[{"title":"About","h1":"Built for Paramedics Who Want Better Decisions","description":"Code 3 Workshop is practical paramedic education: 145 short lessons by category, CardioStrip rhythm practice, and EMS toolkit apps.","url":"/about/","type":"Page","body":"About · Code 3 Workshop Skip to content Home / About About Built for Paramedics Who Want Better Decisions A practical education hub for working paramedics, students, and educators — short lessons, interactive tools, street language. This site exists to help paramedics improve decision-making through interactive practice apps and short, focused learning modules — built for real street work, not classroom theater. It is education, not a clinical product. Who It’s For Working paramedics refreshing high-yield topics between calls or before a shift Students and new medics building a systematic approach to ECG, airway, shock, and trauma priorities Educators and FTOs looking for shareable practice tools and consistent teaching language What You’ll Find Here Learn by Category — 145 lessons of 15 minutes or less (twenty-nine per category) across airway, cardiac, medical, meds, and trauma. Each en","keywords":"About Code 3 Workshop is practical paramedic education: 145 short lessons by category, CardioStrip rhythm practice, and EMS toolkit apps. Page about"},{"title":"Airway & Breathing Lessons","h1":"Airway & Breathing","description":"Twenty-nine prehospital airway lessons: if the bag isn’t moving the chest, nothing else matters. BVM, suction, VL, drowning, stridor, and a CICO plan you say out loud.","url":"/airway-breathing/","type":"Category","body":"Airway & Breathing Lessons · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing Category Airway & Breathing Start with ventilation that works, not a laryngoscope. Two-person BVM, suction that clears vomit, ear-to-sternal-notch, VL and bougie, drowning, stridor, smoke, DSI, peds, trachs, and the minutes after the tube — with a CICO plan you say out loud before the first look. Lessons Modules in This Category Twenty-nine airway modules. Suggested path from BVM to FONA — or jump to the skill you keep missing. Lesson Effective BVM Ventilation 10 min Position, two-person seal, modest volume, and rate — so bagging actually moves the chest. Start lesson → Lesson Waveform Capnography: The Gold Standard 12 min Continuous waveform ETCO₂ — set up early, read the shape, confirm the airway, catch ROSC. Start lesson → Lesson Failed Oxygenation: DOPE-S 10 min When SpO₂ will not cli","keywords":"Airway & Breathing Lessons Twenty-nine prehospital airway lessons: if the bag isn’t moving the chest, nothing else matters. BVM, suction, VL, drowning, stridor, and a CICO plan you say out loud. Category airway-breathing"},{"title":"Cardiac & ECG Lessons","h1":"Cardiac & ECG","description":"Twenty-nine cardiac lessons: two-person arrest, a 12-lead in ten minutes, pacing, cardioversion, TOR, and the chest-pain story that is not ACS.","url":"/cardiac/","type":"Category","body":"Cardiac & ECG Lessons · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG Category Cardiac & ECG The strip, the arrest, and the peri-arrest patient who still has a pulse. Pit-crew CPR, STEMI and the views a 12-lead hides, pacing, cardioversion, TOR, pregnancy and hypothermia arrest, cardiogenic shock, and dissection you must not treat like ACS. Lessons Modules in This Category Twenty-nine cardiac modules. Suggested path from high-quality CPR to dissection suspicion — or jump to the strip you keep missing. Lesson Systematic ECG Approach 10 min Rate, regularity, P, PR, QRS, name — the same pass on every strip. Start lesson → Lesson AV Blocks: Three-Question Path 12 min Three questions separate Wenckebach from Mobitz II and complete block. Start lesson → Lesson Stable vs Unstable Tachycardia 12 min Instability is perfusion — not a number on the monitor. Start lesson → Lesso","keywords":"Cardiac & ECG Lessons Twenty-nine cardiac lessons: two-person arrest, a 12-lead in ten minutes, pacing, cardioversion, TOR, and the chest-pain story that is not ACS. Category cardiac"},{"title":"Contact","h1":"Send feedback","description":"Send feedback, corrections, or lesson-topic requests for Code 3 Workshop. Include the page URL when you report an error.","url":"/contact/","type":"Page","body":"Contact · Code 3 Workshop Skip to content Home / Contact Contact Send feedback Found an error, want a tool, or have a lesson idea? Send a note — include the page URL when you can. Have feedback, found an error, or want to request a lesson topic? Send a note and include the page URL when possible. Email hello@code3workshop.com — copy it, or use the button below. Email feedback Browse Categories","keywords":"Contact Send feedback, corrections, or lesson-topic requests for Code 3 Workshop. Include the page URL when you report an error. Page contact"},{"title":"Disclaimer","h1":"Education & Demonstration Only","description":"Code 3 Workshop is education and demonstration only — not a medical device, not medical direction, and not a substitute for local protocols.","url":"/disclaimer/","type":"Page","body":"Disclaimer · Code 3 Workshop Skip to content Home / Disclaimer Legal Education & Demonstration Only Read this before using any tool or lesson. Protocol and medical direction always win. All content, tools, simulators, converters, quizzes, and category lessons on Code 3 Workshop are provided strictly for education, training, and demonstration . Not for Clinical Care Not a medical device and not software as a medical device Not a substitute for clinical judgment, local protocols, medical direction, or hands-on training Not intended to diagnose, treat, cure, or prevent any disease or condition Not certified for use in patient care environments as a clinical instrument Does not authorize medication doses, routes, procedural techniques, or transport decisions Tools and Simulators Interactive tools such as CardioStrip, Narrative Coach, and unit converters produce educational outputs only. Simu","keywords":"Disclaimer Code 3 Workshop is education and demonstration only — not a medical device, not medical direction, and not a substitute for local protocols. Page disclaimer"},{"title":"CardioStrip","h1":"CardioStrip","description":"CardioStrip: 39 Lead II strips plus teaching 12-leads for paramedics — STEMI patterns, Wellens, de Winter, V4R, posterior leads, and mimics. AHA 2025 and NASEMSO for field pathways; LITFL as a teaching atlas. Education only — not a medical device.","url":"/ems-toolkit/cardiostrip/","type":"Toolkit","body":"CardioStrip · Code 3 Workshop Skip to content CardioStrip Educational EKG Simulator Lead II 12-Lead Learn Compare Drill Quiz Reference Glossary Naming Lead II · 25 mm/s 6-second strip Library Cardiac Rhythms Select a rhythm for a realistic 6-second Lead II strip. Filter by family. Use ↑ ↓ to browse. Search rhythms Rhythm study Normal Sinus Rhythm Regular atrial and ventricular activation from the SA node Zoom in Calipers Export Resample Sweep Mobile tip: Turn your phone sideways (landscape) to see the full life-size 6-second strip on one screen. Rhythm strip · Lead II · life size (25 mm/s · 10 mm/mV) — Drag across the strip to measure Clear 0.04 s · 0.1 mV 0.20 s · 0.5 mV View: 100% life size · 1 large box ≈ 5 mm ← 6.0 seconds → How to Identify Salient Features Systematic Approach Reset Work top-to-bottom — the same six-step pass you use on the truck, at the monitor. Rate Helper 6-second","keywords":"CardioStrip CardioStrip: 39 Lead II strips plus teaching 12-leads for paramedics — STEMI patterns, Wellens, de Winter, V4R, posterior leads, and mimics. AHA 2025 and NASEMSO for field pathways; LITFL as a teaching atlas. Education only — not a medical device. Toolkit cardiostrip"},{"title":"EMS Toolkit","h1":"EMS Toolkit","description":"Educational EMS apps: CardioStrip rhythm practice, Narrative Coach ePCR writing drills, and a kg ↔ lb converter.","url":"/ems-toolkit/","type":"Toolkit","body":"EMS Toolkit · Code 3 Workshop Skip to content Home / EMS Toolkit Toolkit EMS Toolkit Interactive practice apps that pair with the lessons — CardioStrip for Lead II and 12-lead pattern practice, Narrative Coach for ePCR writing, a kg ↔ lb converter for dosing math. Education only. Purpose What Belongs in the Toolkit The EMS Toolkit is a home for interactive educational apps: rhythm practice, narrative writing drills, unit conversion, and other utilities that make study and skill refresh faster. All tools are for education and demonstration only — not a substitute for protocols or medical direction. Learning Tools Simulators and guided practice apps — CardioStrip for Lead II rhythms and teaching 12-leads, Narrative Coach for fictional ePCR writing — that turn recognition into reps. Study utilities Quick converters for study and scenario review. Education only — not for clinical care, not a","keywords":"EMS Toolkit Educational EMS apps: CardioStrip rhythm practice, Narrative Coach ePCR writing drills, and a kg ↔ lb converter. Toolkit ems-toolkit"},{"title":"Narrative Coach","h1":"Narrative Coach","description":"EMS writing academy: SOAP/CHART/DCHART drills, live coach, IMIST-AMBO radio handoff, and a deterministic rubric. Fictional scenarios only. Never enter real