Airway & Ventilation — Editorial Topic
Not publishedof exam
CapnographyOxygenationVentilationRescue airways
Cardiology & Resuscitation — Editorial Topic
Not publishedof exam
ECGArrestBradycardiaTachycardia
Trauma — Editorial Topic
Not publishedof exam
HemorrhageChest injuryTBIBurns
Medical, Obstetric & Pediatric — Editorial Topic
Not publishedof exam
AnaphylaxisSeizuresStroke and diabetesMaternal and newborn care
EMS Operations & Pharmacology — Editorial Topic
Not publishedof exam
TriageToxicologyHeat illnessConsent and classification
Quick Facts
- Resource
- Independent paramedic clinical preparation
- MOH paramedic assessment
- Category and route unverified
- Official exam logistics
- Count, duration, fee and score unverified
- Sponsorship and verification
- Paramedic-specific requirements unverified
- Editorial topics
- Five; no official weights claimed
- Clinical resuscitation reference
- AHA/AAP 2025; Kuwait adoption unverified
- Asthma reference
- GINA 2026; asthma-specific guidance
- Adult arrest CPR
- 100–120 compressions/min; avoid excessive ventilation
- Adult advanced-airway arrest
- 10 breaths/min; continuous compressions
- Clinical application
- Local scope, protocol and medical direction
Capnography & Ventilation
- Resting adult ETCO2 reference
- Approximately 35–45 mm Hg; context matters
- Expiratory upstroke
- Dead-space gas transitions to alveolar gas
- Alveolar plateau
- Mainly alveolar exhalation
- Low ETCO2 during CPR
- Reassess CPR, ventilation and perfusion
- Sudden sustained ETCO2 rise
- Possible ROSC; confirm clinically
- Flat capnogram
- Check displacement, circuit, obstruction, low perfusion
- Shark-fin waveform
- Expiratory flow obstruction; not diagnosis alone
- Adult advanced-airway arrest ventilation
- 10 breaths/min; continuous chest compressions
- TBI ventilation reference
- ETCO2 35–45 mm Hg; avoid hyperventilation
- ETCO2 versus arterial CO2
- Not always interchangeable
Airway Rescue & Asthma
- Neuromuscular paralysis
- Provides neither sedation nor analgesia
- RSI preparation
- Preoxygenation, rescue plan, ongoing sedation
- SGA function
- Rescue ventilation; aspiration remains possible
- Airway confirmation
- Continuous waveform capnography plus clinical checks
- Cuffed ETT estimate, age 2–15
- Age/4 + 3.5 mm internal diameter
- Uncuffed ETT estimate, age 2–15
- Age/4 + 4 mm internal diameter
- ETT size estimates
- Confirm fit/depth; prepare adjacent sizes
- CPAP candidacy
- Breathing, protected airway, adequate circulation
- CPAP unsafe situations
- Apnea, unsafe airway, shock, untreated pneumothorax
- Asthma IM epinephrine
- For associated anaphylaxis; not routine asthma
- GINA 2026 asthma oxygen
- Supplement below 92%; target 92–95%Adults/adolescents and children 6–11
- Cannot intubate/oxygenate
- Trained rescue pathway; age/device-specific access
Adult Arrest Reversible Causes
Volume Oxygen Acid Potassium Cold; Pressure Fluid Toxins Clots
Hypovolemia, hypoxia, acidosis, potassium, hypothermiaTension, tamponade, toxins, pulmonary/coronary thrombosis
Adult Rhythm Action Picker
- Cardiac arrest with VF/pVT→Defibrillate and continue high-quality CPR(Use AHA adult arrest pathway)
- Cardiac arrest with PEA/asystole→CPR; prompt epinephrine; reversible causes(Do not shock a nonshockable rhythm)
- Bradycardia with poor perfusion→Treat causes; atropine; pacing/infusion escalation(Rate alone is not the indication)
