PHECC Paramedic cheat sheet

Cardiac arrest with shockable rhythm (VF/pVT): defibrillate immediately, then CPR 2 min before rhythm recheck; adrenaline 1 mg IV/IO every 3-5 min after the second (or third) shock.

Non-shockable arrest (asystole/PEA): CPR immediately, adrenaline 1 mg IV/IO every 3-5 min, and treat reversible causes (4 Hs and 4 Ts).

Amiodarone 300 mg IV/IO bolus after the third shock in refractory VF/pVT; a further 150 mg may follow after the fifth shock.

Anaphylaxis: adrenaline 0.5 mg IM (1 mg/mL) into the anterolateral thigh; repeat every 5 min as needed; IV adrenaline only by experienced providers with monitoring.

RSI checklist sequence: pre-oxygenate, optimise haemodynamics, ketamine or etomidate induction, rapid-onset neuromuscular blocker, intubate, confirm with waveform capnography.

Waveform capnography: ETCO2 <1.3 kPa (10 mmHg) during CPR suggests poor compression quality or a misplaced/obstructed tube; a sudden rise suggests ROSC.

Tension pneumothorax: needle decompression at the 2nd intercostal space mid-clavicular line (or 4th-5th ICS anterior axillary line) before positive-pressure ventilation worsens it.

Synchronised cardioversion is required for unstable tachycardia with a palpable pulse; unsynchronised shocks are used only for VF/pVT.

Adult CPR: compressions at 100-120/min, depth 5-6 cm, full recoil, minimise interruptions to <10 s, and switch compressor every 2 min.

Adult BVM ventilation with an advanced airway: 1 breath every 6 s (10/min) without pausing compressions; without an advanced airway use 30:2.

STEMI criteria: ST elevation in two contiguous leads (or new LBBB with ischaemic symptoms); activate the cath lab pathway and give aspirin 300 mg chewed.

Suspected stroke: use a validated prehospital screen (e.g. FAST); note exact time of onset and last known well; avoid unnecessary delays to thrombolysis/thrombectomy.

Hypoglycaemia in a conscious patient: oral glucose 15-20 g; if unconscious or unable to swallow, give IM glucagon or IV glucose and reassess blood glucose in 10-15 min.

Opioid overdose: titrate naloxone to restore adequate respiration, not full consciousness; be prepared for re-sedation because naloxone's half-life is shorter than most opioids.

Paediatric defibrillation: 4 J/kg for the first shock, then 4 J/kg (or higher, up to 10 J/kg) for subsequent shocks; use the largest pads that fit without touching.

Burns: estimate surface area with the palmar rule (patient's palm ~1% BSA) and cool with room-temperature water for up to 20 min, avoiding hypothermia.

Primary survey uses a systematic ABCDE approach; life-threatening findings are corrected as they are found before moving to the next step.

Adult respiratory rates: bradypnoea <12/min and tachypnoea >20/min are abnormal; record rate, rhythm, depth and effort.

Oxygen is a drug: titrate to target saturation (94-98% for most adults; 88-92% for those at risk of hypercapnic respiratory failure).

OPQRST structures pain assessment: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time.

SAMPLE history: Signs/symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to the incident.

Spinal motion restriction is indicated by mechanism plus symptoms, not by mechanism alone; use a collar, blocks and straps, and reassess neurology.

Shock signs: tachycardia, pale/cool clammy skin, delayed capillary refill, anxiety, and falling blood pressure as a late sign.

Handover uses a structured format (e.g. ATMIST or SBAR) that includes patient age, mechanism, findings, treatment given and response.

Scene safety assessment precedes any patient contact; do not enter an unsafe scene without appropriate protection.

Adult compression-to-ventilation ratio for one- or two-rescuer CPR is 30:2; for infants and children with two rescuers it is 15:2.

Recovery position: lateral, head tilted back, upper leg flexed, to maintain a clear airway in an unresponsive patient who is breathing normally.

Choking adult: up to 5 back blows between the shoulder blades, then up to 5 abdominal thrusts, alternating and reassessing after each cycle.

Severe bleeding: apply direct pressure with a dressing; if ineffective, consider a tourniquet placed proximal to the wound and record the time applied.

Anaphylaxis first-line treatment is IM adrenaline into the anterolateral thigh; an auto-injector delivers a fixed dose (commonly 0.3 mg adult, 0.15 mg child).

Febrile convulsion: protect the child from injury, do not restrain or place anything in the mouth, and place in the recovery position once the seizure stops.

AED use: apply pads to bare, dry chest, follow voice prompts, ensure no one touches the patient during analysis and shock delivery.

Community paramedicine aims to reduce avoidable ED attendance and hospital admission by delivering assessment, treatment and referral in the home.

Referral pathways commonly include falls services, chronic disease clinics, GP out-of-hours, palliative care teams and social care.

Frequent fallers should be assessed for medication review, home hazards, vision, gait/balance and postural hypotension.

Heart failure monitoring: daily weight, worsening dyspnoea, orthopnoea and oedema are red flags for decompensation requiring escalation.

COPD: provide smoking cessation support, inhaler technique review and a written action plan; escalate for increased sputum purulence or breathlessness.

Frailty assessment considers falls, cognition, continence, nutrition and polypharmacy; a change in one domain often precipitates a crisis.

Safeguarding: unexplained injuries, delayed presentation, fear or inconsistent history in a vulnerable adult should trigger a safeguarding referral.

Documentation in community settings must record consent, capacity assessment, the care plan agreed and the safety-netting advice given.