NREMTP Review-Yaya 🚒🚑 Mixed Topics
LVAD or RVAD
+ palpable pulse
+ BP
May do CPR (Just use caution)
may defibrillate
CPR pulseless, apneic, no "Hum" in the motor
Shoulder Dystocia
Patho-During delivery the baby's shoulder gets stuck and wedged against the pubis symphysis
Causes
Macrosomia-Big ass baby >9 lbs.
Mom has gestational diabetes (Hyperglycemia)
"Turtle Sign=Tortoise sign="Turtling"
Paramedic Treatment
Immediately elevate the hips
McRoberts maneuver (1. Knees to chest position 2. Hard/Firm pressure into the pelvis in an attempt to unwedge the shoulder
Attempt to deliver the Anterior shoulder
Attempt to deliver the Posterior shoulder
Place Mom on all fours!!!!
STAT Emergency
90-90-9 Rule
Relates to Head Trauma w/ Increased ICP
If the SBP falls below 90 mmHg
OR
The Spo2 falls below 90%
OR
GCS falls below 9
There is a 50% increased risk of DEATH!!!
TAH
Total artificial heart
No palpable pulse
No native heart
No EKG
No CPR
Types of Fractures
Transverse
Oblique
Greenstick (most common type of fracture seen in children)-Fracture on the outer portion of the bone
Open fracture=Compound Fracture
Comminuted (Shattered into multiple pieces)
Spiral Fracture=Peds=CHILD ABUSE!!!!!!!
Displaced vs non-displaced
Fractures w/ the most amount of blood loss
Pelvic Fracture-EBL >1000 mL
Femur Fracture->750 mL
Humerus Fracture->500 ml
70-year-old female was having lunch w/ her family, while walking out of the restaurant, she slipped, had a ground level mechanical fall, landing on her Right Hip. Presents w/ severe right hip pain, + crepitus, and shortening of the right leg
What is the hip? THE HIP IS NOT THE PELVIS
Femur!!!!!
Femoral Head
Femoral neck
Greater trochanter
Shock
When the cells, organs, and tissues do not get enough oxygenated blood
Hypoperfusion=Shock
Biproduct of Hypoperfusion=Lactic Acid
Metabolic Acidosis
How does the body know to start compensating?
Receptors
Baroreceptors-"Baro=Pressure-receptors located in the aorta and the carotid sinus
Detect changes in pressure=signal the brain
Chemoreceptors-"Chemical"-Located in the carotids, aorta, and the lungs, that detects changes in chemicals (CO2 & O2)
Detect changes and signal the brain
Answer #2
Activation of the Sympathetic NS (Fight or Flight)
The Adrenal glands release Epi (Adrenaline) & Nor-epi
Answer 3
RAAS System (Renin-Angiotensin-Aldosterone System)
Located in the KIDNEYS!!!!!!
Regulates Blood Pressure=INCREASES BP!!!!
Enzymes-Chemicals that speed up a process
causing vasoconstriction
Step by Step
The kidneys release Renin
The liver releases Angiotensinogen
Convert to Angiotensin I
Lungs release ACE
Converts to Angiotensin II
Adrenals release Aldosterone
Vasoconstriction=Increased BP
Cardiac Arrest=CAB
Immediate high-quality CPR
Immediate Defibrillation
If a pt. does have a pulse=ABCs
65 male found in cardiac arrest, is pulseless and apneic. Bystander CPR was initiated PTA of EMS. You have been performing resuscitative efforts, CPR, IV line is established, and 2 shocks were initiated for V-Fib on the EKG. En route you have now achieved ROSC. What would you do next?
Obtain a full set of VS
Secure an airway-Intubate
waveform capnography-35-45-PPV at 10/min
Maintain Spo2-90-98%
maintain a MAP >65 & SBP >90 mmHg (IV crystalloids and/or Pressors
Obtain a 12 lead EKG
If they are unresponsive or in a Coma-Initiate TTM-32-37 C
Check BGL
Uterus-A large, and extremely strong muscle that holds the baby, and must contract to start the labor process
Upon delivery, it must also continue to contract to stop or prevent post-partum bleeding
Needs Oxytocin from the Pit gland to contract
Uterine Rupture
Due to the uterus become weak, overworked during the labor process, and eventually tears=ruptures
Occurs during labor/childbirth
MASSIVE/Severe Pain-Midline pelvis or Bilateral lower quadrant
Severe vaginal bleeding and/or internal bleeding
Boggy Uterus
Leads to Hypovolemic Shock
No further contractions are felt
Fetal Distress=Fetal Bradycardia
Thrombolytics=Fibrinolytics=Clot Busters=TPA & Alteplase
New update-2026-Must be given within 4.5 hours from onset of symptoms
Decrease in MAP
Shock
Hypoperfusion
Blood Loss
cardiogenic shock=MI, Dysrhythmias
Colonostomy bag
Ensure the bag is tightly connected to the stoma
may have to burp the bag
use caution when placing seatbelts or straps over the area