# Medical Direction on the NREMT



## brooksh (Jul 17, 2009)

I'm using a book called "REA's Interactive Flashcards" for EMT-Basic. There is a question that says you have a diabetic who took his insulin, but did not eat breakfast, what should you do first? A. give O2. B. Give oral glucose. C. Administer insulin D. Contact Medical control. 

In my EMT class all test questions assumed that local protocols were to contact medical control before giving anything. But the book says B (give oral glucose) is the correct answer. So my question is, on the NREMT do you contact medical control first or administer?


----------



## Ridryder911 (Jul 17, 2009)

The NREMT is based upon the NHTSA National Curriculum for EMT's. The question is a poorly written question and does not contain enough information and also not answers that would be similar to those on the NREMT written exam. 

One should be following written under guidelines of protocols. If one has to contact medical control for each time any treatment is performed, the staff would never get anything done. For complex criteria, sure. If you are being taught to contact medical control for all orders, you are being taught wrong. 

Let's look at the question even by process of elimination: 
A. Possible, but are they hypoxic? 
B. That is their problem, but again it did not inform you on how low their sugar was &/or type and how long ago they administered it. Again, poorly written question. Chances are since they are low blood sugar, then yes administration of glucose.
C. We NEVER administer Insulin as well, the stem key told you that they had taken insulin without eating thus they will already have too much insulin. 
D Possibly, but why? You have to contact medical control for everything as simplistic as this?


----------



## brooksh (Jul 17, 2009)

Thanks. I guess I was taught wrong. I don't want to miss quite a few questions just because I choose medical control instead of the intended drug. What if it is nitro, charcoal or epinephrine?


----------



## Ridryder911 (Jul 17, 2009)

brooksh said:


> Thanks. I guess I was taught wrong. I don't want to miss quite a few questions just because I choose medical control instead of the intended drug. What if it is nitro, charcoal or epinephrine?



Again, it is assumed you will be working under protocols and there is a point to contact medical control, as you should had been taught. The texts you are using should had made clarification of this. 

For example, do not administrer Nitro if blood pressure is < 100 or 90 mm/hg systolic, etc...

NREMT follows the AHA recommendations for all CPR and cardiac questions. 

R/r 911


----------



## brooksh (Jul 17, 2009)

Okay, but what I'm trying to get at is on the NREMT exam, if there are no contraindications do you contact medical control?


----------



## ResTech (Jul 17, 2009)

I would say no, you would not contact medical control. As Rid said, it is a poorly written question. But real world, you would not call medical command for a diabetic to ask if you should give O2 or glucose. And BLS nor ALS gives insulin pre-hospital so you can throw that answer out. 

The patient took their insulin and they didn't eat... this eludes to the patient being hypoglycemic. I would say the correct response would be... give glucose. 

What is the correct answer on the flashcard?


----------



## brooksh (Jul 17, 2009)

To give glucose is the right answer. But as I said before in my class you were to contact medical control before giving anything.


----------



## ResTech (Jul 17, 2009)

Ok... thats weird to have to contact medical control before giving anything. Sounds like a local thing... thats not how u will be tested National Registry. I took my National Registry a few years ago and dont recall any questions about calling MC prior to treatment.


----------



## brooksh (Jul 19, 2009)

According to emtb.com (which is also the book I have) one of the practice questions says

Before administering epinephrine for injection from an AnaKit (commercial bee sting kit), what is the first step?
A: Get an order
B: Clean/wipe thigh
C: Place needle in proper position
D: Check expiration date of medication

Answer is A. 

Reason: If you will administer this epinephrine, make the same general preparations you make for an auto injector: Get an order, take BSI precautions, etc

So would you contact medical control because this is their kit, and it isn't something you carry on the ambulance?


----------



## medic417 (Jul 19, 2009)

brooksh said:


> A: Get an order
> 
> So would you contact medical control because this is their kit, and it isn't something you carry on the ambulance?



That could even refer to standing orders, protocols, not necessarily call for authorization.


----------



## Ridryder911 (Jul 19, 2009)

brooksh said:


> According to emtb.com (which is also the book I have) one of the practice questions says
> 
> Before administering epinephrine for injection from an AnaKit (commercial bee sting kit), what is the first step?
> A: Get an order
> ...




Sounds like to me, you need to get another study aid. Sorry, orders are usually written in a protocol form so one does NOT have to receive a verbal order. That type of practice left about 25 years ago. The answers are crappy as well as the question. As a test writer for the NREMT, I can assure you the questions are much better written than the examples you have posted. 

R/r 911


----------



## VentMedic (Jul 19, 2009)

Ridryder911 said:


> Sounds like to me, you need to get another study aid.
> 
> R/r 911


 
Or maybe you could check out one of REA's other fine "help" books.

http://www.rea.com/


----------



## medic417 (Jul 19, 2009)

VentMedic said:


> Or maybe you could check out one of REA's other fine "help" books.
> 
> http://www.rea.com/



Maybe a true case of getting what you pay for?


----------



## WuLabsWuTecH (Jul 19, 2009)

What's wrong with E) take a BG level?  I think that would be most prudent to do as most likely your pt isn't going to keel over on you in the next 30 seconds from low BG.


----------



## brooksh (Jul 19, 2009)

brooksh said:


> According to emtb.com (which is also the book I have) one of the practice questions says
> 
> Before administering epinephrine for injection from an AnaKit (commercial bee sting kit), what is the first step?
> A: Get an order
> ...



This question is actually from EMTB.com which is from the AAOS and Jones and Barlett Publishers not REA.


----------



## Ridryder911 (Jul 19, 2009)

brooksh said:


> This question is actually from EMTB.com which is from the *AAOS and Jones and Barlett Publishers not REA.*




Aww.. hence the problem.

I highly suggest the EMT curriculum form NHTSA (it's free) and AHA CPR and emergency resuscitation for health care providers (latest edition). This is the only true source that the NREMT is obtained from. All material is verified to be within those texts or it is not allowed..period. Many texts add and give opinions which are not allowed on the test. 

R/r 911


----------



## daedalus (Jul 19, 2009)

It seems to me that the correct answer to this question would be to give oxygen. At the EMT level, you need to show that you can at least do the absolute minimum. 

However, it is a poorly written question.


----------



## CAOX3 (Jul 20, 2009)

brooksh said:


> I'm using a book called "REA's Interactive Flashcards" for EMT-Basic. There is a question that says you have a diabetic who took his insulin, but did not eat breakfast, what should you do first? A. give O2. B. Give oral glucose. C. Administer insulin D. Contact Medical control.
> 
> In my EMT class all test questions assumed that local protocols were to contact medical control before giving anything. But the book says B (give oral glucose) is the correct answer. So my question is, on the NREMT do you contact medical control first or administer?



I would write in E. None of the above.

How could you possibly answer this question, without being able to assess the patient.


----------

