NREMT Mini Lecture: Abdominal Emergencies Cholecystitis (Gallbladder Inflammation) Cause - Gallstones blocking bile flow Key Findings - Right upper quadrant (RUQ) pain - Pain after fatty meals - Nausea/vomiting - Pain may radiate to right shoulder EMS Considerations - Oxygen if needed - Pain management - Transport NREMT Pearl RUQ pain after eating = think gallbladder Appendicitis Pathophysiology - Obstruction of appendix → inflammation Key Findings - Pain starts periumbilical (visceral) - Migrates to RLQ (somatic) - Fever, nausea Red Flag - Sudden relief of pain → possible rupture → peritonitis EMS Considerations - Monitor for diffuse abdominal pain - Signs of sepsis or shock - Rapid transport NREMT Pearl Periumbilical → RLQ = appendicitis Kidney Trauma (Right Flank Pain + Hematuria) Causes - Blunt trauma (MVC, falls) Key Findings - Flank pain - Blood in urine (hematuria) - Possible bruising to flank EMS Considerations - Suspect internal bleeding - Monitor for shock - Rapid transport NREMT Pearl Flank pain + hematuria = renal injury until proven otherwise Peptic Ulcer Disease (PUD) & Upper GI Bleed Cause - Breakdown of stomach lining (acid, H. pylori, NSAIDs) Key Findings - Burning epigastric pain - Hematemesis (vomiting blood) - Melena (black tarry stool) EMS Concerns - Hypovolemic shock - Pale, tachycardic, hypotensive EMS Treatment - Oxygen - IV access / fluids - Rapid transport NREMT Pearl Upper GI bleed = coffee-ground emesis or black stools Ulcerative Colitis Pathophysiology - Chronic inflammatory bowel disease - Affects the colon Key Findings - Bloody diarrhea - Abdominal pain - Weight loss - Chronic condition with flare-ups EMS Considerations - Risk for dehydration - Monitor for electrolyte imbalance - Supportive care NREMT Pearl Ulcerative colitis = chronic + bloody diarrhea Rapid Review Cholecystitis - RUQ pain after fatty food

Mike is inviting you to a scheduled Zoom meeting. If you're looking to do a medic prep with me, feel free to jump in! If you can't make it, no worries. I will record it. See you there. Topic: Medic Prep Time: Mar 23, 2026 09:00 AM Eastern Time (US and Canada) Join Zoom Meeting https://us02web.zoom.us/j/83640237364 Meeting ID: 836 4023 7364 --- One tap mobile +13052241968,,83640237364# US +13092053325,,83640237364# US Join instructions https://us02web.zoom.us/meetings/83640237364/invitations?signature=Te8dHvgzyRmaM2Wa9miDheNSnC3fBC4TObLWbJYbMq0

In which leads is the classic 'rabbit ear' RSR’ pattern most diagnostic of RBBB?

NREMT Mini Lecture: Stroke, Sickle Cell & Key Medical Topics Sickle Cell Anemia A genetic disorder where RBCs become sickle-shaped, leading to blockage of blood flow. Key Points - Causes ischemia and severe pain - Triggered by: Hypoxia Dehydration Infection EMS Treatment - Oxygen - IV fluids - Pain control (Fentanyl) - Transport Stroke Management (EMS) Goal: Time is Brain Key Actions - Perform FAST / Cincinnati - Determine last known well - Check blood glucose - Oxygen if hypoxic - Rapid transport to stroke center Stroke Patient Positioning Awake & protecting airway: - Supine with head elevated ~30° - Keep head midline 👉 Helps reduce ICP and improve perfusion Decreased LOC or vomiting risk: - Lateral (recovery position) 👉 Protects airway and prevents aspiration Important Notes - Do NOT lay flat unless hypotensive - Focus on airway first NREMT Pearl - Awake stroke → Head elevated - Unconscious stroke → Lateral position Ischemic vs Hemorrhagic Stroke Ischemic (Most common) - Clot blocks blood flow Hemorrhagic - Bleeding in the brain - Often presents with severe headache Field Approach - Treat both the same - You cannot differentiate definitively prehospital Function of Insulin What it does - Moves glucose into cells - Lowers blood sugar Without insulin - Hyperglycemia - Cells starve → DKA NREMT Pearl Insulin = pushes glucose INTO cells Wernicke-Korsakoff Syndrome Caused by thiamine (B1) deficiency, common in alcoholics. Wernicke’s (Acute) - Confusion - Ataxia - Eye abnormalities Korsakoff (Chronic) - Memory loss - Confabulation - Neuropsychiatric disorder where individuals generate false memories, beliefs, or verbal accounts without the intent to deceive, often called "honest lying". EMS Treatment - Thiamine before glucose Rapid Review Sickle Cell - Vaso-occlusion → pain Stroke - FAST + glucose + transport Positioning - Awake → head elevated - Unconscious → lateral

Great short video to explain 12 lead anatomy. A STEMI occurs when a coronary artery is occluded, causing ischemia in the area that artery supplies. 👉 The leads showing ST elevation = the area of the heart that is injured👉 That area corresponds to a specific coronary artery Coronary Artery Overview There are two main coronary arteries: 1. Left Main Coronary Artery (LMCA) Splits into: - Left Anterior Descending (LAD) - Left Circumflex (LCx) 2. Right Coronary Artery (RCA) Gives off: - Right Marginal Artery - Posterior Descending Artery (PDA) (in most people) Left Anterior Descending (LAD) What it Supplies - Anterior wall of left ventricle - Septum - Often the apex of the heart ECG Findings (Anterior STEMI) ST elevation in: - V1 - V2 - V3 - V4 Key Concept LAD occlusion = anterior MI ⚠️ This is the most dangerous STEMI (“widow maker”) because it affects a large portion of the heart. Left Circumflex (LCx) What it Supplies - Lateral wall of the left ventricle ECG Findings (Lateral STEMI) ST elevation in: - I - aVL - V5 - V6 Key Concept LCx occlusion = lateral MI Right Coronary Artery (RCA) What it Supplies - Right ventricle - Inferior wall of left ventricle - Often the SA node and AV node ECG Findings (Inferior STEMI) ST elevation in: - II - III - aVF Key Concept RCA occlusion = inferior MI ⚠️ May cause: - Bradycardia - Hypotension Posterior Descending Artery (PDA) Origin - Usually from the RCA (right-dominant circulation) What it Supplies - Posterior wall of the left ventricle - Posterior septum ECG Findings (Posterior MI) Posterior MIs are not directly seen on standard 12-lead. Instead you see: ST depression in: - V1 - V2 - V3 👉 This is a mirror image of posterior ST elevation Confirmation Leads - V7 - V8 - V9 → show ST elevation Right Marginal Artery What it Supplies - Right ventricle ECG Relevance - No unique lead pattern - Can contribute to right ventricular infarction