Meningitis Meningitis is inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. Common Symptoms - Fever - Headache - Neck stiffness - Photophobia - Altered mental status Kernig’s Sign Positive when: - The patient’s hip and knee are flexed - Attempting to extend the knee causes pain or resistance Indicates meningeal irritation. Brudzinski’s Sign Positive when: - Flexing the neck causes the knees and hips to flex involuntarily Also suggests meningeal irritation. Abdominal Organs (Function & Quadrant) Right Upper Quadrant (RUQ) Liver - Detoxifies blood - Produces bile Gallbladder - Stores bile - Releases bile for fat digestion Duodenum - First portion of the small intestine Left Upper Quadrant (LUQ) Stomach - Begins digestion of food Spleen - Filters blood - Helps immune function Pancreas - Produces digestive enzymes - Releases insulin and glucagon Right Lower Quadrant (RLQ) Appendix - Small lymphatic organ - Common site of inflammation (appendicitis) Small intestine Left Lower Quadrant (LLQ) Descending colon - Absorbs water from stool Sigmoid colon - Stores stool before elimination Abdominal Emergencies Common NREMT abdominal emergencies include: Appendicitis - RLQ pain - Nausea - Fever - Pain often starts periumbilical then moves to RLQ Cholecystitis - Gallbladder inflammation - RUQ pain - Pain after fatty meals - May radiate to right shoulder Pancreatitis - Severe epigastric pain - Pain radiates to back - Often associated with alcohol use or gallstones Abdominal Aortic Aneurysm (AAA) - Tearing abdominal or back pain - Pulsating abdominal mass - Life-threatening hemorrhage risk Hepatitis Hepatitis is inflammation of the liver, usually caused by viral infection. Common Symptoms - Fatigue - Jaundice - Abdominal pain - Nausea - Dark urine - Pale stools Hepatitis A Transmission: Fecal–oral route

Parkland Burn Formula Used to estimate fluid resuscitation needs in burn patients during the first 24 hours after injury. Formula: 4 mL × body weight (kg) × % TBSA burned Fluid type: Lactated Ringer’s (preferred) Administration: - Half given in the first 8 hours - Remaining half over the next 16 hours Example: 70 kg patient with 30% burns 4 × 70 × 30 = 8,400 mL - 4,200 mL in first 8 hrs - 4,200 mL over next 16 hrs Key exam pearl: Time starts from the burn injury, not EMS arrival. Compartment Syndrome Occurs when pressure builds within a muscle compartment, reducing blood flow and causing tissue ischemia. Common causes: - Fractures - Crush injuries - Burns - Tight casts or dressings Early Signs (most tested) - Severe pain - Pain with passive stretch - Tight swollen compartment Late Signs - Pallor - Paresthesia - Paralysis - Pulselessness (very late) EMS considerations: - Remove constrictive items - Elevate limb to heart level - Rapid transport Shark Fin Waveform (Capnography) A “shark fin” waveform on capnography indicates airflow obstruction. Common causes: - Asthma - COPD - Bronchospasm - Anaphylaxis Why it happens: Bronchospasm causes slow and uneven exhalation, producing the slanted “fin” appearance. EMS management: - Bronchodilators - Oxygen - Treat underlying cause Pleural Effusion A collection of fluid in the pleural space surrounding the lungs. Common causes: - Congestive heart failure - Cancer - Infection - Liver disease Symptoms: - Shortness of breath - Diminished breath sounds - Dullness to percussion - Chest discomfort Exam clue: Often confused with pneumothorax, but effusion usually presents with dullness rather than hyperresonance. Guillain-Barré vs Multiple Sclerosis Guillain-Barré Syndrome (GBS) Cause: Autoimmune attack on peripheral nerves. Key features: - Ascending paralysis - Begins in legs - May progress to respiratory failure - Often follows a viral infection

Breech Deliveries A breech delivery occurs when the buttocks or feet present first instead of the head. Types Frank Breech - Buttocks first - Legs extended upward toward head Complete Breech - Buttocks first - Knees flexed Footling Breech - One or both feet present first - Highest risk of complications Paramedic Treatment - Rapid transport if delivery is not imminent - If delivery occurs: Do NOT pull the baby - Allow body to deliver spontaneously - Support body as it emerges - If head becomes trapped for more than 3 min: Insert two gloved fingers into the vagina and create an airway by pushing the vaginal wall away from the infant’s face - Provide oxygen to mother - Prepare for neonatal resuscitation Prolapsed Umbilical Cord Occurs when the umbilical cord exits the cervix before the baby, causing cord compression and fetal hypoxia. Concerns - Reduced oxygen to fetus - Rapid fetal distress - Possible fetal death Paramedic Treatment - Position mother in knee-chest or Trendelenburg - Insert gloved hand into vagina - Push presenting part off the cord - Do NOT push the cord back in - Cover exposed cord with sterile saline-moistened dressing - Rapid transport Rapid Atrial Fibrillation (AFib with RVR) AFib with rapid ventricular response (>150 bpm). Stable Patient Patient has adequate blood pressure and perfusion. Treatment: - Cardiac monitoring - IV access - Rate control with Diltiazem or Metoprolol - Treat underlying cause (hypoxia, dehydration, sepsis) Unstable Patient Signs of instability: - Hypotension - Altered mental status - Chest pain - Signs of shock Treatment: - Immediate synchronized cardioversion starting at 200J Toxidromes Extrapyramidal Symptoms (EPS) Usually caused by antipsychotics or dopamine-blocking drugs. Symptoms - Muscle rigidity - Tremors - Restlessness (akathisia) - Dystonia - Parkinson-like movements Treatment - Diphenhydramine Serotonin Syndrome

The narrowest portion of an adult’s airway is the:

Which electrolyte stabilizes the cell membrane and helps potassium maintain resting potential?