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Paramedic Medical Study Guide

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This study guide covers Medical Emergencies for paramedics. It aligns with the NREMT Paramedic certification exam, National EMS Scope of Practice Model 2019 (with updates), National EMS Education Standards, AHA ACLS/PALS 2025 Guidelines (current as of 2026), and current evidence-based protocols for prehospital medical care (e.g., NAEMSP position statements, ACEP/NAEMT guidelines). Medical emergencies are a core focus of the NREMT Paramedic exam, heavily tested in Medical, Cardiology/Resuscitation, and Special Patient Populations domains. Paramedic Scope in Medical Emergencies: Advanced airway management (ETT, supraglottic, RSI/DSI), IV/IO access & fluid/medication administration, cardiac monitoring & 12-lead ECG, advanced pharmacology (antiarrhythmics, vasopressors, sedatives, analgesics, antiemetics, etc.), CPAP/BiPAP, needle decompression (in some protocols), and transport to appropriate specialty centers (stroke, STEMI, sepsis). Key Principle: Perform rapid primary survey (ABCs), obtain detailed SAMPLE/OPQRST history, interpret ECG/EtCO&sub2;/capnography, treat reversible causes (Hs & Ts in arrest), and provide time-sensitive interventions (e.g., fibrinolytics in some rural protocols, early antibiotics in sepsis). Always reassess and escalate care as needed.

Disclaimer: This is a study aid, not official. For PDF, copy into a word processor and export. Always follow current local protocols, NREMT skill sheets, and the latest AHA/ACLS/PALS updates.

Section 1: Cardiac / ACS / Arrhythmia Management (ACLS 2025)

Condition Key Signs/Symptoms & ECG Findings Paramedic Interventions Key Notes / 2025 Updates
STEMI / Acute Coronary Syndrome Chest pain/pressure, radiation, diaphoresis, nausea; ST elevation ≥1 mm in ≥2 contiguous leads Aspirin 325 mg chewed; nitroglycerin 0.4 mg SL/IV q5min (if BP allows); heparin 60 units/kg IV bolus (max 4,000); morphine or fentanyl for pain; 12-lead ECG transmission; transport to PCI-capable center Goal: Door-to-balloon <90 min; avoid routine high-dose nitro if inferior MI.
Unstable Bradycardia Hypotension, altered mental status, shock; HR <50 Atropine 1 mg IV q3–5min (max 3 mg); transcutaneous pacing if unresponsive; dopamine/epinephrine infusion 2025: Atropine dose standardized at 1 mg; escalate to pacing early.
Unstable Tachycardia (Narrow & Wide) Hypotension, chest pain, AMS, shock Synchronized cardioversion (narrow regular: 50–100 J; wide: 100 J); adenosine 6 mg → 12 mg rapid IV push for stable narrow-complex SVT Sedation if conscious; amiodarone/lidocaine for refractory VT. VF / Pulseless VT No pulse, shockable rhythm CPR; defibrillation 120–200 J biphasic; epinephrine 1 mg q3–5min; amiodarone 300 mg → 150 mg Early defibrillation priority; waveform capnography to guide quality.

Section 2: Respiratory Emergencies

Condition Signs/Symptoms Paramedic Interventions Key Notes
Severe Asthma / COPD Exacerbation Severe wheezing, silent chest, accessory muscles, SpO&sub2; <90%, hypercapnia Continuous nebulized albuterol + ipratropium; magnesium sulfate 2 g IV over 20 min; CPAP/BiPAP; epinephrine 0.3–0.5 mg IM if anaphylaxis component; ketamine for DSI if needed Avoid routine antibiotics; monitor for fatigue/hypercarbia.
Pulmonary Edema / CHF Pink frothy sputum, rales, JVD, SpO&sub2; <90% CPAP 5–10 cmH&sub2;O; nitroglycerin IV infusion (start 20–50 mcg/min, titrate); furosemide 20–40 mg IV; morphine (cautious); high-flow O&sub2; Preload/afterload reduction priority; avoid fluid bolus.
Anaphylaxis Stridor, angioedema, hypotension, bronchospasm Epinephrine 0.3–0.5 mg IM (repeat q5–15min); diphenhydramine 25–50 mg IV; methylprednisolone 125 mg IV; fluids 500–1,000 mL; albuterol nebulized Early IM epi is lifesaving; monitor for biphasic reaction.

Section 3: Neurological Emergencies

Condition Signs/Symptoms Paramedic Interventions Key Notes
Acute Ischemic Stroke Sudden focal deficit (FAST); last known normal <4.5 h; Cincinnati Prehospital Stroke Scale; glucose check; high-flow O&sub2; if hypoxic; rapid transport to stroke center; avoid BP meds unless >220/120 Time is brain; note exact onset time; no aspirin if stroke suspected.
Status Epilepticus Continuous or recurrent seizures >5 min Midazolam 0.2 mg/kg IV/IM/IN (max 10 mg); lorazepam 0.1 mg/kg IV; second-line: levetiracetam 20–60 mg/kg IV or fosphenytoin Protect airway; check glucose; RSI if airway compromise.
Altered Mental Status AMS of unknown etiology Fingerstick glucose; naloxone 2 mg IN/IV; thiamine 100 mg IV before dextrose; check temperature; 12-lead ECG; rapid transport AEIOU-TIPS mnemonic; broad differential.

Section 4: Metabolic / Toxicological Emergencies

Condition Signs/Symptoms Paramedic Interventions Key Notes
Diabetic Ketoacidosis / HHS Hyperglycemia (>250), Kussmaul respirations, dehydration, AMS IV fluids (NS 500–1,000 mL bolus then 250–500 mL/h); check K+; transport Insulin only in hospital; focus on fluids.
Opioid Overdose Respiratory depression, pinpoint pupils, AMS Naloxone 0.4–2 mg IV/IN titrated; ventilate with BVM; advanced airway if needed 2025: Titrate to respiratory effort; avoid large bolus if chronic user.
Acetaminophen Overdose Nausea, vomiting; later hepatic failure Activated charcoal if <1–2 h ingestion & alert; transport for N-acetylcysteine Bring medication containers.

Section 5: Infectious / Sepsis

Section 6: NREMT Paramedic Skill Emphasis & High-Yield Scenarios

Example Math (Fluid Bolus Calculation):

Question: 70 kg adult in sepsis. Protocol: 30 mL/kg crystalloid bolus. How many mL total? Solution: 30 mL/kg × 70 kg = 2,100 mL (2.1 L). Reasoning: Multiply weight-based dose by patient weight for total volume. Review NREMT Paramedic skill sheets (e.g., Cardiac Arrest Management, Intravenous Therapy, 12-Lead ECG), ACLS/PALS algorithms, and practice medical scenarios with ECG interpretation and medication titration. Good luck on your paramedic certification—assess thoroughly, treat aggressively, and transport smartly!