What Is a Sickle Cell Crisis? A sickle cell crisis occurs when red blood cells become stiff, sticky, and “sickle-shaped.” These abnormal cells can block small blood vessels, causing poor tissue perfusion, ischemia, and severe pain. The most common EMS presentation is a vaso-occlusive pain crisis, but sickle cell disease can also cause serious complications such as stroke, acute chest syndrome, splenic sequestration, infection, and priapism. How the Patient May Present Common findings include: - Severe pain, often in the back, chest, abdomen, arms, or legs - Pain may be described as deep, throbbing, or intense - History of sickle cell disease - Fatigue or weakness - Tachycardia - Fever, if infection is present - Shortness of breath or chest pain, concerning for acute chest syndrome - Pale skin or signs of anemia - Swelling of hands/feet, especially in children - Priapism in males - Stroke-like symptoms in severe cases Red Flags Treat these as high-risk findings: - Chest pain - Shortness of breath - Hypoxia - Fever - Altered mental status - Stroke symptoms - Severe abdominal pain - Signs of shock - Priapism - Severe uncontrolled pain Chest pain, hypoxia, or respiratory distress in a sickle cell patient should raise concern for acute chest syndrome, which can be life-threatening. EMS Management EMS care is supportive and focused on oxygenation, pain control, hydration, and rapid transport. Assessment - Assess airway, breathing, and circulation. - Obtain vital signs. - Check SpO₂. - Consider EtCO₂ if available. - Assess pain severity and location. - Ask about prior sickle cell crises and usual treatment. - Ask about fever, chest pain, shortness of breath, neurologic symptoms, or recent illness. - Check blood glucose if altered mental status is present. Treatment - Give oxygen if hypoxic, short of breath, or in respiratory distress. - Keep the patient warm. - Establish IV access if ALS. - Provide fluids per local protocol, especially if dehydrated. - Avoid overhydration, especially if respiratory symptoms are present. - Treat pain aggressively per protocol. - Monitor ECG, SpO₂, blood pressure, and mental status. - Transport to an appropriate emergency department.

Primipara Meaning: First-time delivery. NREMT clue: A patient giving birth for the first time may have a longer labor, but EMS should still prepare for delivery if birth is imminent. Ask: - How many weeks pregnant? - First pregnancy or first delivery? - Contractions how far apart? - Water broken? - Need to push? - Vaginal bleeding? - Crowning? Increased Blood Volume in Pregnancy Pregnant patients have an increased blood volume, often around 45% higher than normal. Why it matters:Pregnant patients may lose a significant amount of blood before showing obvious signs of shock. NREMT clue: Do not underestimate blood loss in a pregnant trauma or bleeding patient. Ectopic Pregnancy Meaning: Fertilized egg implants outside the uterus, usually in the fallopian tube. Usually occurs: First trimester, often up to 12 weeks. Signs/Symptoms: - Lower abdominal or pelvic pain - Vaginal bleeding - Missed period - Shoulder pain - Dizziness or syncope - Signs of shock if ruptured NREMT clue: Female of childbearing age + abdominal pain + vaginal bleeding = suspect ectopic pregnancy. EMS care: Treat for shock and rapidly transport. Supine Hypotensive Syndrome Important: It is supine hypotensive syndrome, not hypertensive. Meaning: The gravid uterus compresses the inferior vena cava when the patient lies flat. Result: Decreased venous return, decreased cardiac output, and low blood pressure. Signs/Symptoms: - Hypotension while lying supine - Dizziness - Weakness - Nausea - Pale, cool, clammy skin - Near-syncope or syncope EMS care: Place the patient in the left lateral recumbent position or manually displace the uterus to the left. NREMT clue: Pregnant patient feels faint while lying flat = move her onto her left side. Hyperemesis Gravidarum Meaning: Severe nausea and vomiting during pregnancy. Signs/Symptoms: - Persistent vomiting - Dehydration - Weight loss - Weakness - Dizziness - Dry mucous membranes - Tachycardia EMS care: Assess perfusion, check glucose if available, give fluids/antiemetic per protocol, and transport if severe.