- Regular narrow-complex perfusing tachycardia→Vagal maneuvers/adenosine when appropriate(Review contraindications and instability)
- Unstable polymorphic VT→Unsynchronized shock(Reliable synchronization is not feasible)
- ROSC with reliable saturation→AHA adult target 90–98%(Different populations/guidelines can differ)
ECG Localization & ACS
- Inferior leads
- II, III, aVF
- Lateral leads
- I, aVL, V5–V6
- Anterior/septal leads
- V1–V4 conventional localization
- Possible RV infarction
- Consider right-sided leads such as V4R
- Coronary culprit inference
- Anatomy varies; ECG not definitive alone
- Normal initial ECG
- Does not exclude acute coronary syndrome
- Hypotensive RV infarction
- Nitrates may worsen preload-dependent hypotension
- Fluid decision
- Clear lungs alone cannot guarantee safety
Adult Arrest & Perfusing Arrhythmias
- VF or pulseless VT
- Defibrillate promptly with high-quality CPR
- PEA or asystole
- CPR; prompt epinephrine; reversible causes
- Biphasic defibrillation energy
- Manufacturer recommendation; unknown means maximum available
- Adult arrest epinephrine IV/IO
- 1 mg every 3–5 minutes
- Refractory VF/pVT amiodarone IV/IO
- 300 mg, then 150 mg
- Arrest lidocaine first IV/IO dose
- 1–1.5 mg/kg
- Arrest lidocaine second IV/IO dose
- 0.5–0.75 mg/kg
- Unstable bradycardia atropine IV
- 1 mg; total maximum 3 mgRepeat every 3–5 minutes
- Refractory bradycardia
- Pacing and/or titrated vasoactive infusion
- Bradycardia epinephrine infusion IV
- 2–10 mcg/min; titrate response
- Bradycardia dopamine infusion IV
- 5–20 mcg/kg/min; titrate response
- Regular tachycardia adenosine IV
- 6 mg rapid, then 12 mgSaline flush; assess contraindications
- Wide-complex adenosine restriction
- Only stable, regular and monomorphic
- Instability caused by tachyarrhythmia
- Synchronized cardioversion; sedation when feasible
- Unstable polymorphic VT
- Unsynchronized shock; synchronization unreliable
- AHA 2025 adult post-ROSC SpO2
- 90–98% once measurement is reliable
- Adult post-ROSC PCO2 / MAP
- 35–45 mm Hg / ≥65 mm HgPCO2 target absent severe acidemia
Beck vs Cushing Triads
Beck: low pressure; Cushing: high pressure
Beck: muffled sounds, neck veinsCushing: slow pulse, irregular breathingNeither triad is a rule-out test
Tension Pneumothorax vs Tamponade
Tension pneumothorax
- Unilateral breath findings may occur
- Respiratory and circulatory deterioration
Tamponade
- Pericardial pressure impairs filling
- Beck’s triad often incomplete
Classic signs neither prove nor exclude
Trauma Reassessment Picker
- Catastrophic external bleeding→Control immediately within training(Assess airway/breathing concurrently)
- Unilateral breath findings plus shock→Consider tension pneumothorax(Do not wait for tracheal deviation)
- Shock with incomplete Beck’s triad→Tamponade remains possible(Other injuries can coexist)
- Hypotension plus relative bradycardia→Consider neurogenic shock(Still search for hemorrhage)
- Worsening after chest sealing→Reassess for trapped intrathoracic air(Follow trained decompression/seal pathway)
- Low GCS→Assess airway, ventilation and trajectory(Document components and confounders)
Hemorrhage, Chest Injury & TBI
- Catastrophic external hemorrhage
- Immediate control; concurrent airway/breathing assessment
- Tension pneumothorax concern
- Respiratory deterioration, unilateral findings and shock
- Absent tracheal deviation
- Does not exclude tension pneumothorax
- Beck’s triad
- Hypotension, muffled sounds, distended neck veins
- Incomplete Beck’s triad
