🚧 Under construction — VoTechWorks is being built. A free tech program — complimentary, as our commitment to get America working.
voTechWorksGrade 13 · a vocational technology learning center, by urbanicity
newSchoolWorks.com › VoTechWorks › Health & Personal Services › EMT / Paramedic › Field Clinicals: Prehospital Patient Care in the Field › Lesson 9
HLT-EMT39-06 · Lesson 9 · 25.5 clock hours · practice

Medical Emergencies: Cardiac, Respiratory, Neurological, and Endocrine

Objective. Students will formulate and verbalize a correct field impression and treatment plan for simulated patients presenting with STEMI, stroke, status asthmaticus, anaphylaxis, diabetic emergency, and seizure, applying NREMT medical assessment standards.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Medical Emergencies: Cardiac, Respiratory, Neurological, and Endocrine

Prehospital providers encounter life-threatening medical emergencies daily. Your ability to form a rapid, accurate field impression and act on it determines patient outcome. This lesson prepares you to assess and manage six high-priority presentations: ST-elevation myocardial infarction (STEMI), stroke, status asthmaticus, anaphylaxis, diabetic emergency, and seizure.

The Medical Patient Assessment Framework

Every medical call follows the same NREMT-aligned sequence: scene safety, general impression, primary assessment (airway-breathing-circulation), history (OPQRST, SAMPLER), secondary assessment, vital signs, and reassessment. For medical patients, the history often drives the field impression more than physical findings alone. Do not skip or rush history-taking.

Safety first: Don appropriate PPE before contact. On any altered-mental-status call, consider trauma, toxicology, and environmental causes before committing to a single diagnosis.

STEMI

ST-elevation myocardial infarction occurs when a coronary artery is completely occluded, causing ischemia that is visible as ST elevation of 1 mm or more in two or more anatomically contiguous leads on a 12-lead ECG. Classic presentation: chest pressure, diaphoresis, nausea, and radiation to the jaw or left arm. Atypical presentations—especially in women, elderly patients, and diabetics—may include only fatigue, shortness of breath, or epigastric pain.

Field impression triggers a STEMI alert: notify the receiving facility early so the catheterization lab can be activated before the patient arrives. Keep door-to-balloon time as short as possible. Interventions within your scope may include oxygen (titrated to maintain adequate saturation), aspirin if not contraindicated, IV access, cardiac monitoring, and pain management per protocol. Treat symptomatic dysrhythmias per ACLS algorithms.

Stroke

Stroke is a time-critical neurological emergency. Use a validated prehospital screening tool (such as the Cincinnati Prehospital Stroke Scale, which tests facial droop, arm drift, and speech abnormality) to identify likely stroke quickly. Establish the last-known-well time—this is the clock that determines eligibility for thrombolytics at the hospital. Activate a stroke alert en route.

Manage airway and oxygenation; do not give food or fluids orally because swallowing may be impaired. Check blood glucose to rule out hypoglycemia mimicking stroke. Protect the patient from aspiration and injury.

Status Asthmaticus

Status asthmaticus is a severe, prolonged asthma attack that does not respond to initial bronchodilator therapy. Signs include severe accessory muscle use, inability to speak in full sentences, markedly decreased breath sounds, oxygen saturation below 90%, and end-tidal CO₂ (ETCO₂) that may be rising as the patient tires. Silent chest is an ominous sign of near-complete obstruction.

Management priorities: high-flow oxygen, beta-2 agonist nebulization (e.g., albuterol) per protocol, consider ipratropium, and rapid transport. In severe cases, be prepared to assist ventilation; positive-pressure ventilation in a severely bronchospastic patient carries risk of air trapping and barotrauma—use slow rates and allow adequate exhalation time.

Anaphylaxis

Anaphylaxis is a severe, systemic allergic reaction involving two or more body systems (e.g., skin, respiratory, cardiovascular). Key features: urticaria, angioedema, stridor or wheezing, and hypotension. The trigger may be a food, medication, insect sting, or latex exposure.

Epinephrine IM is the first-line treatment—administer to the lateral thigh without delay when anaphylaxis is suspected. Delay in epinephrine is associated with fatal outcomes. Antihistamines (such as diphenhydramine) and corticosteroids are adjuncts, not substitutes for epinephrine. Support circulation with IV fluid boluses for hypotension. Monitor for biphasic reaction and transport all anaphylaxis patients even after improvement.

Diabetic Emergencies

Hypoglycemia (low blood glucose) is more immediately dangerous than hyperglycemia in the prehospital setting. Symptoms range from anxiety and diaphoresis to altered mental status and seizure. Always check blood glucose on any altered-mental-status patient.

For a conscious patient who can protect their airway and swallow safely, oral glucose is appropriate. For an unconscious or unable-to-swallow patient, IV or IO dextrose solution or IM glucagon (per protocol and scope) is indicated. Reassess glucose after treatment. Hyperglycemic emergencies (diabetic ketoacidosis, hyperosmolar hyperglycemic state) present more gradually; field management focuses on IV fluid, airway, and transport.

Seizure

Seizures result from abnormal electrical activity in the brain. Causes include epilepsy, hypoglycemia, hypoxia, hyponatremia, toxins, head trauma, fever, and eclampsia. Protect the patient from injury during the ictal phase—do not restrain limbs forcefully or place objects in the mouth. Position the patient on their side (recovery position) during and after the seizure to protect the airway from secretions and vomit.

The postictal phase (drowsiness and confusion after seizure) is normal but must be distinguished from ongoing neurological compromise. Always check blood glucose. Transport all new-onset seizure patients. Status epilepticus (continuous seizure activity or repeated seizures without recovery) is a life threat requiring airway management and anticonvulsant therapy per paramedic protocol.

