6d • Paramedic Talk
More NREMTP recommendations!
ALLERGIC REACTION / ASTHMA
Scenario Clue Pattern
- Onset while eating
- Itching neck/chest
- Thick tongue
- Wheezes
- History of asthma
Mild Allergic Reaction
- Localized rash
- Itching
- No airway involvement
- No hypotension
Treatment:
- Antihistamine (diphenhydramine)
- Monitor
Moderate Allergic Reaction
- Diffuse urticaria
- Mild airway involvement
- Wheezing
- GI symptoms
Treatment:
- Epinephrine IM (if systemic)
- Antihistamine
- Steroids
- Albuterol if bronchospasm
Severe Anaphylaxis
- Thick tongue
- Stridor
- Hypotension
- Altered LOC
- Severe bronchospasm
FIRST medication:
Epinephrine IM
Not albuterol. Not Benadryl alone.
Then give the other medications. Don't forget about IV epi infusion.
Asthma Pathophysiology
Asthma =
- Bronchoconstriction
- Airway inflammation
- Mucus production
Leads to:
- Wheezing
- Prolonged expiration
- CO₂ retention (late)
- Fatigue → silent chest (critical)
TOXICOLOGY
Man-Made Toxic Gases
Examples:
- Chlorine
- Phosgene
- Ammonia
- Hydrogen sulfide
Test trick: Many industrial gases end similarly (e.g., "-ine" or "-ide")
Beta Blocker OD
- Bradycardia
- Hypotension
- Hypoglycemia (especially kids)
- Shock
Treatment:
- Glucagon
- Atropine
- Fluids
Methamphetamine OD
- Tachycardia
- Hypertension
- Hyperthermia
- Dilated pupils
- Agitation
Treatment:
- Benzodiazepines
- Cooling
- Supportive care
NEUROLOGY / STROKE
Posterior Stroke Signs
- Vertigo
- Ataxia
- Diplopia
- Dysphagia
- Nystagmus
- Normal FAST possible
Vertigo vs Stroke
Peripheral vertigo:
- Severe spinning
- Nausea
- No focal weakness
Stroke:
- Ataxia
- Weakness
- Slurred speech
- Vision changes
Aphasia + Weakness
That does NOT differentiate ischemic vs hemorrhagic.
Both can cause:
- Aphasia
- Unilateral weakness
You cannot tell type without imaging.
Hemorrhagic Stroke
- Severe headache
- Vomiting
- Rapid decline
- Hypertension
Ischemic Stroke
- More gradual
- Less headache
- Often embolic or thrombotic
Sickle cells occlude cerebral vessels → ischemic stroke.
Why Sickle Cell Hurts
Misshapen RBCs:
- Block capillaries
- Cause tissue ischemia
- Pain crisis
CARDIOLOGY
Unstable Bradycardia at 59
If unstable:
- Hypotension
- AMS
- Chest pain
- Shock
Give:
Atropine before pacing
Know which meds are used for different cardiac arrhythmias
NEONATAL
Neonate with pulse but not breathing:
40–60 breaths per minute
If HR <60:
- Begin compressions 3:1 ratio
PSYCHIATRY
Bipolar Medications
- Lithium
DERM / INFECTIOUS
Tick Bite
Likely:
- Lyme disease
- Erythema migrans (bulls eye rash)
TRAUMA – SPINAL INJURY ORDER
If suspected spinal injury + neuro deficit:
Correct sequence:
- Manual C-spine stabilization
- Airway management
- Apply C-collar
- Assess neurological deficits
- Full immobilization
Do NOT delay airway for collar placement.
GI EMERGENCY
Boerhaave Syndrome
Tear of the:
Esophagus
Usually after:
- Forceful vomiting
- Severe chest pain
- Subcutaneous emphysema
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