one of the biggest components of passing your nremt is understanding signs and symptoms of the nramt in this video right here i'm pulling out the whiteboard we're talking about three major science symptoms you gotta know [Music] hey it's evan the paramedic coach now you got to stay at the end of this video it's super important i'm going to be going through an nremt style question and we're going to tackle it together let's tackle our signs and symptoms here we go now let's start with cardiac tamponade remember the cardiac tamponade is putting a tremendous amount of pressure on the heart that sac is around the heart is being filled it's being pressurized and what's happening is the heart is suffering due to that so what happens the heart fails as a pump because it's being squeezed due to cardiac tamponade right so what do we think the effect would be okay well if the heart fails the pump and there's pressure around it what would we expect well if we understand heart blood flow if we have heart failure blood backs up right so what that means is we get back up in the venus well here's jvd okay that's one of we have a bex triad right here that explains cardiac tamponade okay what else well if my heart fails the pump i'm gonna get hypotension if my heart fails the pump and it's being pressurized being squeezed i'll probably have muffled heart sounds so muffled heart sounds jvd and hypotension is bec's triad i guarantee you on nremt you'll have a scenario like this that was number one let's move into the next one our second nremt science symptom we got to know is what happens when we have increased inter cranial pressure increased icp what that is the triad called cushing's triad now here's the big key why would we have increased intracranial pressure could be head trauma could be stroke we talk about brain hemorrhage brain bleeds all that right that makes sense right now the big key here is you gotta know we're gonna start with the first one you can see right here we talk about rising blood pressures when we have an increase in intracranial pressure okay the big key is that the systolic blood pressure goes basically and shoots up what that causes is the number one piece of cushing's triad is that hypertension yes but that winding pulse pressure between the systolic and the diastolic blood pressure so it's high blood pressure and a wide pulse pressure because the systolic is going to the roof okay that's in points so that's the first key increase icp hypertension second piece is bradycardia the final piece is irregular slow respirations could lead to apnea sure but it's going to be irregular slow respirations now can i give you a pearl here here's the pearl this right here you can see cushing's triad what happens when we get increased intracranial pressure what happens we get hypertension bradycardia and then slow aspirations now the way you can remember cushing's triad is it is the opposite of a shock patient so a shock patient initially what's gonna happen tachycardia hypotension increased respirations exactly this is the opposite it could be a way for you to remember both by locking these in let's go on to the next one now our third piece is a wheezing patience i always tell my students when you hear a wheeze think a a c the first a is for asthma second anaphylaxis third copd remember that asthma these are all wheeze okay but remember a few perfect let's go through them asthma that's going to be your main wheezing patients commonly that patient with asthma like all these happens acutely when they're going to call 9-1-1 the big key with anaphylaxis is remember it's two or more body systems and also anaphylaxis can have strider and wheezing nausea vomiting hives some big keys there now the final piece copd has chronic bronchitis and emphysema these patients are very commonly on long-term steroids that might be in the question as well something to think about there is you also with this patient with copd they might be on auction when you actually show up on the call they might be on home auction a few quick tips there now let's dive into our nramt style question here we go welcome to the bonus section you made it give me a hashtag bonus down below if you made it to the bonus section going over an nramt style question here we go now you have a patient as a 42 year old female patient found in care of pd the police department the officers on scene at a local bar the patient is confused altered mental status tachycardic so a high heart rate and has bulging eyes you should suspect what do you think it is is it a psychiatric crisis a cocaine overdose an opiate overdose or graves disease what is going on in your mind with this patient so let's talk about the first thing okay what do we actually have as the information from this question notice we have no vitals so we can't go off that we don't have a blood sugar so we can't go off that okay it appears in this question we have just arrived on scene and we've gotten where we've begun a baseline of the mental status we've gotten essentially a pulse or heart rate okay this tachycardia we know it's high and we can see the patients because we can see that patient has bulging eyes we got from the officers how old the patient is okay and we know where the patient is found okay and we know the page is not obeying commands okay so based on this information where does this look to now here's the big question and this is what i always say to my students now my friends this question is not trying to trick you remember the nramt is trying to see if you are competent in this area so here it is let's break these down now a cocaine overdose what would that look like well the patient could be altered they could be okay but most commonly they'll put with a cocaine overdose that's going to be dilated pupils and very very high heart rate tachycardia right okay now we have bulging eyes okay so that's not dilated pupils right altered mental could be but um usually it's more of a dilated people tachycardia issue okay so we're gonna let that one sit opiate overdose anticardiac doesn't make any sense my friends opiate patients are going to be for example respiratory depression bradycardic hypotension bring the patient down not up so we're going to cross off opiate overdose okay we'll consider cocaine let's continue now could it be a psychiatric crisis it could be right but what about graves disease here's the question did you study this chapter did you study content over questions because this question is extremely easy if you understand grave's disease if you did not go over great disease you're gonna have no idea and you're probably getting this question wrong and you're either gonna go with a or c this is a trap when you don't study content on nremt the answer is grave disease and this is clear cut due to bulging eyes ams and tachycardia there it is i've put together something very special for you especially if you're getting ready for nremt whether you're an emt advanced emt or paramedic i've personally helped thousands of students pass the nremt we call it on easy mode but understanding content cold at a deep level now my video study course you can see in the screen here whether you're emt advanced empty or paramedic i've put together my life's work of over 400 plus videos and access to our private student group you can get access right now by clicking the link in the description i'll give you a lifetime access my friends hope you enjoyed this video i'll see you there take care please don't waste any time don't don't be hesitant and just do it because i know this program works and i know it's it got me to where i was where it's been a year without school from emt to hey i passed my test and 70 questions like go for it you could do it like do not hesitate and don't waste any time well they don't know you they need to they need this program this program is not a choice to me this program is a happy to take thousands and thousands of pages in the books and you just narrow it down and just make everything simple past the registry so uh this is great content man i promise you it's worth it took this with three weeks left to go in my class and i just i'm not sure if i would have been able to pass my course or the nremt first try without this course the fact like when i was taking the the national and i would read the question and i would be like whoa evan literally just went over this in the car so it's it really it helps i got to the point where i was just ready to spill all my knowledge onto this freaking test so i'm like you know what man just go ahead go for it open it up boom congratulations you passed it was um outside of having my children that's probably not like the happiest day of my life do you