Burn Depth Burns are classified by how deep they go into the skin. Superficial burns, or 1st-degree burns, affect only the outer layer of skin. They are red, dry, painful, and do not have blisters. A sunburn is a common example. Partial-thickness burns, or 2nd-degree burns, involve the epidermis and part of the dermis. These burns are usually red or pink, moist, blistered, swollen, and very painful. Full-thickness burns, or 3rd-degree burns, destroy the epidermis and dermis. They may appear white, waxy, leathery, brown, or charred. These burns may have little or no pain in the center because the nerve endings are destroyed. Major Burn Concerns EMS providers should focus on stopping the burning process, assessing the airway, supporting breathing and circulation, estimating burn size, covering burns with dry sterile dressings, preventing hypothermia, and transporting to the appropriate facility. Inhalation Injury Inhalation injury should be suspected with facial burns, singed nasal hairs, soot in the mouth or nose, hoarseness, stridor, black sputum, or burns from an enclosed-space fire. Airway swelling can worsen quickly, so early recognition is critical. Rule of Nines The Rule of Nines is used to estimate the percentage of body surface area burned in adults. The adult body is divided into sections such as the head, arms, trunk, legs, and groin. For burn calculations, only partial-thickness and full-thickness burns are counted. Superficial burns are not included. Parkland Formula The Parkland formula estimates fluid needs for major burns: 4 mL × body surface area burned × weight in kg = total fluid for the first 24 hours Half of that amount is given in the first 8 hours from the time of the burn, and the other half is given over the next 16 hours. Burn Shock Large burns can cause fluid to shift out of the bloodstream and into the tissues, leading to hypovolemic shock. Signs may include tachycardia, weak pulses, anxiety, delayed capillary refill, cool skin, and late hypotension.

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Shock is poor tissue perfusion. The body is not delivering enough oxygenated blood to the cells. Important NREMT point: Shock can exist before the blood pressure drops. Perfusion Basics Remember: Pump + Fluid + Container + Obstruction General Signs of Shock Common findings include: - Altered mental status - Anxiety or restlessness - Tachycardia - Tachypnea - Pale, cool, clammy skin - Weak pulses - Delayed capillary refill - Hypotension, usually late Compensated Shock The body is still maintaining blood pressure. Key signs: - Normal blood pressure - Fast heart rate - Fast respirations - Pale, cool, clammy skin - Anxiety or restlessness - Weak pulses Study point: Compensated shock = shock with a normal blood pressure. Decompensated Shock The body can no longer maintain blood pressure. Key signs: - Hypotension - Altered mental status - Weak or absent peripheral pulses - Cool, pale, cyanotic, or mottled skin - Respiratory distress or failure Study point: Decompensated shock = shock with failing compensation. Irreversible Shock Shock has progressed too far and causes severe cellular damage. Key signs: - Profound hypotension - Unresponsive mental status - Bradycardia or weak pulse - Mottled/cyanotic skin - Organ failure - Cardiac arrest may occur Study point: Irreversible shock = prolonged hypoperfusion with severe organ damage. Types of Shock Hypovolemic Shock Problem: Not enough circulating volume. Common causes: - Bleeding - Trauma - Vomiting - Diarrhea - Dehydration - Burns Key findings: - Pale, cool, clammy skin - Tachycardia - Weak pulses - Flat neck veins - Delayed capillary refill - Hypotension late EMS care: - Control bleeding - Oxygen as needed - IV/IO access - Fluids or blood products per protocol - Prevent hypothermia - Rapid transport Distributive Shock Problem: Blood vessels dilate or leak, causing poor blood distribution. Main types: - Septic shock - Anaphylactic shock - Neurogenic shock