PHI.","url":"/ems-toolkit/narrative-coach/","type":"Toolkit","body":"Narrative Coach · Code 3 Workshop Skip to content Narrative Coach Narrative Coach Loading academy… Narrative Coach is for education and demonstration only . Fictional drills — not an ePCR, not a medical device, and not a substitute for protocol or medical direction. Never enter real PHI. Read the full disclaimer .","keywords":"Narrative Coach EMS writing academy: SOAP/CHART/DCHART drills, live coach, IMIST-AMBO radio handoff, and a deterministic rubric. Fictional scenarios only. Never enter real PHI. Toolkit narrative-coach"},{"title":"Narrative Coach lessons","h1":"Lessons","description":"Narrative Coach lessons on SOAP, CHART, DCHART, CHEATED, and chronological ePCR writing. Fictional scenarios only. No CE.","url":"/ems-toolkit/narrative-coach/lessons/","type":"Toolkit","body":"Narrative Coach lessons · Code 3 Workshop Skip to content Narrative Coach Lessons Loading academy…","keywords":"Narrative Coach lessons Narrative Coach lessons on SOAP, CHART, DCHART, CHEATED, and chronological ePCR writing. Fictional scenarios only. No CE. Toolkit lessons"},{"title":"Progress · Narrative Coach","h1":"Progress","description":"On-device Narrative Coach progress: lesson checks, drill scores, and skill mix. Stored in this browser only.","url":"/ems-toolkit/narrative-coach/progress/","type":"Toolkit","body":"Progress · Narrative Coach Skip to content Narrative Coach Progress Loading academy…","keywords":"Progress · Narrative Coach On-device Narrative Coach progress: lesson checks, drill scores, and skill mix. Stored in this browser only. Toolkit progress"},{"title":"Narrative Coach drills","h1":"Scenario drills","description":"Fictional EMS scenario drills for narrative practice. Score SOAP, CHART, and more with an on-device rubric. Never enter real PHI.","url":"/ems-toolkit/narrative-coach/scenarios/","type":"Toolkit","body":"Narrative Coach drills · Code 3 Workshop Skip to content Narrative Coach Scenario drills Loading academy…","keywords":"Narrative Coach drills Fictional EMS scenario drills for narrative practice. Score SOAP, CHART, and more with an on-device rubric. Never enter real PHI. Toolkit scenarios"},{"title":"Writing studio · Narrative Coach","h1":"Writing studio","description":"Write a fictional EMS narrative from a call sheet and score it with a deterministic rubric. Never enter real PHI.","url":"/ems-toolkit/narrative-coach/studio/","type":"Toolkit","body":"Writing studio · Narrative Coach Skip to content Narrative Coach Writing studio Loading academy…","keywords":"Writing studio · Narrative Coach Write a fictional EMS narrative from a call sheet and score it with a deterministic rubric. Never enter real PHI. Toolkit studio"},{"title":"Weight Converter (kg ↔ lb)","h1":"Weight Converter","description":"Convert kilograms and pounds for EMS study. Uses 1 kg = 2.20462 lb. Education only — not a dose calculator.","url":"/ems-toolkit/weight-converter/","type":"Toolkit","body":"Weight Converter (kg ↔ lb) · Code 3 Workshop Skip to content Home / EMS Toolkit / Weight converter Converter Weight Converter Convert kilograms and pounds for study, scenarios, and weight-based math. Education only — not a dosing tool. kg ↔ lb Type in either field — the other updates automatically. Uses 1 kg = 2.20462 lb. Kilograms (kg) ⇄ Pounds (lb) Conversion — Enter a weight in kg or lb. Street math tips: kg × 2.2 ≈ lb · lb ÷ 2.2 ≈ kg. Exact factor used here is 2.20462. Many weight-based meds are calculated in kg — convert carefully, then check your protocol. Why This Matters for Paramedics Weight errors are a top medication-safety failure mode. Pounds left in a kilograms slot roughly doubles a mg/kg dose; the reverse underdoses. Use this converter for study and scenario practice — then run the full dosing sequence from the lesson below. Convert first, calculate second — confirm kg be","keywords":"Weight Converter (kg ↔ lb) Convert kilograms and pounds for EMS study. Uses 1 kg = 2.20462 lb. Education only — not a dose calculator. Toolkit weight-converter"},{"title":"Code 3 Workshop · Paramedic Education","h1":"Paramedic education for the street","description":"One hundred forty-five EMS lessons of 15 minutes or less — airway, cardiac, medical, meds, and trauma — plus CardioStrip, Narrative Coach, and practice apps for paramedics.","url":"/","type":"Home","body":"Code 3 Workshop · Paramedic Education Skip to content Paramedic Education Paramedic education for the street One hundred forty-five lessons of 15 minutes or less, plus CardioStrip, Narrative Coach, and practice apps — built for paramedics who