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When BVM fails, rapid placement of a supraglottic airway (SGA) such as a King LT or i-gel provides a secure airway, allowing oxygenation and ventilation without requiring visualization of cords. RSI/intubation should not delay immediate oxygenation efforts; chest compressions are only for pulseless patients. Paramedic airway objectives stress following the “cannot ventilate, cannot oxygenate” algorithm, using adjuncts (OPA, NPA), and escalating to SGA promptly. If SGA also fails, surgical cricothyrotomy is the last resort. Early correction prevents hypoxic arrest.

Abruption = premature placental separation, causing painful bleeding, rigid uterus, shock, and fetal distress. Previa = painless bleeding. Rupture = severe pain with palpable fetal parts. EMS: O₂, fluids, left lateral tilt, rapid transport with OB alert.

Most pediatric arrests are secondary to respiratory failure. Immediate BVM ventilation with oxygen is the priority intervention for bradypnea, bradycardia, and hypoxemia. Chest compressions are indicated if HR <60 with poor perfusion after ventilation support. Fluids are not primary. Naloxone is only useful if opioid overdose is confirmed. Paramedic pediatric objectives stress airway and ventilation first, recognizing that oxygenation typically improves bradycardia and perfusion in children.

The classic Beck’s triad (hypotension, muffled heart tones, jugular venous distention) strongly suggests cardiac tamponade. Unlike tension pneumothorax, breath sounds remain equal and lungs are clear. Hemothorax causes dullness to percussion, absent breath sounds, and hypovolemic features without JVD. Neurogenic shock usually shows hypotension with bradycardia, not tachycardia. In the prehospital setting, treatment focuses on rapid recognition, airway and oxygen support, cautious fluid administration, and immediate transport for definitive pericardiocentesis or thoracotomy. Paramedics must recognize obstructive shock patterns and communicate findings early to receiving trauma centers.

If HR <60 after 30 seconds of effective PPV, start chest compressions at 3:1 ratio with ventilation. After 60 seconds of coordinated compressions and ventilation, if HR remains <60, give epinephrine. Intubation may be considered if mask ventilation is ineffective, but compressions come first.