Complete Paramedic exam prep — 10 medical domains, drug reference, OB/GYN, and NREMT exam strategy
| Parameter | Normal | Critical Low | Critical High |
|---|---|---|---|
| SpO2 | 95–100% | <90% | — |
| EtCO2 | 35–45 mmHg | <25 (hyperventilation) | >50 (hypoventilation) |
| Blood Glucose | 70–110 mg/dL | <60 (hypoglycemia) | >300 (DKA concern) |
| Systolic BP | 100–140 mmHg | <90 (shock) | >180 (hypertensive crisis) |
| Heart Rate | 60–100 bpm | <50 (symptomatic brady) | >150 (symptomatic tachy) |
| Respiratory Rate | 12–20/min | <8/min | >30/min |
| Temperature | 97–99°F | <95°F (hypothermia) | >104°F (heat emergency) |
| GCS | 15 | <8 = intubate consideration | — |
| Drug | Mechanism | Indication | Key Contraindication | Side Effects |
|---|---|---|---|---|
| Albuterol | Beta-2 agonist → bronchodilation | Bronchospasm, asthma, COPD | Tachyarrhythmias (relative) | Tachycardia, tremor, hypokalemia |
| Ipratropium | Anticholinergic → bronchodilation | COPD exacerbation | Peanut allergy (some formulations) | Dry mouth, urinary retention |
| Epi 1:1,000 IM | Alpha + Beta agonist | Anaphylaxis, severe asthma | None in true anaphylaxis | Tachycardia, HTN, anxiety |
| Magnesium Sulfate | Smooth muscle relaxant | Severe asthma (refractory), Torsades, eclampsia | Hypermagnesemia, heart block | Hypotension, respiratory depression |
| Succinylcholine | Depolarizing NMJ blocker | RSI paralytic | Hyperkalemia, crush injury, burns, malignant hyperthermia hx | Hyperkalemia, malignant hyperthermia |
| Ketamine | NMDA receptor antagonist | RSI induction, pain, excited delirium | Severe HTN (relative) | Tachycardia, laryngospasm, emergence reaction |
| Etomidate | GABA agonist | RSI induction | Adrenal insufficiency (relative) | Myoclonus, adrenal suppression |
| Drug | Mechanism | Indication | Key Contraindication | Side Effects |
|---|---|---|---|---|
| Epi 1:10,000 IV | Alpha + Beta agonist | Cardiac arrest | None in cardiac arrest | Tachycardia, HTN |
| Amiodarone | K+ channel blocker (class III) | V-fib/V-tach arrest, stable V-tach | Bradycardia, hypotension, AV block | Hypotension, bradycardia |
| Atropine | Anticholinergic → increased HR | Symptomatic bradycardia | Tachycardia | Tachycardia, dry mouth |
| Adenosine | AV node blocker (ultra-short) | SVT (narrow-complex, regular) | V-fib, V-tach, WPW + A-fib | Transient asystole, chest pain |
| Aspirin | COX inhibitor → antiplatelet | ACS (STEMI/NSTEMI) | Active GI bleed, true aspirin allergy | GI upset, bleeding |
| Nitroglycerin | NO donor → vasodilation | ACS chest pain, CHF, HTN | SBP <90, PDE-5 inhibitor use, RV infarct | Hypotension, headache |
| Furosemide | Loop diuretic | CHF/pulmonary edema | Sulfa allergy, hypovolemia | Hypovolemia, hypokalemia |
| Drug | Indication | Key Pearl |
|---|---|---|
| Dextrose 50% | Confirmed hypoglycemia | Verify glucose first; tissue necrosis if extravasated |
| Thiamine | Wernicke's, alcoholism | Give BEFORE D50 in alcoholics |
| Naloxone | Opioid overdose | Titrate — don't precipitate full withdrawal |
| Haloperidol | Excited delirium, psychosis | Watch for QTc prolongation |
| Hydroxocobalamin | Cyanide poisoning | Red skin/urine discoloration is normal |
| Sodium Bicarbonate | TCA overdose, severe metabolic acidosis | Sodium channel stabilizer in TCA overdose |
| Magnesium Sulfate | Eclampsia, Torsades | Loss of DTRs = toxicity sign; Ca gluconate is antidote |
Hyperreactive airways — bronchospasm + mucosal edema + mucus. Air trapping on exhalation. Treatment: albuterol → ipratropium → Epi 1:1000 IM → Mag sulfate → CPAP → RSI.
