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Primary assessment Scene safety ABCDE assessment Level of consciousness — AVPU/GCS Vital signs Patient history — SAMPLE/OPQRST Airway & breathing Airway positioning Suctioning Oropharyngeal/nasopharyngeal airway Bag-valve-mask ventilation Oxygen administration SpO₂ monitoring Basic airway obstruction management Cardiac skills ECG lead placement 12-lead ECG acquisition and recognition of major abnormalities CPR AED/defibrillator use Recognition of shock and acute coronary syndrome IV & medication skills IV cannulation Fluid administration Medication preparation and administration within your local scope/protocol IM/SC injections where permitted Medication calculations and checking Trauma Bleeding control Pressure dressing Tourniquet use Splinting Spinal precautions when indicated Fracture/dislocation assessment Trauma patient assessment Emergency conditions Anaphylaxis Asthma/COPD exacerbation Hypoglycaemia Seizures Stroke recognition Burns Poisoning/overdose Shock Patient handling & transport Safe lifting Log roll Stretcher operation Patient positioning Transfer between bed/stretcher/ambulance Communication Taking a focused history Reassuring and communicating with patients Handover using SBAR/MIST Documentation Communication with doctors/nurses/other EMS staff Above topic one by one Clean and clear explain

This is a massive syllabus covering EMS/paramedic core skills. It spans six major domains. Here's the map before we go deep on any one:
1. Primary Assessment - scene safety, ABCDE, AVPU/GCS, vitals, SAMPLE/OPQRST history
2. Airway & Breathing - positioning, suctioning, OPA/NPA, BVM, oxygen therapy, SpO2 monitoring, choking management
3. Cardiac Skills - ECG lead placement, 12-lead acquisition/interpretation, CPR, AED/defib, shock and ACS recognition
4. IV & Medication Skills - cannulation, fluids, drug preparation/administration, IM/SC injections, dose calculations
5. Trauma - bleeding control, pressure dressings, tourniquets, splinting, spinal precautions, fracture/dislocation assessment, trauma patient assessment
6. Emergency Conditions - anaphylaxis, asthma/COPD exacerbation, hypoglycaemia, seizures, stroke recognition, burns, poisoning/overdose, shock
7. Patient Handling & Transport - safe lifting, log roll, stretcher operation, positioning, transfers
8. Communication - focused history taking, patient reassurance, SBAR/MIST handover, documentation, interprofessional communication
Overview: These represent the standard competency framework for EMT/paramedic-level prehospital care. It starts with ensuring the scene and patient are safe, then a structured primary assessment (ABCDE) to catch immediate life threats, followed by hands-on skills for airway, breathing, and circulation support. Cardiac and IV/medication skills build on this for more advanced interventions. Trauma and specific emergency conditions (anaphylaxis, stroke, DKA/hypoglycaemia, etc.) each have their own recognition patterns and protocols. Handling/transport and communication (especially structured handover tools like SBAR/MIST) tie everything together for safe, efficient patient care and continuity between providers.
Given the depth involved (each topic could be its own detailed lesson with steps, indications, contraindications, and clinical pearls), let's tackle this one topic at a time.
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This is a massive syllabus covering EMS/paramedic core skills. It spans six major domains. Here's the map before we go deep on any one:
1. Primary Assessment - scene safety, ABCDE, AVPU/GCS, vitals, SAMPLE/OPQRST history
2. Airway & Breathing - positioning, suctioning, OPA/NPA, BVM, oxygen therapy, SpO2 monitoring, choking management
3. Cardiac Skills - ECG lead placement, 12-lead acquisition/interpretation, CPR, AED/defib, shock and ACS recognition
4. IV & Medication Skills - cannulation, fluids, drug preparation/administration, IM/SC injections, dose calculations
5. Trauma - bleeding control, pressure dressings, tourniquets, splinting, spinal precautions, fracture/dislocation assessment, trauma patient assessment
6. Emergency Conditions - anaphylaxis, asthma/COPD exacerbation, hypoglycaemia, seizures, stroke recognition, burns, poisoning/overdose, shock
7. Patient Handling & Transport - safe lifting, log roll, stretcher operation, positioning, transfers
8. Communication - focused history taking, patient reassurance, SBAR/MIST handover, documentation, interprofessional communication
Overview: These represent the standard competency framework for EMT/paramedic-level prehospital care. It starts with ensuring the scene and patient are safe, then a structured primary assessment (ABCDE) to catch immediate life threats, followed by hands-on skills for airway, breathing, and circulation support. Cardiac and IV/medication skills build on this for more advanced interventions. Trauma and specific emergency conditions (anaphylaxis, stroke, DKA/hypoglycaemia, etc.) each have their own recognition patterns and protocols. Handling/transport and communication (especially structured handover tools like SBAR/MIST) tie everything together for safe, efficient patient care and continuity between providers.
Given the depth involved (each topic could be its own detailed lesson with steps, indications, contraindications, and clinical pearls), let's tackle this one topic at a time.
Reading File
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Reading File

Topic 1: Primary Assessment

This is the first and most critical step in any prehospital or emergency encounter. It follows a fixed sequence so nothing life-threatening gets missed.

