Blog

Scenario: Enroute  The Paramedic is dispatched to a birthing center for a 29-year-old patient who is in active labor. The time of the call is 0600. The response time will be 10 minutes.   The Paramedic is partnered with an EMT, and a BLS fire department engine crew is dispatched with an ambulance. The patient is located inside the birthing center. It’s a clear spring afternoon, and the temperature is 88°F (31°C). A small hospital is located 15 minutes away, and the nearest comprehensive medical facility is 30 minutes away.   Scenario: Scene  The patient (70 kilograms) is sitting awake in the birth center water room inside a bathtub. The midwife states the patient has been in labor for 5 hours and started having imminent delivery 10 minutes ago. The infant’s head is delivered, but you notice the umbilical cord is tightly wrapped around the neck. The patient has a history of 39-week gestation, gravida 4, parity 3, and no abortions. Prenatal care is up to date, and no complication reported with previous and current pregnancy. Patient’s birth plan was a water birth, and no complications were indicated prior to labor. The patient has allergies to penicillin and iodine. The patient’s skin is cool, clammy, and diaphoretic. The amniotic sac has ruptured with 200 mL of vaginal bleeding visible; patients obey motor commands. Eyes are open, and the pupils are 5 mm and reactive to light. The vital signs are BP 110/60, P 118, R 20, SpO2 96% on room air, and T 98.6°F (37°C). The blood glucose is 80 mg/dL.   Scene  What is your first intervention? 

Clinical Judgement: On scene phase You are dispatched to a residence for a 4-month-old male patient; 15 pound experiencing a prolonged seizure. The caregiver reports the child has been seizing for over 10 minutes and is unresponsive. The apartment is dimly lit, and the caregiver single father, 22 years old, he appears anxious but inconsistent in their story. No visible signs of trauma in the environment. The father reports the baby was “acting weird,” then started convulsing. No known medical conditions, Full term birth, no complication. Vaccination is up to date, no known medication allergies. Patient is currently seizing with irregular, periods of apnea, respiratory rate 20 breaths/min, SpO2 90% on room air. Patient is warm, pale, weak pulse at 160 bpm, capillary refill >3 seconds, and Glasgow Coma Scale 6. The patient continues to seize despite all efforts; you decide to administer Diazepam to treat Status epilepticus. Diazepam is supplied as 10 mg/2 mL. How many milliliters will you administer?

What action must an EMS provider take when a 16-year-old patient tells you a relative has sexually assaulted him?

You have recently performed a field delivery. The mother continues to bleed vaginally and has lost approximately 800-1000 ml. Which of the following should you do FIRST?

You are preparing to intubate a 4-year-old apneic patient. Which of the following uncuffed endotracheal tube sizes would be MOST appropriate?

ALS providers are dispatched to a daycare facility for a child short of breath. After assessing the patient, they suspect the child has croup. What unique treatment plan would they offer this patient during transport, if available?

Which of the following is the most likely clinical finding in a pediatric patient with a significant hemothorax?

Clinical Judgement: Enroute phase You are dispatched to a residential home for a 2-year-old female; 22 pound with burn injuries. The caregiver states the child “accidentally spilled hot water on herself” while playing in the kitchen. What will be the most concerning finding on this pediatric patient?

You arrive on the scene of a house fire. You are presented with an infant who has burns covering both legs. Which of the following represents the correct percentage of surface area involved?

You are treating a 7-year-old patient in cardiac arrest. The monitor shows ventricular fibrillation. Which of the following would be the appropriate energy setting for the SECOND shock if the patient weighs 30 kg?