Kuwait MOH Paramedic cheat sheet

Oropharyngeal airway: only in patients without a gag reflex; measure from corner of mouth to angle of mandible; it displaces the tongue anteriorly.

Nasopharyngeal airway: contraindicated with suspected basilar skull fracture or severe midface trauma; measure from nostril tip to earlobe; lubricate and insert along the nasal floor.

Bag-valve-mask ventilation targets 6-7 mL/kg (about 500-600 mL in adults) over 1 second per breath, enough for visible chest rise; excess volume causes gastric insufflation and regurgitation.

Adult compression-to-ventilation ratio without advanced airway is 30:2; with an advanced airway, give 1 breath every 6 seconds (10/min) and continuous compressions.

Two-rescuer BVM technique (E-C clamp plus jaw thrust) is more effective than one-rescuer; the Sellick maneuver is not routinely recommended because it can impede ventilation.

Oxygen targets: 94-98% SpO2 for most patients; 88-92% for those at risk of hypercapnic respiratory failure (COPD); titrate to effect rather than giving high-flow oxygen to all.

Supraglottic airways (e.g., i-gel, LMA) do not protect against aspiration and are unsuitable for prolonged ventilation; confirm placement with waveform capnography, chest rise, and bilateral breath sounds.

Signs of esophageal intubation include absent waveform capnography, gurgling epigastrium, progressive hypoxemia, and no chest rise; remove and reattempt rather than leaving the tube in place.

Needle decompression for tension pneumothorax in adults: 2nd intercostal space midclavicular line or 4th-5th intercostal space anterior axillary line, using a large-bore catheter; follow with tube thoracostomy.

Primary survey follows ABCDE: Airway, Breathing, Circulation, Disability (GCS/pupils/glucose), Exposure; intervene immediately as each problem is found.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15; GCS ≤8 indicates need for definitive airway management.

OPQRST for pain: Onset, Provocation/Palliation, Quality, Radiation, Severity, Time; SAMPLE for history: Signs/Symptoms, Allergies, Medications, Past history, Last meal, Events.

Shock index = heart rate ÷ systolic blood pressure; a value >0.9-1.0 in adults suggests significant occult blood loss and need for rapid transport.

Vital sign red flags in adults: SBP <90 mmHg, HR >120 or <50, RR >30 or <8, SpO2 <90% on room air, GCS <13, or glucose <70 mg/dL.

Trend reassessment every 5 minutes for unstable patients and every 15 minutes for stable patients; document and report changes to the receiving facility.

Focused history in trauma uses mechanism of injury plus DCAP-BTLS: Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin; it is completed before touching the child and guides urgency.

Field triage uses physiology (vitals/GCS), anatomy (injury pattern), mechanism, and patient modifiers; patients meeting red criteria go to the highest-level trauma center.

Adult high-quality CPR: rate 100-120/min, depth 5-6 cm (2-2.4 inches), full recoil, minimize interruptions to <10 seconds, and switch compressors every 2 minutes.

Defibrillation: biphasic 120-200 J (manufacturer recommendation) or monophasic 360 J; resume compressions immediately after the shock without checking a pulse.

Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; non-shockable are asystole and pulseless electrical activity.

Epinephrine 1 mg IV/IO of 1:10,000 every 3-5 minutes in cardiac arrest; amiodarone 300 mg IV/IO after the third shock, then 150 mg once.

Reversible causes (Hs and Ts): hypoxia, hypovolemia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis (coronary and pulmonary).

ROSC signs: palpable pulse, rise in end-tidal CO2 (typically >40 mmHg), spontaneous breathing, and improved blood pressure; post-ROSC target SpO2 94-98% and avoid hyperventilation.

Acute coronary syndrome: give aspirin 160-325 mg chewed, nitroglycerin 0.4 mg sublingual if SBP >90 mmHg and no recent PDE-5 inhibitor use, and obtain a 12-lead ECG within 10 minutes.

Symptomatic bradycardia: atropine 1 mg IV every 3-5 minutes up to 3 mg; if ineffective, use transcutaneous pacing or a dopamine/epinephrine infusion.

Unstable tachycardia with a pulse: synchronized cardioversion starting at 50-100 J for narrow-complex, 100 J for narrow regular SVT, and 100-200 J for wide-complex; sedation if conscious.

Anaphylaxis: epinephrine 0.3-0.5 mg IM (1:1000) into the anterolateral thigh, repeated every 5-15 minutes as needed; adjuncts include oxygen, IV fluids, and antihistamines.