1. Scene Safety

Before touching the patient, assess the scene itself.
  • Hazards: traffic, fire, electrical lines, unstable structures, hazardous materials, aggressive bystanders or animals.
  • Standard precautions: gloves, eye protection, mask/gown as indicated (blood, body fluids, airborne precautions).
  • Number of patients: is this a single patient or a mass casualty situation requiring triage?
  • Mechanism of injury / nature of illness (MOI/NOI): scan the environment for clues (e.g. deployed airbags, medication bottles, spilled chemicals).
  • Need for additional resources: fire, police, extra ambulances, extrication equipment.
Rule: you cannot help the patient if you become a second casualty. Scene safety is reassessed continuously, not just on arrival.

2. ABCDE Assessment

A rapid, structured sweep to find and fix immediate threats to life, done in this exact order because each letter can kill faster than the next.
StepWhat you checkImmediate actions if abnormal
A - AirwayPatency, noisy breathing (stridor, gurgling, snoring), foreign body, facial/neck traumaHead-tilt/chin-lift or jaw-thrust, suction, OPA/NPA
B - BreathingRate, depth, symmetry, effort, chest wall injuries, breath sounds, SpO2Oxygen, BVM ventilation, seal open chest wounds, decompress tension pneumothorax if trained
C - CirculationPulse rate/quality, skin colour/temperature/moisture, external bleeding, capillary refillControl haemorrhage, IV access, fluids, CPR if pulseless
D - DisabilityLevel of consciousness (AVPU/GCS), pupils, gross motor/sensory function, blood glucosePosition for airway protection, treat hypoglycaemia, spinal precautions
E - Exposure/EnvironmentUndress to check for hidden injuries, temperature control, prevent hypothermiaCover to preserve dignity and warmth once assessed
In trauma this is often called the "primary survey." Any life threat found at any letter is treated immediately before moving to the next letter (treat-as-you-go).

3. Level of Consciousness - AVPU / GCS

AVPU - quick screening tool:
  • A - Alert
  • V - responds to Voice
  • P - responds to Pain
  • U - Unresponsive
GCS (Glasgow Coma Scale) - more granular, used for trending and severity classification. Three components, scored and summed (range 3-15):
ScoreEye OpeningVerbal ResponseMotor Response
6--Follows commands
5-Alert and orientedLocalizes pain
4SpontaneousConfused/disorientedWithdraws to pain
3To speechInappropriate wordsAbnormal flexion
2To painIncomprehensible soundsExtension
1No responseNo responseNo response
Severity classification (traumatic brain injury): severe 3-8, moderate 9-13, mild 14-15. A GCS ≤8 generally signals the need to secure the airway. Serial GCS checks over time matter more than a single reading, since it tracks improvement or deterioration (Tintinalli's Emergency Medicine).

4. Vital Signs

Baseline set, then repeated at intervals to trend the patient:
  • Respiratory rate and quality (normal adult: ~12-20/min)
  • Pulse rate, rhythm, strength (normal adult: ~60-100/min)
  • Blood pressure
  • SpO2 (pulse oximetry)
  • Temperature
  • Blood glucose (mandatory in any altered mental status)
  • Pain score
A single vital sign reading tells you little; trends over serial measurements reveal whether the patient is stabilizing, compensating, or decompensating.

5. Patient History - SAMPLE / OPQRST

SAMPLE - general history framework:
  • S - Signs/Symptoms
  • A - Allergies
  • M - Medications
  • P - Past medical history
  • L - Last oral intake (meal, fluids)
  • E - Events leading up to the incident
OPQRST - used to characterize a specific symptom (classically pain):
  • O - Onset (sudden vs gradual)
  • P - Provocation/Palliation (what makes it better/worse)
  • Q - Quality (sharp, dull, crushing, burning)
  • R - Radiation/Region (where, does it spread)
  • S - Severity (0-10 scale)
  • T - Time (duration, constant vs intermittent)
These are gathered from the patient, family, or bystanders in parallel with the physical exam, not as a separate delayed step, especially in unstable patients.
That covers Primary Assessment in full. Say "next" or name a topic (e.g. Airway & Breathing, Cardiac Skills, Trauma, Emergency Conditions, etc.) and I'll go through it the same way.

Explain Airway & Breathing skills (positioning, suctioning, BVM, oxygen)

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Topic 2: Airway & Breathing Skills

1. Airway Positioning

Goal: open an airway obstructed by the tongue or soft tissue relaxation (the most common cause of obstruction in an unresponsive patient).
  • Head-tilt/chin-lift - for patients with no suspected spinal injury. Tilt the head back while lifting the chin forward; this pulls the tongue off the posterior pharyngeal wall.
  • Jaw-thrust - used when spinal injury is suspected. Grip the angles of the mandible and lift the jaw forward without extending the neck. Maintains manual in-line spinal stabilization.
  • Recovery position - for a breathing, unresponsive patient with no trauma concern; lying on their side protects the airway from aspiration if they vomit.
  • Sniffing position (ear canal aligned with the sternal notch) - optimal alignment for airway management/intubation in adults without trauma.