- Does not exclude tamponade
- Cushing’s triad
- Hypertension, bradycardia, irregular breathing
- Cushing’s triad timing
- Late warning; TBI possible without triad
- GCS components
- Eyes 4; verbal 5; motor 6
- GCS range
- 3–15; document components and confounders
- GCS ≤8
- Serious concern; not sole intubation decision
- Chest seal reassessment
- Worsening breathing may indicate trapped air
- Three-sided dressing
- Not a guaranteed one-way valve
Cushing Pattern vs Hemorrhagic Shock
Raised ICP pattern
- Hypertension, bradycardia, irregular breathing
- Often late; not always present
Hemorrhagic shock
- Bleeding and impaired perfusion
- Rate/pressure patterns can vary
Mixed injuries can produce mixed findings
Burns, Shock & Pelvic Injury
- Classic Parkland estimate
- 4 mL/kg per %TBSA; historical
- Classic first-half timing
- Within 8 hours from burn
- 70 kg; 30% classic estimate
- 8,400 mL over first 24 hours
- ABA 2024 adult initial basis
- 2 mL/kg per %TBSAAdults with ≥20% TBSA burns
- Burn fluid reassessment
- Adjust to response; children differ
- Burn area calculation
- Exclude superficial erythema from resuscitation TBSA
- Neurogenic shock pattern
- Hypotension with relative bradycardia; variable
- Trauma shock differential
- Hemorrhage can coexist with neurogenic shock
- Flail segment definition
- ≥3 adjacent ribs; ≥2 fractures each
- Flail injury hypoxemia
- Contusion, pain and associated injuries contribute
- Pelvic binder location
- Over greater trochanters, not iliac crests
- Trauma TXA
- Significant bleeding; timely, protocol-specific regimen
Neurogenic vs Hypovolemic Shock
Neurogenic pattern
- Loss of sympathetic tone
- Relative bradycardia and warmth possible
Hypovolemic pattern
- Reduced circulating volume
- Bleeding common after trauma
Exclude hemorrhage; causes can coexist
Adult DKA vs HHS
DKA
- Ketosis plus metabolic acidosis
- ≥200 mg/dL or prior diabetes
- Euglycemic presentations possible
HHS
- Severe hyperglycemia and hyperosmolality
- Without significant ketosis/acidosis
- Mixed presentations occur
Glucose alone does not establish diagnosis
Maternal & Newborn Action Picker
- Maternal arrest; uterus ≥umbilicus→Manual left uterine displacement(Maintain supine high-quality compressions)
- Eclamptic seizure→Magnesium under obstetric protocol(Monitor breathing, reflexes and circulation)
- Shoulder dystocia→McRoberts plus suprapubic pressure(No fundal pressure)
- Newborn apnea/gasping or HR <100→Effective ventilation; 30–60 inflations/min(Correct leak/obstruction and reassess)
- Newborn HR <60 despite ventilation→Compressions 3:1 with ventilation(Optimize ventilation before escalation)
- Persistent newborn HR <60→Neonatal intravascular epinephrine pathway(After optimized ventilation and compressions)
Anaphylaxis, Seizures, Stroke & Diabetes
- Adult anaphylaxis epinephrine IM
- 0.3–0.5 mg of 1 mg/mLAnterolateral thigh; protocol/product-specific
- RCUK adult anaphylaxis regimen
- 0.5 mg IM1 mg/mL solution
- RCUK repeat if not improving
- After 5 minutes; reassess
- 0.5 mg at 1 mg/mL
- 0.5 mL; not arrest concentration
- Convulsive status concern
- About 5 minutes or no recovery
- Seizure midazolam without access
- NASEMSO: IM/IN 0.2 mg/kgMaximum 10 mg; monitor ventilation
- Seizure midazolam with access
- NASEMSO: IV/IO 0.1 mg/kgMaximum 4 mg; cumulative doses matter
- Stroke last-known-well
- Last known baseline, not discovery time
- Stroke mimic check
- Measure glucose; hypoglycemia can mimic stroke