12-Lead ECG Systematic Approach

Use a consistent method for every strip: (1) rate, (2) rhythm regularity, (3) P-wave presence and relationship to QRS, (4) PR interval, (5) QRS width, (6) ST segment and T-wave changes, (7) identify the pattern. This prevents missed findings. Third-degree (complete) AV block shows no relationship between P waves and QRS complexes—treat symptomatic bradycardia per protocol. Atrial fibrillation shows irregularly irregular rhythm with absent distinct P waves.

Safety Reminders

Key terms10

STEMIST-elevation myocardial infarction; a complete coronary artery occlusion identified by ST elevation in two or more contiguous ECG leads, requiring immediate hospital activation (STEMI alert) for reperfusion therapy.
Last-known-well timeThe last time a stroke patient was confirmed to be at neurological baseline; this time stamp drives hospital decisions about thrombolytic eligibility and must be established and communicated by prehospital providers.
Status asthmaticusA severe, prolonged asthma attack unresponsive to initial bronchodilator treatment, carrying risk of respiratory failure; recognized by silent chest, rising ETCO₂, and inability to maintain oxygenation.
AnaphylaxisA rapid-onset, life-threatening systemic allergic reaction involving two or more body systems; first-line prehospital treatment is epinephrine administered intramuscularly without delay.
Postictal phaseThe period of decreased consciousness, confusion, or drowsiness that follows a generalized seizure; it is a normal consequence of seizure but must be distinguished from ongoing neurological injury.
Cincinnati Prehospital Stroke ScaleA validated prehospital screening tool assessing facial droop, arm drift, and abnormal speech to identify likely stroke and trigger early hospital notification.
End-tidal CO₂ (ETCO₂)The concentration of carbon dioxide measured at the end of exhalation; used in respiratory emergencies to monitor ventilation effectiveness and, in asthma, to detect impending respiratory failure as values rise.
Biphasic anaphylaxisA recurrence of anaphylactic symptoms hours after the initial reaction appears to resolve, even without re-exposure to the trigger; the reason all anaphylaxis patients require transport and observation.
Third-degree (complete) AV blockA cardiac dysrhythmia in which no electrical impulses from the atria conduct to the ventricles, resulting in independent atrial and ventricular rhythms and no consistent P-wave-to-QRS relationship.
Status epilepticusA neurological emergency defined as continuous seizure activity or repeated seizures without return to baseline consciousness; requires airway management and anticonvulsant therapy within the paramedic's scope.
In class: Case-based rounds: instructor presents six written case vignettes with vital signs and 12-lead or capnography tracings; student teams diagnose the field impression, identify the priority interventions, and state hospital notification criteria for each (e.g., STEMI alert, stroke alert). · Simulation scenarios in the lab: students manage a manikin with a high-fidelity simulator portraying anaphylaxis (urticaria, stridor, hypotension), administering epinephrine IM, diphenhydramine, and fluid as directed; a separate scenario covers hypoglycemia assessment and oral glucose or dextrose administration. · 12-lead ECG interpretation drill: students identify normal sinus rhythm, ST-elevation patterns in standard leads, atrial fibrillation, and third-degree AV block on a set of ten printed 12-lead strips, using a systematic interpretation method taught by instructor.
Materials: High-fidelity manikin simulator or standardized patient with moulage, 12-lead ECG monitor/simulator, printed 12-lead strips, medication props (epinephrine auto-injector trainer, oral glucose tube, dextrose vial prop), NREMT medical patient assessment checklist, case vignette handouts
Check: Students identify correct field impression and list all priority interventions for at least five of six vignettes; simulation scenario scored on NREMT medical assessment checklist with zero critical criteria failures; 12-lead drill: 80% correct on ten-strip set.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Cardiology / Medical Assessment
1. You arrive to find a 58-year-old male complaining of chest pressure radiating to his left jaw, diaphoresis, and nausea. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Which action is the highest priority after ensuring a patent airway and IV access?
Neurology / Medical Assessment
2. A 72-year-old woman has right-sided facial droop, right arm drift, and slurred speech. Her family states she was normal at breakfast two hours ago. What is the most critical piece of information to relay to the receiving hospital?
Immunology / Pharmacology
3. A 19-year-old female was stung by a bee ten minutes ago. She presents with diffuse urticaria, audible stridor, and a blood pressure of 80/50 mmHg. Which intervention must be performed first?
Endocrinology / Pharmacology
4. During your assessment of a 45-year-old male found unresponsive, your partner checks the blood glucose and obtains a critically low result. The patient cannot protect his airway or swallow safely. Which treatment is most appropriate?
Neurology / Patient Safety
5. A patient is in an active generalized tonic-clonic seizure. A bystander is attempting to hold the patient's limbs still and has placed a wallet in the patient's mouth. What is the correct intervention?
Cardiology / ECG Interpretation
6. You are reviewing a 12-lead ECG strip. P waves occur at a regular rate of about 80 per minute, QRS complexes occur at a regular rate of about 35 per minute, and there is no consistent relationship between P waves and QRS complexes. What rhythm does this describe?
Respiratory / Medical Assessment
7. A patient with a known history of asthma is in severe respiratory distress. Breath sounds are nearly absent bilaterally, oxygen saturation is 86%, and ETCO₂ is rising. The patient has already received two albuterol treatments without improvement. What does the near-absence of breath sounds most likely indicate?
Immunology / Patient Safety
8. Which of the following best explains why all patients who experience anaphylaxis should be transported to the hospital even after their symptoms appear to resolve with epinephrine?
Record this lesson on my transcript. Sign in with your key and enrollment email to record lessons (enroll free if you have no key). This page stays open to read and practise.
← Previous lessonProgram planNext lesson →