2. Suctioning

Clears blood, vomit, secretions, or debris that positioning alone can't fix.
  • Rigid (Yankauer) suction: used for the mouth/oropharynx, large-bore, handles thick material well, but can only reach the visible oral cavity.
  • Flexible/French catheter suction: soft, can pass through the nose or an airway adjunct/ET tube into deeper structures.
  • Technique: suction only while withdrawing the catheter (not while inserting), limit each pass to about 10-15 seconds to avoid hypoxia, and monitor SpO2/heart rate during the procedure since suctioning can trigger vagal bradycardia.
  • Always have suction ready and immediately accessible before any airway intervention - it is often the first thing needed when a patient vomits.

3. Oropharyngeal (OPA) / Nasopharyngeal (NPA) Airway

Adjuncts that hold the tongue/soft tissue away from the airway once positioning alone isn't enough.
Oropharyngeal airway (OPA)
  • Only for unconscious patients with no gag reflex (an intact gag reflex means the patient will vomit around it).
  • Sizing: corner of the mouth to the earlobe (or angle of the jaw).
  • Insertion: insert inverted along the hard palate, then rotate 180 degrees as it passes the soft palate so the tip sits in the hypopharynx - or use a tongue depressor to push the tongue down and insert it right-side-up without rotating (Roberts and Hedges' Clinical Procedures in Emergency Medicine).
Nasopharyngeal airway (NPA)
  • Better tolerated in a semi-conscious patient with an intact gag reflex.
  • Caution/relative contraindication: suspected basilar skull fracture or significant midface trauma.
  • Sizing: tip of the nose to the earlobe.
  • Insertion: lubricate generously, advance along the floor of the nasal passage straight back toward the occiput (never angled upward/cephalad), advance fully until the flared end sits at the nostril (Roberts and Hedges').

4. Bag-Valve-Mask (BVM) Ventilation

Used to ventilate a patient who is apneic or breathing inadequately.
  • Mask seal - "E-C clamp" technique: thumb and index finger form a "C" over the mask holding it to the face, remaining three fingers form an "E" along the jaw lifting it into the mask (this also performs a jaw-thrust simultaneously).
  • Two-person technique is preferred when possible: one provider seals the mask with two hands, the other squeezes the bag - produces a far better seal and tidal volume than one-handed ventilation.
  • Rate: roughly 1 breath every 6 seconds (about 10/min) for an adult with a pulse but not breathing; asynchronous ventilation during CPR with an advanced airway; adjust ratio to compressions if no advanced airway is placed per current CPR protocol.
  • Volume/technique: just enough to see visible chest rise - avoid over-ventilating, which causes gastric insufflation, vomiting/aspiration, and reduced venous return.
  • Use an OPA/NPA underneath the mask whenever possible to keep the airway patent and make ventilation easier.
  • Attach to high-flow oxygen and use the reservoir bag to deliver close to 100% FiO2.

5. Oxygen Administration

Match the device to how much oxygen the patient needs.
DeviceFlow rateApprox. FiO2Use case
Nasal cannula1-6 L/min~24-44%Mild hypoxia, stable patients
Simple face mask6-10 L/min~40-60%Moderate hypoxia
Non-rebreather mask10-15 L/min (reservoir must stay inflated)~80-95%Serious hypoxia, trauma, shock, major illness
BVM with reservoir15 L/minNear 100%Apnea or inadequate breathing
Principle: give supplemental oxygen to any patient with hypoxia, respiratory distress, shock, major trauma, or altered mental status. Titrate to a target SpO2 (commonly ≥94% in most acute patients) rather than automatically maximizing everyone to 100%, since over-oxygenation has downsides in some conditions (e.g. COPD retainers, post-cardiac arrest care).

6. SpO2 Monitoring (brief, since it pairs directly with oxygen therapy)

  • Continuous pulse oximetry confirms oxygenation and trends the response to therapy.
  • Limitations: inaccurate readings with poor peripheral perfusion (shock, cold extremities), nail polish, carbon monoxide poisoning (falsely normal/high SpO2 despite tissue hypoxia), and severe anemia.
  • Always correlate SpO2 with clinical appearance and respiratory effort, not the number alone.

7. Basic Airway Obstruction Management (brief)

  • Conscious, effective cough: encourage coughing, do not intervene.
  • Conscious, ineffective cough (choking): back blows and abdominal thrusts (Heimlich maneuver) in adults; back blows and chest thrusts in infants.
  • Unconscious: begin CPR; each time you open the airway to give breaths, look inside the mouth for a visible object and remove it only if seen.
Want to move to Cardiac Skills (ECG, CPR, AED, ACS recognition) next, or another topic from the list?
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