- DKA diagnostic triad
- Diabetes/hyperglycemia, ketosis and metabolic acidosis
- DKA glucose criterion
- ≥200 mg/dL or prior diabetes
- Euglycemic DKA
- Possible; glucose alone cannot exclude
- HHS pattern
- Severe hyperglycemia, hyperosmolality and dehydration
Croup Pattern vs Dangerous Upper-Airway Obstruction
Croup pattern
- Barking cough, hoarseness, stridor
- Severity guides protocol-based care
Dangerous obstruction concern
- Drooling, toxic appearance, severe distress
- Avoid agitation or forced throat examination
One sign cannot establish the diagnosis
Maternal, Newborn & Pediatric Care
- Eclampsia medication
- Magnesium sulfate under obstetric protocol
- Magnesium toxicity concern
- Lost reflexes, respiratory depression; stop infusion
- Maternal arrest: uterus ≥umbilicus
- Manual left displacement; supine high-quality CPR
- Cord prolapse
- Trained elevation relieves presenting-part pressure
- Shoulder dystocia
- McRoberts plus suprapubic pressureNever apply fundal pressure
- PPH treatment
- Early concurrent bundle; urgent escalation
- WHO 2025 early PPH trigger
- 300 mL plus abnormal vital signs
- WHO PPH volume trigger
- 500 mL also triggers first response
- Fundal massage
- Different from bimanual uterine compression
- Newborn apnea/gasping or HR <100
- Effective ventilation; reassess heart-rate response
- AHA/AAP 2025 newborn ventilation
- 30–60 inflations/min; not old 40–60
- Newborn HR <60 despite ventilation
- Coordinated compressions and ventilation 3:1
- Persistent newborn HR <60
- Epinephrine after optimized ventilation/compressions
- Newborn intravascular epinephrine
- 0.01–0.03 mg/kg; neonatal algorithm
- Pediatric Assessment Triangle
- Appearance, breathing work, skin circulation
- Suspected dangerous upper-airway obstruction
- Avoid agitation and forced throat examination
Classic Adult START Branches
30 respirations; 2-second refill; can follow commands
>30/min or poor perfusion: redCannot follow commands: redAlgorithm is not ordinary physiological normality
Anticholinergic vs Sympathomimetic Clues
Anticholinergic pattern
- Dryness, mydriasis, delirium possible
- Urinary retention and reduced bowel sounds
Sympathomimetic pattern
- Sweating, mydriasis, agitation possible
- Tachycardia and hypertension commonly accompany agitation
Sweating alone is not diagnostic proof
Triage & Scope Picker
- Walking after initial sorting→START minor/green; reassess(Use incident-authorized triage system)
- Adult spontaneous RR >30/min→START immediate/red(Classic START has no <10 branch)
- Adult cannot follow commands→START immediate/red(After breathing and perfusion assessment)
- Child apneic but pulse present→JumpSTART: 5 rescue breaths(Resumed breathing leads immediate/red)
- Child RR <15 or >45/min→JumpSTART immediate/red(These are triage thresholds)
- Kuwait booking or sponsorship question→Confirm with MOH classification authority(No paramedic-specific route established here)
Triage & Toxicology
- Adult START respiratory branch
- >30/min prompts immediate/red
- Adult START perfusion branch
- Absent radial pulse; refill >2 secondsEither abnormal finding prompts red
- Adult START mental-status branch
- Cannot follow commands prompts immediate/red
- Adult START persistent apnea
- Black category after airway opening
- JumpSTART apnea with pulse
- Give 5 rescue breaths
- JumpSTART breathing after rescue breaths
- Immediate/red
- JumpSTART respiratory branch
- <15 or >45/min prompts red