Asthma: albuterol 2.5 mg nebulized plus ipratropium 0.5 mg, corticosteroids, and magnesium sulfate 2 g IV over 20 minutes for severe exacerbations.

Status epilepticus: benzodiazepines first (midazolam 10 mg IM or 5 mg IV/IN, or lorazepam 4 mg IV); if seizures persist, use a second-line agent such as levetiracetam or fosphenytoin.

Hypoglycemia: if glucose <70 mg/dL and the patient can swallow, give oral glucose; if unconscious, give dextrose 50% 25 g IV or glucagon 1 mg IM.

Stroke: use the Cincinnati Prehospital Stroke Scale (facial droop, arm drift, abnormal speech); note the last known well time and transport to a stroke-capable facility without delay.

Diabetic ketoacidosis presents with polyuria, polydipsia, Kussmaul respirations, fruity breath, and glucose usually >250 mg/dL; give isotonic fluids and transport.

Upper GI bleeding: maintain airway, give IV fluids, and consider tranexamic acid per protocol; keep the patient NPO and monitor for hypovolemic shock.

Opioid overdose: give naloxone 0.4-2 mg IV/IM/IN, titrating to adequate respirations rather than full consciousness, and support ventilation with a BVM.

Hemorrhage control sequence: direct pressure, wound packing with hemostatic gauze, then a tourniquet placed 5-7 cm above the wound and tightened until bleeding stops; note the application time.

Permissive hypotension in trauma targets SBP about 80-90 mmHg (or a palpable radial pulse) until hemorrhage is controlled, except in TBI where SBP ≥110 mmHg is preferred.

Tension pneumothorax signs: unilateral absent breath sounds, tracheal deviation away from the affected side, distended neck veins, and hypotension; treat with needle decompression before ventilation deteriorates.

Flail chest: three or more adjacent ribs fractured in two or more places; manage with positive-pressure ventilation and analgesia rather than rib binding.

Pelvic fracture: apply a pelvic binder at the level of the greater trochanters and give IV fluids; avoid repeated log-rolling.

Head injury: maintain SpO2 ≥94%, normocapnia (ETCO2 35-45 mmHg), head elevation 30 degrees, and avoid hypotension and hypoxia, both of which worsen outcomes.

Burns: use the Rule of Nines (each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%); give fluids per the Parkland formula (4 mL × kg × %TBSA) with half in the first 8 hours.

Trauma triage: transport to a Level I or II trauma center for GCS <14, SBP <90, RR <10 or >29, penetrating torso injury, or flail chest.

Spinal motion restriction is indicated for midline tenderness, neurological deficit, altered mental status, or distracting injury; use a rigid collar plus backboard only when needed for extrication.

In pregnancy, the uterus is displaced left; perform manual left uterine displacement or tilt the patient 15-30 degrees to relieve aortocaval compression.

Cardiac arrest in pregnancy: continue CPR, and if the uterus is at or above the umbilicus with no ROSC by 4 minutes, perform perimortem cesarean delivery within 5 minutes.

Eclampsia: give magnesium sulfate 4-6 g IV over 20 minutes, then 1-2 g/hour; monitor for loss of deep tendon reflexes, respiratory depression, and oliguria as signs of toxicity.

Pediatric vital signs: HR 100-160 in infants, RR 30-60 in newborns, and SBP roughly 70 + (2 × age in years) for children 1-10 years.

Pediatric defibrillation: use 2 J/kg for the first shock, 4 J/kg for the second, and ≥4 J/kg (max 10 J/kg or adult dose) thereafter; use the smallest pads that fit.

Geriatric patients: polypharmacy and reduced physiologic reserve mean drugs act longer and more strongly; start low and titrate, and assess for dehydration and hypothermia.

Bariatric patients: use a bariatric stretcher rated for the weight, plan lifting with adequate personnel, and expect difficult IV access and airway management; consider a ramp position for intubation.

Neonatal resuscitation: initial steps are warming, drying, stimulating, and positioning; use the 3:1 compression-to-ventilation ratio with 90 compressions and 30 breaths per minute.

Child abuse red flags: injuries inconsistent with the history, injuries in nonmobile infants, patterned or spiral fractures, and delay in seeking care; report per local law.

Five rights: right patient, right drug, right dose, right route, right time; add right documentation and right reason in EMS practice.

IV push rates: most adult drugs are given over 1-2 minutes; adenosine 6 mg is given as a rapid push followed by a saline flush, and amiodarone is diluted and given over 10 minutes outside arrest.

Epinephrine concentrations: 1:1,000 (1 mg/mL) for IM anaphylaxis; 1:10,000 (0.1 mg/mL) for IV/IO cardiac arrest; never give 1:1,000 IV.

