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AI Tools for Paramedics
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Pre-oxygenation
BVM + NRB · achieve SpO2 >95% before induction
Induction agents
Etomidate 0.3 mg/kg · Ketamine 1–2 mg/kg
Paralytics
Succinylcholine 1.5 mg/kg · Rocuronium 1.2 mg/kg
Failed airway backup
Video laryngoscopy → supraglottic → cric
Post-intubation
Confirm with waveform capnography + CXR
Advanced airway management and decision-making
Assess airway difficulty, select appropriate techniques, manage RSI medications, and decide on airway interventions.
A 55-year-old with altered mental status, stridor, and difficulty swallowing. Assessment suggests epiglottitis. Do I attempt intubation or keep airway patent?
Compiled epiglottitis management: DO NOT attempt intubation in field if epiglottitis suspected—risk of airway obstruction. Keep patient upright, 100% oxygen, notify receiving facility (need OR standby), arrange rapid transport. If airway compromise evident: consider needle cricothyrotomy as last resort. Key: epiglottitis is a "DO NOT DELAY" transport situation. Antibiotics/treatment happens in ED/OR, not in field. Maintain calm, oxygenate, transport.
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Intubation attempt?
DO NOT attempt — risk complete obstruction
Position
Upright (tripod) · do not lay patient down
Oxygen
100% non-rebreather mask · passive flow
Last resort
Needle cricothyrotomy if complete obstruction
Transport priority
Rapid transport · notify OR standby needed
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DrugUseDose
Epinephrine neb.Reduce swelling0.5 mL 2.25%
DexamethasoneAnti-inflammatory0.6 mg/kg IV
Helium-O2 (Heliox)Reduce turbulence70:30 mix
Verify against local medical director protocols
RSI (Rapid Sequence Intubation) medication management
Verify induction agent and paralytic drug dosing, manage sequences, anticipate complications, and ensure rapid intubation success.
RSI for 80kg patient with head injury and altered mental status. Which induction agent? Paralytic? Dosing?
RSI sequence: Pre-oxygenation → induction agent → paralytic → intubation attempt. For head injury patient: Etomidate 0.3mg/kg IV (24mg for 80kg) preferred (maintains cerebral perfusion pressure) OR propofol 1.5-2mg/kg (avoid if hypotensive). Paralytic: succinylcholine 1-1.5mg/kg (80-120mg) for rapid onset OR rocuronium 1.2mg/kg (96mg) slightly slower onset. KEY: pre-oxygenate fully, have backup airway ready, expect elevated ICP with intubation—manage head of bed elevation and sedation.
ToolRouter lookup_docs
DrugDoseAmount (80 kg)
Etomidate0.3 mg/kg IV24 mg
Succinylcholine1.5 mg/kg IV120 mg
Rocuronium (alt)1.2 mg/kg IV96 mg
Lidocaine (opt)1.5 mg/kg IV120 mg
Pre-oxygenate to SpO2 >95% before induction
Sepsis recognition and early intervention
Recognize sepsis in field, initiate early interventions (fluids, antibiotics timeline if available), and arrange rapid hospital transport.
A 72-year-old with fever, altered mental status, rapid heart rate, low BP. Suspected urosepsis. What field management?
Compiled sepsis protocol (qSOFA): altered mental status = YES, tachycardia = YES, hypotension = YES → SEPSIS ALERT. Field management: high-flow oxygen, IV access, rapid fluid bolus (500mL or more), measure vitals including temperature, notify hospital (activate sepsis protocol), arrange rapid transport. Time to hospital is critical—every hour delays antibiotics. Transport > scene time for sepsis. Keep patient warm. Document time of intervention (critical for hospital sepsis bundle).
ToolRouter research
qSOFA score
AMS ✓ · HR >100 ✓ · SBP <100 ✓ = SEPSIS
Oxygen
High-flow O2 · SpO2 target >94%
IV access
2× large bore · 500 mL NS bolus
Transport priority
Rapid transport — every hour = worse outcome
Hospital notification
Activate sepsis protocol en route
Clinical decision-making for transport and treatment intensity
Determine appropriate transport destination, treatment intensity, advanced interventions, and medical control consultation.
A 45-year-old with syncope, now awake and stable vitals, no chest pain. Does this patient need transport to hospital? Advanced interventions?
Syncope evaluation: even if now stable, syncope has cardiac etiology risk. Evidence shows: 10% of syncope cases have serious underlying cause (arrhythmia, structural heart disease). Recommendation: transport to hospital for evaluation (ECG, labs, monitoring). Do not leave at home despite current stability. Basic vital signs not sufficient to rule out serious cause. Advanced interventions: IV access if available, continuous monitoring. Most syncopal patients need hospital evaluation.
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Transport needed?
YES — 10% of syncope has serious cause
Cardiac risk
Arrhythmia, structural disease cannot be ruled out field
Monitoring
Continuous 12-lead ECG monitoring en route
IV access
Establish IV access for monitoring and access
Do NOT leave at home
Current stability does not rule out serious cause
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San Francisco Syncope Rule
Age >45, CHF Hx, EKG abnormality = high risk
ROSE rule
BNP >300, hematocrit <30 = high risk
30-day serious outcomes
~10% of syncope patients have cardiac cause
Evidence recommendation
Transport all first-time syncope to ED
Ready-to-use prompts
RSI protocols
Research rapid sequence intubation (RSI) including pre-oxygenation, induction agents, paralytics, and complications to watch for.
Medication dosing
Look up paramedic medication dosing for induction agents (etomidate, propofol), paralytics (succinylcholine, rocuronium), and vasopressors.
Sepsis management
Research sepsis recognition, qSOFA criteria, and evidence-based pre-hospital sepsis protocols.
Difficult airway
Research assessment and management of difficult airway in the field including backup techniques and equipment.
Drug interactions
Look up potential drug interactions for common paramedic medications and contraindications.
Cardiac protocols
Research advanced cardiac life support (ACLS) and post-resuscitation care protocols for paramedics.
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Advanced life support call management
Assess patient, initiate advanced interventions (airway, medications, monitoring), and arrange appropriate transport.
Difficult patient or treatment decision
For complex cases, research evidence on best practices and clinical outcomes before making treatment decisions.
Frequently Asked Questions
How do I know when to use a specific induction agent for RSI?
Etomidate for head injury (maintains cerebral perfusion), propofol for general patients (avoid if hypotensive), ketamine for trauma (maintains airway reflexes). Drug selection depends on patient condition. When unsure, contact medical control.
What do I do if I cannot intubate after RSI?
Plan B: video laryngoscopy, plan C: supraglottic airway (King LT, LMA), plan D: needle cricothyrotomy if complete airway obstruction. Always have backup plan before attempting RSI. Know your protocols.
How important is field administration of antibiotics for sepsis?
If your service carries antibiotics: YES, administer immediately (time to antibiotics = outcome). If not available: rapid transport is priority. Notify hospital of suspected sepsis (activate sepsis protocol). Early recognition and fluid resuscitation are equally critical.
When should I consult medical control versus acting on standing orders?
Standing orders = act immediately (chest pain, asthma, etc.). Non-standard situations, medication questions, or uncertain diagnoses = call medical control. It's better to ask than to guess in complex cases.
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