Medical Emergencies on the NREMT Paramedic Exam: The 24–28% Domain

What the 24–28% covers on the Paramedic test plan

On the National Registry Paramedic Certification Examination, Medical/Obstetrics/Gynecology is the second-largest domain, at 24–28%, behind Clinical Judgment at 34–38%. The test plan does not list conditions for it. It names three knowledge areas, the same ones it uses for airway, cardiology and trauma: assessment, pathophysiology and management. Pediatric items are integrated across the domain. These are the Paramedic test plan's domains; the EMT exam uses a different blueprint.

That structure suggests a way to study. Instead of collecting a long list of diseases, take each condition you study through the three knowledge areas and end with a decision you could defend from a named guideline. The three cases below show the method on conditions where current guidance gives clear, conditional answers. Your protocols and medical director decide real care.

Study the domain in three passes

The last column matters most. Medical items can hinge on a condition: a pulse present or absent, a temperature above or below a threshold, a first drug versus a later one.

Case 1: respiratory arrest with a pulse after a suspected opioid overdose

The patient is fictional. A man in his 30s is slumped in a parked car with a syringe on the seat. He is not breathing, and you feel a definite carotid pulse.

• Assessment. No breathing, but a definite pulse. That pulse is the cue that decides the branch.
• Pathophysiology. The likely problem is respiratory depression from an opioid, so the immediate threat is lack of ventilation, not a lost circulation.
• Management. The 2025 AHA special-circumstances guidance says trained rescuers should give breaths or bag-mask ventilation to an adult or child with suspected opioid overdose who has respiratory depression or arrest and a definite pulse (COR 1). It also says an opioid antagonist such as naloxone should be given for respiratory arrest from suspected opioid overdose (COR 1). For an adult with a pulse who is not breathing normally, the adult BLS guideline calls 1 breath every 6 seconds reasonable.

Two tempting options fail the conditions. Chest compressions belong to a patient without a pulse, and waiting for naloxone to work before ventilating leaves the first recommendation undone. The free mixed set has an item built on this branch, so once the conditions are clear, try the opioid respiratory-arrest item in a mixed NREMT Paramedic set →.

Case 2: anaphylaxis with low blood pressure

The patient is fictional. A woman in her 40s is stung by a wasp while gardening. Within minutes she has spreading hives, a tight throat and wheezing, and her blood pressure is low.

• Assessment. Skin, airway and circulation findings together, minutes after an exposure.
• Pathophysiology. A severe allergic reaction that is affecting breathing and blood pressure.
• Management. The 2024 AHA and American Red Cross first aid guidelines call intramuscular epinephrine the mainstay of immediate treatment. They describe strong international consensus for early intramuscular epinephrine in the lateral thigh as the primary treatment, whatever the trigger, and note that patients may also need intubation, IV fluids, vasopressors and other advanced care.

Two cautions keep this case accurate. The anaphylaxis statements come from a first-aid guideline, so the paramedic version of the sequence, and every amount, follows your protocol. And the 2025 AHA special-circumstances part addresses cardiac arrest caused by anaphylaxis, which is a different situation from the patient above. On the exam, an antihistamine, a steroid or IV fluid on its own is a weaker first choice than intramuscular epinephrine. The pharmacology guide puts this decision beside the other medication rules.

Case 3: exertional heat stroke

The patient is fictional. A 19-year-old football player collapses during an afternoon practice. He is confused, his skin is hot, and his measured core temperature is 41.6 °C (106.9 °F).

• Assessment. Altered mental status plus a core temperature above 40 °C after exertion in heat.
• Pathophysiology. Life-threatening hyperthermia, which the guideline says to cool as rapidly as possible.
• Management. For adults with life-threatening hyperthermia (core temperature above 40 °C), the 2025 AHA guidelines recommend starting active cooling together with standard resuscitation (COR 1). Ice-water immersion at 1–5 °C is reasonable over other cooling methods (2a). If ice water is not available, immersion in tepid water (8–17 °C) or tarp-assisted ice-water cooling is reasonable (2a). Cooling should be as fast as possible, at least 0.15 °C per minute (2a), and active cooling should stop when the core temperature reaches 38.6 °C (2a). Dantrolene is not useful for hyperthermia from causes other than malignant hyperthermia (3: No Benefit).

The arithmetic shows why the stop point matters. From 41.6 °C to 38.6 °C is 3 °C. At the minimum rate of 0.15 °C per minute, that takes 20 minutes; faster cooling gets there sooner, so the temperature has to be monitored while cooling runs. Cold packs during transport, or fanning and misting, when an immersion tub is ready, choose another method over the one the guideline prefers.

After working the numbers, review the heat-stroke cooling item in the free NREMT Paramedic set → and compare its explanation for each option with the rows above.

Where stroke and obstetrics fit in the domain

Two large parts of the domain have their own guides:

• Stroke. The 2026 AHA/ASA acute ischemic stroke guideline says prehospital stroke scales improve early detection but remain nondiagnostic, and that EMS prenotification of the receiving hospital improves treatment timelines and outcomes. The stroke guide covers destination, the prehospital quality metrics and what not to do.
• Obstetrics and newborn care. Cardiac arrest in pregnancy and the first minutes of newborn care follow specific 2025 rows. The OB/GYN and newborn guide works through them.

Medication routes and your medical director

The National EMS Scope of Practice Model 2019 limits every paramedic medication route to medical director approved medications. That is why this page names drugs and decisions but no amounts. Learn the amounts your protocol uses with your program, and keep the exam reasoning on the decision: which drug, under which condition, and what you reassess next.