Fertilization (High-Yield Foundation) - Fertilization occurs in the fallopian tube - The fertilized egg then travels to the uterus for implantation NREMT takeaway: If implantation occurs outside the uterus → think ectopic pregnancy (life-threatening) Abruptio Placentae (Placental Abruption) What it is: - Premature separation of the placenta from the uterine wall Classic Signs & Symptoms (MEMORIZE) - Painful vaginal bleeding - Occurs >20 weeks gestation - Dark red bleeding - Abdominal pain / uterine tenderness - Possible shock out of proportion to visible bleeding Clinical Significance - Decreased oxygen to fetus - High risk of maternal hemorrhage and fetal demise EMS Management - High-flow oxygen - IV access, fluid resuscitation - Rapid transport - Treat for shock NREMT Pearl: Painful + dark blood = Abruptio placentae(Contrast: painless bleeding = placenta previa) Stages of Labor Stage 1 – Cervical Dilation - Begins with contractions - Ends when cervix is fully dilated (10 cm) - Patient may have urge to push near the end Stage 2 – Expulsion (Delivery of the Baby) - Fully dilated cervix → pushing begins - Ends with delivery of the newborn Stage 3 – Placental Delivery - Delivery of the placenta - Usually occurs within minutes after birth EMS Considerations - Do NOT pull on the placenta - Allow it to deliver naturally - Monitor for bleeding Breech Delivery (Critical Scenario) What it is: - Baby presents feet or buttocks first High-Risk Complication: - Body delivers, but head becomes trapped What to do (NREMT CRITICAL STEP) - Insert fingers to create a “V” airway to allow breathing - Position mother knees-to-chest - Rapid transport What NOT to do: - Do NOT pull the baby out - Do NOT perform uterine massage to deliver the head NREMT Pearl: Airway first → create space for breathing until head delivers Umbilical Cord Presentation / Prolapse What it is: - Umbilical cord presents before the baby

After ROSC, which oxygen saturation should you aim to maintain?

Abnormal Breathing Patterns Biot’s / Ataxic Breathing What it is: - Completely irregular breathing with random apnea periods What it suggests: - Brainstem injury, ↑ ICP EMS Assessment: - Observe for unpredictable pattern - Prepare for airway control Cheyne-Stokes Breathing What it is: - Cyclic pattern: gradually increasing → decreasing → apnea What it suggests: - Brain injury, stroke, CHF EMS Assessment: - Watch for waxing/waning respirations - Monitor mental status Kussmaul Breathing What it is: - Deep, rapid respirations What it suggests: - Metabolic acidosis (DKA) EMS Assessment: - Note depth + rate - Check blood glucose Eupnea What it is: - Normal breathing EMS Assessment: - Rate: 12–20 (adult) - Regular, non-labored Apneustic Breathing What it is: - Prolonged inspiratory phase with short exhalation What it suggests: - Brainstem (pons) injury EMS Assessment: - Look for gasping, holding inhale Eye Findings Mydriasis What it is: - Dilated pupils Causes: - Hypoxia, stimulants, brain injury EMS Assessment: - Check pupil size + light response Miosis What it is: - Constricted pupils Causes: - Opioids, organophosphates EMS Assessment: - “Pinpoint pupils” Anisocoria What it is: - Unequal pupil sizes What it suggests: - Brain injury / increased ICP EMS Assessment: - Compare pupils side-to-side Nystagmus What it is: - Involuntary eye movement Causes: - Alcohol, drugs, neurological issues EMS Assessment: - Observe for rapid side-to-side eye movement Neck & Circulation JVD (Jugular Venous Distention) What it is: - Visible neck vein distention How to Assess - Position patient at ~45° angle - Look at internal jugular vein What it suggests - Right-sided heart failure - Fluid overload - Tension pneumothorax / tamponade Flat Neck Veins What it is: - Collapsed jugular veins What it suggests:

The Ryan White Act requires hospitals to:

The narrowest portion of an adult’s airway is the: