6d • Paramedic Talk
Today's prep to pass the National!
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
Occurs when excess serotonin accumulates, often from medication interactions.
Causes
- SSRIs
- MAO inhibitors
- MDMA
- Tramadol
Symptoms
- Agitation
- Hyperthermia
- Tremor
- Clonus
- Hyperreflexia
- Diaphoresis
Treatment
- Benzodiazepines
- Supportive care
- Cooling if hyperthermic
Babinski Reflex
A neurological reflex tested by stroking the sole of the foot.
Normal Adult Response
- Toes curl downward
Abnormal Response (Positive Babinski)
- Big toe extends upward
- Other toes fan outward
Indicates upper motor neuron damage such as:
- Stroke
- Spinal cord injury
- Brain injury
Normal in infants under ~1 year.
Types of Pain
Nociceptive Pain
Pain caused by actual tissue injury.
Examples:
- Trauma
- Burns
- Fractures
Somatic Pain
Pain from skin, muscles, bones, or joints.
Characteristics:
- Localized
- Sharp or aching
Examples:
- Fracture
- Laceration
- Musculoskeletal injury
Visceral Pain
Pain from internal organs.
Characteristics:
- Poorly localized
- Dull or pressure-like
- Often causes referred pain
Examples:
- Appendicitis
- Kidney stones
- Gallbladder disease
Mean Arterial Pressure (MAP)
MAP represents average arterial pressure during a cardiac cycle.
Normal Perfusion Threshold
MAP ≥ 65 mmHg
Below this level:
- Organs may become hypoperfused
- Risk of shock and organ failure
MAP Formula
MAP =(SBP + 2 × DBP) ÷ 3
Example:120/80
MAP = (120 + 160) ÷ 3MAP = 93
Complications of Dialysis
Dialysis patients often have vascular access sites.
Arteriovenous (AV) Fistula
Surgical connection between artery and vein.
Features
- Strong thrill (vibration)
- Bruit heard with stethoscope
- Preferred access type
- Lower infection risk
AV Shunt / Graft
Synthetic tubing connecting artery and vein.
Risks
- Infection
- Clotting
- Bleeding
EMS Considerations
- Never take BP on that arm
- Never start IV in that arm
- If bleeding occurs: Direct pressure
Types of Seizures
Generalized Tonic-Clonic
Formerly called grand mal.
Features:
- Loss of consciousness
- Full body convulsions
- Postictal confusion
Absence Seizure
Brief episodes of staring.
Features:
- Seconds long
- No postictal phase
- Common in children
Focal Seizure
Originates in one area of the brain.
Types:
- Focal aware (patient conscious)
- Focal impaired awareness
Status Epilepticus
Seizure lasting >5 minutes or repeated seizures without recovery.
Treatment:
- Benzodiazepines
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