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Placenta previa—placental implantation over or near the cervical os—classically presents in the third trimester with painless, bright red bleeding. By contrast, placental abruption often involves painful contractions, uterine tenderness, and dark bleeding due to placental separation; uterine rupture is typically catastrophic with severe pain and hemodynamic compromise. In the field, do not perform vaginal exams. Place the patient in left lateral tilt to optimize venous return, establish IV access, monitor vitals, and prepare for significant hemorrhage. Administer oxygen if hypoxemic and monitor fetal movement if the patient can report it; fetal monitoring is hospital-based. Rapid transport to obstetric-capable care is essential. Paramedic OB objectives emphasize hemorrhage recognition, avoidance of digital exams, and readiness for shock management. Trauma can precipitate bleeding in previa due to shear at the placental interface. Reassure the patient, maintain normothermia, and communicate estimated blood loss. Definitive diagnosis and management (e.g., C-section) are hospital responsibilities.

Hypoglycemia requires rapid correction: IV dextrose (D10/D50 depending on protocol) or IM/IN glucagon if IV unavailable. Insulin worsens hypoglycemia. Fluids don’t correct glucose deficit. Epinephrine is not appropriate. Reassess after therapy and transport for evaluation of underlying cause.

For suspected hemorrhagic shock without traumatic brain injury, many protocols support permissive hypotension to avoid dislodging clots and worsening bleeding. A practical field target is mental status adequacy and a palpable radial pulse (roughly SBP ~80–90). Aggressively normalizing SBP with large crystalloid volumes promotes dilutional coagulopathy and hypothermia. For TBI, higher pressures (SBP ≥90–100) are preferred to ensure cerebral perfusion. Diuretics are contraindicated. Paramedic shock objectives stress rapid transport, external hemorrhage control (tourniquet, hemostatic dressings, pelvic binder), limited warmed crystalloids, prevention of hypothermia, and early notification. Continual reassessment guides fluid titration; consider blood products if your system carries them.

The liver stores glycogen and releases glucose through glycogenolysis and gluconeogenesis, maintaining blood sugar. Pancreas produces insulin/glucagon. Kidneys filter blood and contribute to gluconeogenesis but are secondary. Stomach digests food but doesn’t regulate glucose. Paramedic physiology objectives stress metabolic emergencies like hypoglycemia and DKA.

DKA presents with deep rapid respirations (Kussmaul) as compensation, abdominal pain/nausea, and fruity acetone breath odor. It is accompanied by hyperglycemia and dehydration. Management: airway/ventilation support, IV fluids, ECG monitoring, transport for insulin/electrolyte correction.