- JumpSTART 15–45/min
- Triage band, not universal normal range
- Organophosphate care
- PPE/decontamination, ventilation and atropine
- Atropine respiratory endpoint
- Improving ventilation and bronchial secretions
- Opioid respiratory depression
- Support ventilation; product-specific naloxone
- TCA sodium-channel toxicity
- Bicarbonate; ECG/lab monitoring; expert direction
Cholinergic Crisis Clues
Secretions plus bronchorrhea bronchospasm bradycardia
Protect staff; support ventilationPupils alone do not guide atropine
Heat, Pediatric Arrest & Kuwait Scope
- Heat stroke concern
- Heat illness plus CNS dysfunction
- Sweating or temperature <40 °C
- Does not exclude treated heat stroke
- Heat stroke priority
- Rapid effective cooling; support ABCs
- Pediatric first shock
- 2 J/kg
- Pediatric second shock
- 4 J/kg
- Subsequent pediatric shocks
- At least 4 J/kg10 J/kg or adult dose
- Pediatric shock ceiling
- 10 J/kg or adult doseDo not exceed either maximum
- Pediatric arrest epinephrine IV/IO
- 0.01 mg/kg; 0.1 mg/mLMaximum 1 mg; every 3–5 minutes
- 20 kg first shock
- 40 J
- 20 kg arrest epinephrine
- 0.2 mg = 2 mLUse 0.1 mg/mL solution
- Hazardous-material approach
- Safe direction; incident command; appropriate PPE
- Hot-zone care
- Trained protected teams; incident plan governs
- Refusal capacity
- Understanding, appreciation, reasoning and choice
- GCS 15
- Does not establish decision-making capacity
- Kuwait paramedic exam route
- Unverified; confirm classification with MOH
- Prometric/DataFlow/sponsorship
- Not established for this paramedic-specific route
- Other MOHKW categories
- Do not transfer their exam rules
- Clinical guidelines
- Educational references; Kuwait adoption unverified
Common Traps
Different Epinephrine Indications and Routes
Adult arrest epinephrine IV/IO ≠ Anaphylaxis epinephrine IM
Different Oxygen Targets
AHA adult post-ROSC: 90–98% ≠ GINA asthma oxygen: 92–95%
Score vs Decision Capacity
GCS 15 ≠ Established decision-making capacity
Stabilization vs Potassium Removal
Calcium myocardial stabilization ≠ Potassium removal from the body
Triage vs Physiological Normality
JumpSTART 15–45/min triage band ≠ Universal normal child respiratory range
Other Professions vs Verified Paramedic Policy
Other professions’ MOHKW exam rules ≠ Verified paramedic-specific assessment policy
Anatomy vs Visible Motion
Flail segment anatomical definition ≠ Every patient’s visible paradoxical motion
Last Minute
- 1.Adult arrest compression rate: 100–120/min
- 2.Adult advanced-airway arrest: 10 breaths/min
- 3.Adult arrest epinephrine IV: 1 mg
- 4.Arrest epinephrine interval: 3–5 minutes
- 5.Adult bradycardia atropine maximum: 3 mg
- 6.Adult adenosine IV first: 6 mg
- 7.Adult adenosine IV second: 12 mg
- 8.Unstable polymorphic VT: unsynchronized shock
- 9.AHA adult post-ROSC SpO2: 90–98%
- 10.Flail injury: paradoxical motion sometimes masked
- 11.Pelvic binder: greater trochanters
- 12.Newborn ventilation: 30–60 inflations/min
- 13.Newborn compression/ventilation ratio: 3:1
- 14.JumpSTART bands differ from normal physiology
- 15.Children’s defibrillation energy depends on weight
- 16.Children’s arrest epinephrine is not IM
- 17.Anaphylaxis epinephrine: IM anterolateral thigh
- 18.Heat stroke can include sweating
- 19.GCS 15 does not establish capacity
- 20.Kuwait paramedic assessment route: unverified
- 21.Official paramedic blueprint weights: unverified
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