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“Turtle sign” indicates shoulder dystocia, an obstetric emergency where the anterior shoulder is impacted behind the pubic symphysis. The first-line maneuver is McRoberts: hyperflex the mother’s hips onto the abdomen to straighten the lumbosacral angle, which often frees the shoulder. Apply firm suprapubic pressure directed posteriorly and laterally to dislodge the anterior shoulder—never fundal pressure, which worsens impaction and risks uterine rupture. Episiotomy does not relieve bony impaction and is not a prehospital maneuver. Pulling on the head risks brachial plexus injury (Erb palsy). Additional steps, if needed and trained, include delivery of the posterior arm or rotational maneuvers (Rubin/Woods). Paramedic obstetric objectives stress calling for additional help, timing/documentation, avoiding excessive traction, and preparing for neonatal resuscitation due to potential hypoxia. After resolution, assess mother for hemorrhage and newborn for compromise. Prompt, sequential application of evidence-based maneuvers improves outcomes for both patients.

Epiglottitis presents with sudden sore throat, stridor, drooling, tripod position, and toxicity. Croup = barking cough. Asthma = wheezing. Anaphylaxis = rash, hypotension, wheeze. EMS management: keep child calm, avoid airway manipulation, provide blow-by O₂, transport emergently.

DKA features ketone production and anion-gap metabolic acidosis. The body compensates with Kussmaul respirations—deep, rapid breathing that lowers CO₂ (respiratory alkalosis compensation). Prior to therapy, serum bicarbonate is low, pH decreased, and ETCO₂ often reduced. Paramedic systems objectives include recognition of dehydration, hyperglycemia, and acidosis, careful fluid resuscitation, airway support, and avoidance of insulin in the field unless specifically authorized. Monitoring ETCO₂ and mental status trends helps assess severity and response to initial care while definitive electrolyte and insulin management occur in-hospital.

Continuous waveform capnography is the most reliable method to confirm and monitor tube placement. Chest rise and auscultation can be misleading. Condensation is unreliable. Paramedic airway protocols require capnography for confirmation and ongoing monitoring.

In pediatrics, HR <60 with poor perfusion despite oxygen/ventilation requires CPR. Bradycardia is most often due to hypoxia. Atropine is for vagal causes or organophosphate poisoning. Epinephrine is for cardiac arrest, not isolated bradycardia with pulse unless progressing. Observation risks deterioration.