Nitroprusside, nitroglycerin, and other vasodilators are contraindicated with SBP <90 mmHg or recent PDE-5 inhibitor use (sildenafil within 24 hours, tadalafil within 48 hours).

Pediatric dosing is weight-based (mg/kg); use a length-based tape or calculated weight, and never exceed the adult dose.

Drug routes in order of onset: IV/IO fastest, then IM, then subcutaneous, then oral; IO access can be used for all resuscitation drugs and fluids.

Aspirin is contraindicated with active GI bleeding or true aspirin allergy; give 160-325 mg chewed for suspected ACS.

Dextrose 50% 25 g IV or glucagon 1 mg IM raises blood glucose; glucagon works even without IV access but requires liver glycogen stores.

Document drug, dose, route, time, indication, response, and any adverse effect for every medication given.

Hazmat zones: hot zone requires full PPE and no unprotected entry; warm zone is the decontamination corridor; cold zone is the safe treatment area.

Decontamination is performed before the patient enters the ambulance; remove clothing (removes most contaminant) and use copious water irrigation, avoiding runoff into uncontained areas.

CHEMPACK and antidote pairs: organophosphate nerve agent uses atropine plus pralidoxime; cyanide uses hydroxocobalamin; opioid uses naloxone.

Incident command uses a single Incident Commander with sections for Operations, Planning, Logistics, and Finance/Administration; EMS reports to the medical branch within Operations.

Triage uses START for adults (RPM: respiration, perfusion, mental status) and JumpSTART for children; categories are immediate (red), delayed (yellow), minor (green), and deceased/expectant (black).

Vehicle extrication: stabilize the vehicle, disconnect the battery, and use hydraulic tools; maintain spinal precautions and protect the patient from glass and sharp edges.

Confined space and trench rescue require atmospheric monitoring (O2 19.5-23.5%, LEL <10%, H2S <10 ppm, CO <35 ppm) before entry.

Mass casualty communication uses plain language, not codes, and includes the number of patients, severity, location, and resource needs in the initial report.

Weapons of mass destruction: a secondary device is common, so stage upwind and uphill, establish command outside the hot zone, and do not enter until the scene is declared safe.

A patient care report must include dispatch and response times, scene findings, vital signs with times, interventions, response to treatment, and refusal or transfer details.

Refusal of care requires the patient to be alert and oriented, informed of risks, and to sign; document capacity, the specific risks explained, and any advice to seek care.

HIPAA permits disclosure of protected health information for treatment, payment, and operations, and as required by law; minimum necessary applies.

Consent types: expressed (verbal/written), implied (unconscious or life-threatening emergency), and informed consent requires capacity, information, and voluntariness.

Do-not-resuscitate orders must be valid in the jurisdiction; verify identity, signature, and date, and follow local protocol if the document cannot be verified.

Response mode: use lights and sirens only when time-critical; emergency driving increases crash risk and should follow local policy and due regard for safety.

Documentation of vital signs should include time, method, and position; repeat vitals are required after any intervention.

Professionalism includes scope of practice adherence, honesty in documentation, and reporting of errors or near misses through the appropriate channel.

Chain of custody is required for evidence such as weapons, drugs, or clothing; document each handoff and keep items secured.

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask, eye protection, and safe sharps handling regardless of diagnosis.

Hand hygiene with soap and water for 40-60 seconds, or alcohol-based rub for 20-30 seconds; wash with soap and water when hands are visibly soiled or after C. difficile exposure.

N95 respirators require fit testing and are used for airborne precautions such as tuberculosis, measles, and varicella; surgical masks are for droplet precautions.

Needlestick injury: wash the site with soap and water, report immediately, and follow post-exposure prophylaxis protocols; do not squeeze or scrub the wound.

Bloodborne pathogen exposure risk is highest for hepatitis B (up to 30% from a needlestick) followed by hepatitis C (about 3%) and HIV (about 0.3%).

PPE doffing order removes the most contaminated item first: gloves, then goggles/face shield, gown, and mask/respirator last; perform hand hygiene after.

Ambulance disinfection: clean high-touch surfaces (stretcher, rails, monitor, door handles) with an EPA-registered disinfectant between patients and after body fluid contamination.

Scene safety: assess for traffic, violence, hazardous materials, and environmental hazards before exiting the vehicle; request law enforcement when the scene is unsafe.

Immunizations recommended for EMS personnel include hepatitis B, influenza, Tdap, and MMR; TB screening is performed at baseline and periodically.