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Pulseless VT/VF is a shockable rhythm. Immediate defibrillation with high-quality CPR maximizes survival. Epinephrine and amiodarone follow in subsequent cycles, but shock delivery should not be delayed. Synchronized cardioversion is for perfusing unstable tachycardias, not pulseless states. Paramedic ACLS objectives stress rapid rhythm recognition, early defibrillation, minimizing CPR pauses, and addressing reversible causes (H’s and T’s).

Delirium tremens occurs 48–96 hours after alcohol cessation: agitation, tremors, hallucinations, seizures, autonomic hyperactivity. Hypoglycemia causes altered mentation but resolves with glucose. Stroke is focal neuro deficit. Sepsis presents with fever and hypotension. EMS care includes airway protection, IV access, benzodiazepines per protocol, fluids, and rapid transport.

If HR <60–80 after effective PPV, begin chest compressions (3:1 ratio). If HR remains <60 after 60 sec of compressions + PPV, give epinephrine. Intubation may follow if mask ventilation fails. EMS must adhere to neonatal resuscitation algorithm.

Epiglottitis presents with toxic appearance, drooling, tripod positioning, and stridor. Airway manipulation may cause complete obstruction. Do not attempt field intubation unless patient arrests. The best approach is to keep child calm, provide blow-by oxygen, and transport rapidly. Avoid OPA and forceful positioning. Paramedic airway objectives stress recognizing red flags, minimizing agitation, and preparing for rapid deterioration with backup airway equipment en route.

Placenta previa presents as painless bright red bleeding in the third trimester. Placental abruption causes painful, dark bleeding and uterine tenderness. Uterine rupture presents with severe pain and maternal shock. Miscarriage occurs earlier. Paramedic OB objectives stress no vaginal exams, oxygen, IV fluids, left lateral tilt, and rapid transport.