QCHP Paramedic cheat sheet

Oropharyngeal airway is contraindicated in a patient with an intact gag reflex; a nasopharyngeal airway is preferred when gag is present and no midface trauma exists.

Adult bag-mask ventilation targets 500-600 mL per breath (about 6-7 mL/kg) delivered over 1 second, at 10-12 breaths/min for an adult with a pulse.

Sellick maneuver (cricoid pressure) is applied at the cricoid ring to occlude the esophagus during positive-pressure ventilation in a suspected full-stomach patient.

Oxygen delivery: nasal cannula 1-6 L/min gives roughly 24-44% FiO2; a nonrebreather at 10-15 L/min delivers approximately 90-100% FiO2.

Pulse oximetry SpO2 below 90% indicates hypoxemia; values are unreliable with poor perfusion, carbon monoxide poisoning, or nail polish.

End-tidal CO2 waveform (capnography) confirms tube placement: sustained waveform indicates tracheal placement; loss of waveform suggests esophageal intubation or dislodgement.

Signs of adequate ventilation include chest rise, bilateral breath sounds, and improving SpO2; gastric sounds on auscultation suggest esophageal placement.

Tension pneumothorax, flail chest, and severe asthma are causes of inadequate ventilation requiring assisted ventilation and rapid transport.

Primary survey follows ABCDE: Airway, Breathing, Circulation, Disability (mental status), Exposure; life threats are corrected as found.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15; GCS of 8 or less generally indicates need for airway protection.

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

SAMPLE history collects Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to injury.

Vital sign norms for adults: respiratory rate 12-20/min, heart rate 60-100/min, systolic BP 90-140 mmHg, SpO2 94-100%.

Reassessment intervals: every 5 minutes for unstable patients; every 15 minutes for stable patients during transport.

A focused history and physical is used for patients with a known chief complaint; a rapid trauma assessment is used for significant mechanism of injury.

Adult high-quality CPR: compression rate 100-120/min, depth 5-6 cm, full recoil, and a compression-to-ventilation ratio of 30:2 for one- or two-rescuer adult BLS.

Defibrillation for shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) is delivered as soon as possible; energy per device manufacturer recommendation.

Epinephrine 1 mg IV/IO every 3-5 minutes is the standard vasopressor in adult cardiac arrest; amiodarone is given for refractory VF/pVT.

Symptomatic bradycardia with a pulse is treated with atropine 0.5 mg IV every 3-5 minutes up to a total of 3 mg, or pacing.

STEMI recognition: ST-segment elevation in two or more contiguous leads; time from symptom onset to reperfusion is the key determinant of outcome.

A 12-lead ECG should be obtained within 10 minutes of arrival for suspected acute coronary syndrome; aspirin 160-325 mg chewed is given if not contraindicated.

Cardiogenic shock presents with hypotension, cool clammy skin, and altered mental status; treatment includes cautious fluid and vasopressor support.

The primary survey in trauma follows ABCDE; catastrophic hemorrhage is controlled with direct pressure and tourniquet before airway management when it is the immediate threat.

A tourniquet is applied 5-7 cm proximal to the wound and is not loosened once applied; the time of application is recorded.

Signs of tension pneumothorax include unilateral absent breath sounds, tracheal deviation away from the affected side, and hypotension; treatment is needle decompression.

Flail chest produces paradoxical movement of the chest wall; treatment is positive-pressure ventilation and stabilization.

Spinal immobilization is indicated for suspected spinal injury with neurologic deficit, altered mental status, or significant mechanism of injury.

Hypovolemic shock in trauma is treated with controlled fluid resuscitation, typically isotonic crystalloid, while definitive hemorrhage control is arranged.

Burns are estimated by the rule of nines: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%.

Hypoglycemia presents with altered mental status, diaphoresis, and tremors; treatment is oral glucose if the patient can swallow, or IV dextrose/glucagon if not.

