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For two-rescuer pediatric CPR, the ratio is 15 compressions : 2 breaths. For single rescuer, 30:2 (same as adults). Neonates: 3:1. Adequate depth (1/3 chest diameter), full recoil, and minimizing pauses improve outcomes. Paramedics must remember pediatric-specific ratios and prioritize high-quality compressions with airway/ventilation support.

“Turtle sign” = shoulder dystocia. McRoberts maneuver (knees to chest) and suprapubic pressure relieve impaction. Fundal pressure worsens obstruction. Traction causes brachial plexus injury. C-section is hospital procedure. EMS must be prepared for neonatal resuscitation and maternal hemorrhage after dystocia.

Wheezing and mild respiratory distress in a child is often due to asthma/reactive airway disease or viral bronchiolitis. Initial management includes inhaled beta-agonists (albuterol) delivered via nebulizer or MDI with spacer; ipratropium is beneficial in moderate to severe exacerbations. Titrate oxygen to maintain adequate saturation (commonly ≥94%). Steroids are useful but not immediately acting; they do not replace bronchodilators. IV epinephrine is inappropriate and dangerous here. CPAP is reserved for significant distress or impending failure and may not be tolerated in young children. Paramedic pediatric objectives emphasize minimal agitation, frequent reassessment of work of breathing and auscultation, and ETCO₂ (if available) to gauge ventilation. Consider differential diagnoses (pneumonia focal crackles, foreign body unilateral wheeze). Early bronchodilation improves airflow, reduces work of breathing, and can prevent deterioration requiring advanced airway support.

Post-ROSC care focuses on maintaining perfusion (MAP goals), oxygenation/ventilation (avoid both hypoxia and hyperventilation), and identifying causes. Persistent hypotension after adequate fluid challenge warrants vasopressors (e.g., epinephrine or norepinephrine) per protocol. Excessive crystalloids risk pulmonary edema. Hyperventilation reduces cerebral perfusion and worsens outcomes; maintain ETCO₂ ~35–45 unless directed otherwise. Thrombolysis is hospital-driven unless special protocols exist. Paramedic cardiac objectives include 12-lead acquisition, temperature management per system, glucose correction, seizure control, and rapid transport to PCI-capable centers when indicated.

Acute neurologic deterioration with markedly elevated BP and unequal pupils suggests intracranial hemorrhage with herniation. Ischemic stroke may also present suddenly but is less associated with extreme hypertension and anisocoria. Hypoglycemia can mimic stroke but is ruled out with glucose check. Hypovolemic shock causes hypotension, not hypertension. Paramedic assessment objectives emphasize rapid glucose testing, stroke screening, airway management, blood pressure monitoring, and rapid transport to stroke-capable centers. Avoid aggressive BP reduction in the field.