Paramedic OB/Pediatrics Study Guide
Download Study Guide PDFThis study guide covers Obstetrics (OB) and Pediatrics for paramedics, aligned with NREMT paramedic certification standards (National EMS Scope of Practice Model 2019 with updates), AHA BLS/ACLS/PALS 2025 Guidelines (current as of 2026), and national EMS education standards. OB/Peds represents about 10-15% of NREMT exam content in categories like Cardiology/Resuscitation, Resuscitation, and Medical/OB/GYN. Key focus: Anatomical/physiological differences in peds/pregnant patients, assessment triangles, emergency deliveries, resuscitation, and common pathologies. Always prioritize ABCs, use length-based resuscitation tape (e.g., Broselow) for peds dosing/equipment, and consider family-centered care. For pregnant patients >20 weeks, transport on left lateral side to avoid vena cava compression. AHA 2025 Updates: Emphasis on early recognition of shock in peds (e.g., compensated vs. hypotensive); refined neonatal resuscitation (e.g., delayed cord clamping if possible); integration of capnography in peds ventilation; no routine use of high-flow O&sub2; in uncomplicated deliveries.
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Section 1: Obstetrics (OB) Overview
Pregnancy Physiology:
- Uterus displaces organs; Increased blood volume (40-50%); Respiratory changes (higher RR, lower PaCO&sub2;); Supine hypotension syndrome >20 weeks.
- Gestational Age: Term: 37-42 weeks; Preterm: <37 weeks; Viability ~24 weeks.
- Assessment: Gravida/Para (G/P), last menstrual period (LMP), prenatal care, complications (e.g., preeclampsia: HTN + proteinuria/edema).
Common OB Emergencies
| Emergency | Signs/Symptoms | Management | Notes/AHA 2025 |
|---|---|---|---|
| Ectopic Pregnancy | Lower abdominal pain, vaginal bleeding, shoulder pain (rupture). | ABCs; IV access; Fluid bolus if shock; Rapid transport. | Suspect in reproductive-age females with abdominal pain; Surgical emergency. |
| Preeclampsia/Eclampsia | HTN (>140/90), headache, visual changes, seizures (eclampsia). | Left lateral position; Mag sulfate 4-6 g IV load (eclampsia); BP control (labetalol/hydralazine if severe). | 2025: Monitor for HELLP syndrome; Seizure prophylaxis priority. |
| Placental Abruption | Painful vaginal bleeding, uterine tenderness, fetal distress. | IV fluids; Monitor fetal HR; Transport. | Trauma common cause; DIC risk. |
| Placenta Previa | Painless bright red bleeding. | Avoid vaginal exam; IV fluids; Transport. | Cesarean needed. |
| Prolapsed Cord | Cord visible/palpable; Fetal bradycardia. | Knee-chest position; Manual cord elevation; Urgent transport. | Keep cord warm/moist. |
| Postpartum Hemorrhage | >500 mL blood loss; Uterine atony, lacerations. | Fundal massage; Oxytocin 10-40 units IV/IM; TXA 1 g IV if trauma. | 2025: Early TXA in massive bleed; Bimanual compression if needed. |
Normal/Abnormal Delivery
- Stages of Labor: 1st (cervical dilation), 2nd (delivery), 3rd (placenta).
- Indications for Field Delivery: Crowning, urge to push, contractions <2 min apart.
- Steps for Normal Delivery (NREMT Skill): BSI/PPE; Prepare OB kit. Support perineum; Guide head (control expulsion). Check for nuchal cord (slip over head or clamp/cut if tight). Deliver shoulders (anterior first, gentle traction). Clamp/cut cord (2 clamps, 4-6 inches from baby). Dry/stimulate/warm newborn; Assess APGAR at 1/5 min. Deliver placenta; Fundal massage.
- Abnormal Deliveries:
- Breech: Support body; If head trapped, Mauriceau maneuver or suprapubic pressure.
- Shoulder Dystocia: McRoberts maneuver (knees to chest); Suprapubic pressure; Woods screw (rotate posterior shoulder).
- Multiple Births: Clamp each cord; Expect postpartum bleed.
Section 2: Neonatal Resuscitation (AHA 2025 NRP Integration)
- Initial Assessment: Term? Tone? Breathing/crying?
- Routine Care (Uncomplicated): Dry, warm, stimulate; Skin-to-skin if stable; Delayed cord clamping (30-60 sec if vigorous).
- Resuscitation Algorithm: Warm/dry/stimulate (tactile: Back rub, foot flick).
- If HR <100 or apnea/gasping: PPV at 40-60/min (BVM or T-piece).
- If HR <60 after 30 sec PPV: Chest compressions (3:1 ratio, thumbs encircling or 2-finger).
