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Eclampsia = preeclampsia (hypertension, edema, proteinuria) + seizures. It is life-threatening to mother and fetus. Management: protect airway, give magnesium sulfate if protocol, oxygen, IV access, rapid transport. Previa = painless bleeding. Abruption = painful bleeding. Uterine rupture = severe pain, fetal parts palpable.

Basilar skull fracture hallmarks include periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle’s sign), and CSF otorrhea/rhinorrhea. These indicate dural tear and intracranial risk. Tachycardia and diaphoresis are nonspecific. Jaw pain is dental/mandibular trauma. Unequal pulses suggest aortic dissection. Field assessment includes cervical spine precautions, airway/ventilation monitoring, avoiding NG tubes (risk of intracranial placement), and rapid transport.

An open pneumothorax (“sucking chest wound”) requires an occlusive dressing taped on three sides to allow air out but not in. Needle decompression is for tension pneumothorax. CPAP worsens injury. Fluids don’t address cause. EMS must reassess for tension and be ready to escalate.

Atropine is the first-line drug for unstable symptomatic bradycardia (hypotension, altered mentation, shock). Dose: 0.5 mg IV push, repeated q3–5 min to max 3 mg. If ineffective, pacing or dopamine/epinephrine infusion may be required. Amiodarone is for tachyarrhythmias. Adenosine slows AV nodal reentry tachycardias, not bradycardia. IM epinephrine is for anaphylaxis. Pharmacology objectives stress recognizing unstable rhythms and applying ACLS medications appropriately.

Normal transitional physiology includes lower oxygen saturations in the first minutes after birth; target SpO₂ rises gradually (e.g., ~60–65% at 1 min, ~65–70% at 2 min, ~70–75% at 3 min, progressing to >85% by 10 min). The infant is breathing with a normal heart rate, so ventilation is adequate. Free-flow supplemental oxygen titrated to targets is appropriate; avoid over-oxygenation which can cause oxidative stress. Chest compressions and epinephrine are indicated for HR <60 despite effective ventilation, which is not the case here. Intubation is reserved for inadequate ventilation, meconium with poor tone, or failed mask ventilation. Paramedic neonatal objectives emphasize warm/dry/stimulate, proper positioning, pulse oximetry on the right hand (pre-ductal), and titration of oxygen using blended sources when available. Reassess frequently; if saturations fail to rise with oxygen or respiratory effort deteriorates, escalate to positive pressure ventilation. Understanding normal saturation trajectories prevents unnecessary invasive interventions.