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Pre-eclampsia A pregnancy complication characterized by hypertension after 20 weeks gestation with signs of organ involvement. Key Findings - BP ≥ 140/90 - Protein in urine (proteinuria) - Headache - Visual disturbances - Edema (face/hands) - Epigastric or RUQ pain EMS Concerns - May progress to eclampsia (seizures). - Monitor airway and blood pressure. - Magnesium sulfate is the treatment for seizures. Hydrocephalus (Children) Hydrocephalus is the accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles. Key Signs in Infants - Enlarged head circumference - Bulging fontanelle - “Sunsetting eyes” (downward gaze) - Irritability - Vomiting Causes - Congenital defects - Infection - Brain tumors - Intraventricular hemorrhage Many children are treated with a ventriculoperitoneal (VP) shunt. Delta Wave A delta wave is an ECG finding associated with Wolff-Parkinson-White (WPW) syndrome. ECG Characteristics - Short PR interval - Slurred upstroke of the QRS complex (delta wave) - Wide QRS Why it Happens An accessory pathway allows electrical signals to bypass the AV node. Clinical Risk Can cause supraventricular tachycardia (SVT). Osborn Wave (J Wave) An Osborn wave is a positive deflection at the J-point on an ECG. Most Common Cause Hypothermia Other Possible Causes - Hypercalcemia - Brain injury ECG Clue Small “camel hump” or notch at the end of the QRS complex. J-Point The J-point is the location where the QRS complex ends and the ST segment begins. Why It Matters ST elevation or depression is measured starting at the J-point. Clinical Relevance Used to identify STEMI or ischemia. Lead Poisoning in Children Lead poisoning is most common in children exposed to old paint or contaminated environments. Symptoms - Developmental delay - Abdominal pain - Irritability - Learning problems - Seizures in severe cases Sources - Old house paint - Contaminated water pipes - Soil contamination

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