Board prep, domain by domain
Six domains, zero fluff. Each one shows the high-yield points the exam loves, then hands you the exact drug cards, rhythm strips, field cases and exam questions to drill it. Finish a domain, then prove it on the timed board exam.
High-yield before the exam
- Capnography confirms EVERY tube: no waveform, no airway. Esophageal tubes get pulled, not debated.
- BVM before blade: pre-oxygenate 3+ minutes or 8 vital-capacity breaths before any intubation attempt.
- Suction passes are 15 seconds max in adults — pre-oxygenate before and re-oxygenate after.
- EtCO₂ 35–45 is normal; a sudden drop to near zero means tube dislodgement or arrest, a rise during CPR means ROSC.
- Pediatric airways: big occiput (pad the shoulders), tongue is the #1 obstruction, bradycardia = hypoxia until proven otherwise.
Drug cards to review
Rhythms to know
Rhythm drills live on the EKG study guide.
Field cases
Skills to drill
Sample board question
Best first indicator that a supraglottic airway is correctly placed?
- A. Condensation in the tube
- B. Waveform capnography with a normal square wave
- C. Chest rise alone
- D. Absence of a gag reflex
Drill it on the site
High-yield before the exam
- Shock the shockable: VF/pVT get defibrillation, not more epi-first debate. Unstable tachy with a pulse gets synchronized cardioversion.
- Epinephrine 1 mg IV/IO every 3–5 minutes in arrest; amiodarone 300 mg then 150 mg for refractory VF/pVT.
- Symptomatic bradycardia ladder: atropine 1 mg → pacing → dopamine/epi drip. High-degree blocks skip atropine.
- Adenosine 6 mg fast push → 12 mg for stable narrow-complex SVT; wide-complex regular tachy = treat as VT.
- 12-lead early: STEMI goes to a cath lab, posterior MI shows ST depression in V1–V3, Sgarbossa reads paced rhythms.
Drug cards to review
Rhythms to know
Field cases
Skills to drill
Sample board question
Adult in witnessed VF arrest. Highest-priority intervention?
- A. IV epinephrine
- B. Immediate defibrillation with high-quality compressions
- C. Advanced airway
- D. Amiodarone
Drill it on the site
High-yield before the exam
- Scene size-up first: a dead medic saves nobody. Gloves on, hazards called, number of patients estimated.
- Load-and-go criteria: unstable airway, shock, chest/abdominal penetrating trauma, ejection, high-fall mechanism.
- Permissive hypotension in penetrating torso trauma: titrate fluids to a radial pulse / mentation, not a 'normal' BP.
- Tension pneumothorax: unilateral absent sounds + JVD + hypotension + tachycardia → needle decompression now.
- Head injury: avoid hypoxia AND hyperventilation; brief hyperventilation only for herniation signs (blown pupil, posturing).
Drug cards to review
Rhythms to know
Field cases
Skills to drill
Sample board question
Tension pneumothorax field treatment?
- A. High-flow oxygen only
- B. Needle decompression on the affected side
- C. Chest tube
- D. Supine positioning and transport
Drill it on the site
High-yield before the exam
- Kids compensate until they crash: tachycardia is early shock, hypotension is LATE and ominous.
- Use a length-based tape (Broselow) — weight-based dosing beats memory under stress.
- Pediatric bradycardia is usually hypoxia: oxygenate and ventilate BEFORE reaching for atropine or epi.
- Airway differences: occiput padding under shoulders, smaller tongue-to-mouth ratio, no cricoid pressure debates on the exam.
- Fluid bolus 20 mL/kg for perfusion problems; reassess lung sounds after every bolus.
Drug cards to review
Rhythms to know
Field cases
Skills to drill
Sample board question
Pediatric patient with stridor at rest and drooling. Priority action?
- A. Inspect the oropharynx with a tongue depressor
- B. Keep the child calm, humidified oxygen, position of comfort, transport
- C. Force an oral airway
- D. Lay the child flat
Drill it on the site
High-yield before the exam
- Altered mental status: check glucose early. Hypoglycemia is the most fixable coma on the truck.
- Seizures: benzos stop them (midazolam IM works without an IV); eclampsia gets magnesium.
- Anaphylaxis: epi IM in the thigh — waiting for IV access loses the airway.
- OB: third-trimester bleeding = placenta previa/abruption; crowning + contractions = you're delivering on scene.
- Sepsis: fever + hypotension + altered = fluids, early notification, and time-sensitive transport.
Drug cards to review
Rhythms to know
Rhythm drills live on the EKG study guide.
Field cases
Skills to drill
Sample board question
Suspected opioid overdose with a respiratory rate of 4. First priority?
- A. Naloxone before anything else
- B. Ventilate with a BVM, then titrate naloxone
- C. IV fluids
- D. Immediate intubation
Drill it on the site
High-yield before the exam
- Incident Command: first unit establishes command; you report to it, you don't invent your own.
- MCI triage (START): respirations → perfusion → mental status. Red = immediate, yellow = delayed, green = walking, black = expectant.
- Hazmat: upwind, uphill, upstream. You cannot help anyone from inside the hot zone.
- Documentation protects you: if it isn't written, it didn't happen.
- Know your scope: protocols and medical direction override anything a test question implies.
Drug cards to review
No drug cards tagged here — see the full Meds tab.
Rhythms to know
Rhythm drills live on the EKG study guide.
Field cases
New cases land in the simulator first.
Skills to drill
Sample board question
A competent adult refuses care after a fall. Correct approach?
- A. Transport against their will
- B. Explain the risks, document informed refusal, offer to return
- C. Leave without documentation
- D. Call police to force transport
Drill it on the site
Educational review only — always follow your local protocols and medical direction. Not affiliated with or endorsed by the NREMT.