⚠️ EXAM TRAP: Silent chest = NO air movement = impending arrest. Students hear "no wheeze" and think improved. WRONG — prepare for RSI immediately.
Give O2 — target SpO2 88–92%. Don't withhold O2 from a hypoxic COPD patient. Albuterol + Ipratropium first-line. CPAP for respiratory distress with adequate LOC.
⚠️ EXAM TRAP: Don't withhold O2 from a hypoxic COPD patient to "protect hypoxic drive." Give O2 and monitor.
Sudden dyspnea + pleuritic chest pain + CLEAR lung sounds. Tachycardia, hypotension (massive PE). Risk: Virchow's triad — stasis, hypercoagulability, endothelial damage. Treatment: O2, cautious IV fluid (250–500 mL), rapid transport — definitive Tx is hospital-based.
⚠️ PE distinguisher: Clear lung sounds + pleuritic pain + tachycardia + risk factors (immobility, surgery, pregnancy, OCP, malignancy)
Crackles bilaterally, pink frothy sputum, JVD, peripheral edema, orthopnea. Sits upright, won't lie flat. Treatment: CPAP first-line, NTG (SBP ≥100), furosemide, O2.
Simple: unilateral decreased breath sounds, trachea midline. Tension: JVD, tracheal deviation AWAY, hypotension, absent breath sounds. Treatment: Tension = immediate needle decompression (2nd ICS MCL or 4th/5th ICS AAL).
| STEMI | NSTEMI/UA | |
|---|---|---|
| ECG | ST elevation ≥2mm in 2+ contiguous leads | ST depression or T-wave inversion (or normal) |
| Biomarkers | Troponin elevated (hospital) | Troponin elevated (hospital) |
| Treatment | Aspirin 324mg, NTG, O2 if SpO2<94%, IV, 12-lead, rapid transport — PCI goal <90 min | Same — ASA, O2, NTG, IV, transport |
⚠️ RV Infarct: ST elevation in V1, V3R, V4R. CONTRAINDICATE NTG and diuretics. Give IV fluid instead.
Hypotension + pulmonary edema + cold/clammy skin. Pump failure. Cautious fluids (may worsen), vasopressors (dopamine/norepinephrine), rapid transport.
SBP >180 or DBP >120 WITH end-organ damage = emergency. Headache, altered mental status, visual changes. Gradual BP reduction — avoid rapid drops.
Cincinnati Stroke Scale: Facial droop, Arm drift, Speech abnormality — any one = 72% stroke probability, all three = 85%. Last known well time is CRITICAL — drives tPA eligibility (within 3–4.5 hrs).
⚠️ Do NOT give glucose to a stroke patient without confirming hypoglycemia. Hypoglycemia mimics stroke — check glucose first.
Generalized tonic-clonic: protect airway, suction, O2, lateral recovery position. Status epilepticus (>5 min or recurrent): Midazolam (IM/IN) or Lorazepam (IV) — benzodiazepines first-line. Transport all first-time seizures.
⚠️ Postictal phase = altered mental status after seizure. Patient is NOT still seizing. Document duration, type, postictal period.
| Hypoglycemia | DKA | HHS (HONK) | |
|---|---|---|---|
| Glucose | <60 mg/dL | 250–600 mg/dL | >600 mg/dL |
| Onset | Rapid (minutes) | Hours–days | Days–weeks |
| Ketones | None | High (fruity breath) | Minimal |
| pH | Normal | Acidotic (<7.35) | Normal/slightly low |
| LOC | Altered — can be severe | Varies (less common) | Severe coma |
| Type | T1 or T2 | Type 1 DM most common | Type 2, elderly |
| Treatment | D50 IV or glucagon IM or oral glucose | IV fluids, O2, transport | IV fluids, transport |
⚠️ EXAM TRAP: Hypoglycemia can mimic stroke. ALWAYS check glucose in altered mental status. Treat first — transport second.
