxtin1987 (Nov 2, 2009)

Yeah i'm sort of getting the same vibe though from everyone i've talked to about registry in that it pinpoints areas that you didn't master and drills you on that as well as it being majority of "what would you do" rather than "what does this mean".

All the insight is appreciated, and i will be sure to study "everything" prior to taking the exam.


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