- Epinephrine: 0.01-0.03 mg/kg IV/IO (1:10,000) if HR <60 after compressions + ventilation.
- Volume: 10 mL/kg NS if blood loss.
- APGAR Score: Appearance, Pulse, Grimace, Activity, Respiration (0-2 each; Total 0-10). Not for guiding resuscitation.
- 2025 Updates: PPV first for most; Intubate if prolonged PPV needed; EtCO&sub2; for confirmation; Therapeutic hypothermia for HIE if indicated (hospital).
Section 3: Pediatrics Overview
- Anatomical Differences: Larger head/tongue; Compliant chest wall; Higher metabolic rate; Smaller airways (obstruction risk).
Vital Signs by Age:
| Age | HR | RR | SBP |
|---|---|---|---|
| Newborn | 120-160 | 40-60 | >60 |
| Infant (<1y) | 100-160 | 30-40 | >70 |
| Toddler (1-3y) | 90-150 | 24-30 | >80 |
| School Age (6-12y) | 70-120 | 18-24 | >90 |
| Adolescent | 60-100 | 12-20 | >100 |
Pediatric Assessment Triangle (PAT):
- Appearance (tone/interactivity), Work of Breathing (retractions/stridor), Circulation (color/cap refill).
Section 4: Common Pediatric Emergencies
| Emergency | Signs/Symptoms | Management | Notes/AHA 2025 |
|---|---|---|---|
| Respiratory Distress/Failure | Retractions, grunting, nasal flaring, hypoxia. | O&sub2; (titrate to 94-99%); Nebulized albuterol/epi for wheeze/stridor; CPAP if severe. | Causes: Asthma, bronchiolitis, croup, FBAO. 2025: Early capnography; Avoid over-oxygenation. |
| Shock | Compensated: Tachycardia, delayed cap refill; Hypotensive: Late sign in peds. | 20 mL/kg NS bolus (repeat x2); Vasopressors if needed (epi 0.1-1 mcg/kg/min). | Types: Hypovolemic, distributive (sepsis), cardiogenic. 2025: Recognize compensated shock early. |
| Seizures | Tonic-clonic, febrile common. | Protect airway; Midazolam 0.1-0.2 mg/kg IV/IM/IN; Check glucose. | Status: Benzodiazepines first; Then levetiracetam/phenytoin. Altered Mental Status. |
| Altered Mental Status | Hypoglycemia, infection, trauma. | Glucose check; D10 2-4 mL/kg IV if low; Support ABCs. | AEIOU-TIPS mnemonic. |
| SIDS/ALTE/BRUE | Unexplained apnea/irritability in infant. | Full assessment; Transport all. | 2025: BRUE (Brief Resolved Unexplained Event) low-risk criteria for discharge (hospital). |
| Child Abuse | Inconsistent history, patterned bruises. | Report; Treat injuries; Document. | Mandatory reporting. |
Section 5: Pediatric Resuscitation (AHA PALS 2025)
- BLS Differences: 15:2 compression:ventilation if 2 rescuers (infant/child); Lone rescuer: 30:2. Compression Depth: Infant: 1.5 in; Child: 2 in; Rate 100-120/min.
- Defibrillation: 2-4 J/kg (initial); 4 J/kg subsequent.
- ACLS Adaptations: IO access preferred if IV difficult; Weight-based dosing.
- Algorithms:
- Bradycardia: Epi 0.01 mg/kg if unstable.
- Tachycardia: Vagal maneuvers; Adenosine 0.1 mg/kg (max 6 mg) for SVT.
- Arrest: Epi 0.01 mg/kg every 3-5 min; Amiodarone 5 mg/kg for VF/pVT.
- 2025 Updates: Emphasis on team dynamics; Post-arrest care (targeted temperature management 32-36°C for comatose); IO first in arrest if needed.
Section 6: Special Considerations
- Transport: Secure in age-appropriate device; Involve parents; Minimize separation.
- Pain Management: Use FLACC/ Wong-Baker scales; Fentanyl 1 mcg/kg IN/IV for severe pain.
- Fever: Acetaminophen 15 mg/kg PO/PR; Avoid routine cooling.
- NREMT Skills: Peds airway (OPA/NPA/BVM); IO insertion; Spinal immobilization.
Example Dosage Calculation (Math Reasoning)
Question: Calculate epinephrine infusion rate for a 20 kg pediatric patient in shock (0.2 mcg/kg/min).
Solution: 0.2 mcg/kg/min × 20 kg = 4 mcg/min. Reasoning: Multiply dose per kg by weight to get total per min. For setup (e.g., 1 mg in 100 mL = 10 mcg/mL), rate = 4 mcg/min ÷ 10 mcg/mL = 0.4 mL/min (or 24 mL/h).