| Toxidrome | Cause | Signs | Antidote/Treatment |
|---|---|---|---|
| Cholinergic (SLUDGE/DUMBELS) | Organophosphates, nerve agents | Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis + bronchospasm, bradycardia, miosis | Atropine (dry the lungs), Pralidoxime (PAM) within 24h |
| Anticholinergic | Antihistamines, TCAs, atropine | "Hot, Dry, Red, Blind, Mad" — hyperthermia, dry skin, flushing, mydriasis, delirium, tachycardia, urinary retention | Physostigmine (rarely), supportive care, benzos for agitation |
| Opioid | Heroin, fentanyl, oxycodone | Miosis, respiratory depression, decreased LOC — the triad | Naloxone — titrate to adequate respirations |
| Sympathomimetic | Cocaine, meth, amphetamines | Tachycardia, HTN, hyperthermia, mydriasis, agitation, diaphoresis | Benzos, cooling, NO beta-blockers (unopposed alpha) |
| Sedative-Hypnotic | Benzos, barbiturates, ETOH | CNS/respiratory depression, normal pupils | Supportive, airway management; flumazenil (caution — seizures) |
⚠️ TCA Overdose: Wide QRS, hypotension, seizures. Give NaHCO3 (sodium bicarb) to stabilize sodium channels. Do NOT give physostigmine — can cause cardiac arrest.
⚠️ Carbon Monoxide: SpO2 reads falsely normal (normal pulse ox measures carboxyhemoglobin as oxyhemoglobin). Use CO-oximeter if available. High-flow O2 is definitive prehospital treatment.
Crowning = deliver in place. NEVER delay delivery to transport if crowning. Head delivers — apply gentle pressure. Check for nuchal cord — loop over head or clamp/cut. Suction mouth then nose. Dry, warm, stimulate. Clamp cord 1–3 min (delayed cord clamping). Deliver placenta (up to 30 min — don't pull).
| Pre-eclampsia | Eclampsia | |
|---|---|---|
| Definition | HTN (>140/90) + proteinuria after 20 weeks | Pre-eclampsia + SEIZURES |
| Symptoms | Headache, visual changes, RUQ pain, edema | Tonic-clonic seizure in pregnant patient |
| Treatment | Magnesium sulfate IV (4–6g loading dose), antihypertensives, transport | Mag sulfate, protect airway, O2, IV, transport, left lateral decubitus |
⚠️ Mag Sulfate Toxicity: Loss of deep tendon reflexes is the FIRST sign. Respiratory depression = serious toxicity. Antidote: Calcium gluconate 1g IV.
| Emergency | Presentation | Management |
|---|---|---|
| Prolapsed Cord | Cord visible/palpable in vaginal canal | Elevate presenting part off cord with 2 fingers, knee-chest position, high-flow O2, transport. DO NOT push cord back. |
| Placenta Previa | Painless bright red vaginal bleeding, 3rd trimester | O2, IV, no vaginal exam, rapid transport — placenta covers cervical os |
| Abruptio Placentae | Painful dark red vaginal bleeding, rigid abdomen | O2, IV, left lateral decubitus, rapid transport — placenta separating |
| Postpartum Hemorrhage | >500mL blood loss after delivery | Fundal massage, oxytocin (if ordered), IV fluids, transport |
| Ectopic Pregnancy | Unilateral abdominal pain, missed period, vaginal bleeding | IV, O2, shock management, rapid transport — surgical emergency |
Treatment: Aggressive IV fluid resuscitation (30 mL/kg NS — up to 1–2L), O2, blood cultures (hospital), broad-spectrum antibiotics (hospital), vasopressors if fluid-refractory (norepinephrine first-line). TIME IS TISSUE — every hour of delay increases mortality 7%.