Status epilepticus is a seizure lasting more than 5 minutes or repeated seizures without recovery; treatment includes airway support and benzodiazepines.

Anaphylaxis is treated with intramuscular epinephrine 0.3-0.5 mg (1:1000) into the lateral thigh, repeated every 5-15 minutes as needed.

Stroke recognition uses the FAST mnemonic: Face droop, Arm weakness, Speech difficulty, Time of onset; onset time determines thrombolytic eligibility.

Asthma exacerbation treatment includes supplemental oxygen, inhaled beta-2 agonist, and ipratropium; severe cases may need systemic corticosteroids.

Opioid overdose presents with respiratory depression and pinpoint pupils; treatment is naloxone titrated to restore adequate breathing.

Diabetic ketoacidosis presents with hyperglycemia, ketosis, and metabolic acidosis; treatment is fluid resuscitation and insulin therapy.

The five rights of medication administration are right patient, right drug, right dose, right route, and right time.

Intravenous push medications are given over the rate specified by protocol; rapid push of concentrated drugs can cause arrhythmia or extravasation.

Epinephrine 1:10,000 (0.1 mg/mL) is used IV/IO in cardiac arrest; 1:1000 (1 mg/mL) is used IM for anaphylaxis.

Naloxone is titrated to adequate respiration rather than full alertness to avoid withdrawal and agitation.

An IV site should be checked for patency, infiltration, and phlebitis; infiltration causes swelling and pain and requires immediate discontinuation.

Drug calculations use the formula: dose ordered / dose on hand × volume on hand = volume to administer.

Adenosine is given as a rapid IV push followed by a saline flush for stable narrow-complex supraventricular tachycardia.

Pediatric vital signs vary by age: infants have higher heart and respiratory rates; a normal infant heart rate is roughly 100-160/min.

Pediatric CPR uses a compression-to-ventilation ratio of 30:2 for one rescuer and 15:2 for two rescuers.

In a pregnant patient beyond 20 weeks, left lateral uterine displacement improves venous return during CPR.

Eclampsia is treated with magnesium sulfate; the loading dose is typically 4-6 g IV over 15-20 minutes per protocol.

Postpartum hemorrhage is most commonly caused by uterine atony; treatment includes fundal massage and uterotonic agents.

Neonatal resuscitation begins with warming, drying, and stimulation; positive-pressure ventilation is started if the heart rate is below 100/min.

Shoulder dystocia is managed by calling for help, positioning the mother, and applying suprapubic pressure, not fundal pressure.

Scene safety assessment precedes patient contact; hazards include traffic, fire, hazardous materials, and violence.

The emergency vehicle driver is responsible for due regard for the safety of others; emergency privileges do not remove liability for reckless driving.

Ambulance collision risk increases with speed and at intersections; intersections require slowing and clearing before proceeding.

Standard precautions require gloves, and eye/mask protection when splash risk exists; hand hygiene follows every patient contact.

Hazardous materials scenes require identification from a safe distance using placards and the emergency response guidebook before entry.

Patient lifting should use proper body mechanics with the load close to the body and legs used for lifting to reduce back injury.

Decontamination is performed before transport for patients exposed to hazardous substances.

Informed consent requires capacity, disclosure of risks and benefits, and voluntariness; treatment without consent may proceed under implied consent in an emergency.

Patient confidentiality is a legal and ethical duty; disclosure is permitted only for legal reporting requirements or with patient authorization.

Advance directives and do-not-resuscitate orders must be verified and honored per local policy and the applicable Qatari health regulations.

Mandatory reporting includes suspected abuse, certain communicable diseases, and specified incidents as defined by Qatari health authority requirements.

Scope of practice is defined by the licensing authority; paramedics must not perform interventions outside their authorized scope.

Documentation must be contemporaneous, objective, and complete; it is a legal record and may be used in litigation.

The Qatar Council for Healthcare Practitioners (QCHP) is the licensing body for healthcare practitioners in Qatar, and continuing professional development is required for license renewal.