want better decisions under sirens and stress. Learn by Category Open EMS Toolkit 145 short lessons 15 min or less each 5 clinical paths 3 live apps How it works Read. Check. Practice. Short modules, a quiz on that lesson only, then reps in the toolkit — education and demonstration only. Street-length lessons Twenty-nine modules in each category. Each one is built to finish in 15 minutes or less, including the self-check. Check your understanding Every lesson ends with a short quiz drawn only from that session — no trivia from another module. Then get reps Pair cardiac with CardioStrip, documentation habits with Narrative Coach, and dosing math with","keywords":"Code 3 Workshop · Paramedic Education One hundred forty-five EMS lessons of 15 minutes or less — airway, cardiac, medical, meds, and trauma — plus CardioStrip, Narrative Coach, and practice apps for paramedics. Home"},{"title":"Airway Attempt Limits: Stop Digging","h1":"Airway Attempt Limits: Stop Digging","description":"Prehospital intubation culture: limit attempts, change something each look, oxygenate between, and declare CICO before the fourth pass. DAS/AHA teaching — protocol owns the number.","url":"/learn/airway-breathing/airway-attempt-limits/","type":"Lesson","body":"Airway Attempt Limits: Stop Digging · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Airway Attempt Limits: Stop Digging Lesson Airway Attempt Limits: Stop Digging 11 min Airway & Breathing Skip to quiz Objective: Treat each laryngoscopy as a scarce resource: oxygenate between looks, change one thing, and stop digging when the plan is failing. Why This Is Hard The sat is 70% and the crew is still “just going to try one more look.” DAS and Vortex teaching: repeated identical attempts steal oxygen and make CICO more likely. AHA airway teaching for cardiac arrest still wants high-quality CPR first — the tube is not the first intervention. On the street, ego and “I almost had it” are the usual reasons people keep digging. On this truck You have a clock (sat, EtCO₂, and how long since the last breath), not an OR full of extra blades. Each look is a dose of apnea. Co","keywords":"Airway Attempt Limits: Stop Digging Prehospital intubation culture: limit attempts, change something each look, oxygenate between, and declare CICO before the fourth pass. DAS/AHA teaching — protocol owns the number. Lesson airway-attempt-limits"},{"title":"Angioedema: The Airway That Swells Shut","h1":"Angioedema: The Airway That Swells Shut","description":"ACE-inhibitor, allergic, and hereditary angioedema on the truck: sit them up, do not poke a swelling tongue repeatedly, and leave early for a difficult-airway destination.","url":"/learn/airway-breathing/angioedema-airway-field/","type":"Lesson","body":"Angioedema: The Airway That Swells Shut · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Angioedema: The Airway That Swells Shut Lesson Angioedema: The Airway That Swells Shut 12 min Airway & Breathing Skip to quiz Objective: Recognize progressive lip/tongue/floor-of-mouth swelling as a time-critical airway, oxygenate without serial failed looks, and choose a destination that can do a surgical airway. Why This Is Hard They can still talk, so crews stay and “watch.” ACE-inhibitor angioedema can progress after the last pill. Allergic angioedema may need epinephrine; ACE-I and hereditary often do not melt with epi. DAS/ASA difficult-airway teaching: a swelling upper airway is a predicted difficult airway. The street mistake is three looks while the mouth disappears. On this truck Sit them up. High-flow oxygen. Suction ready. Do not lay a swelling tongue flat unles","keywords":"Angioedema: The Airway That Swells Shut ACE-inhibitor, allergic, and hereditary angioedema on the truck: sit them up, do not poke a swelling tongue repeatedly, and leave early for a difficult-airway destination. Lesson angioedema-airway-field"},{"title":"Asthma & COPD Crisis Ventilation","h1":"Asthma & COPD Crisis Ventilation","description":"Ventilate severe asthma and COPD without stacking air: prolonged exhalation, cautious rates, auto-PEEP, and when bagging can cause arrest.","url":"/learn/airway-breathing/asthma-copd-ventilation/","type":"Lesson","body":"Asthma & COPD Crisis Ventilation · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Asthma & COPD Crisis Ventilation Lesson Asthma & COPD Crisis Ventilation 12 min Airway & Breathing Objective: Ventilate severe asthma and COPD with exhalation time and modest volumes so you do not worsen auto-PEEP and hypotension. Why This Is Hard Severe asthma and COPD look like “just bag harder.” That instinct can kill. Obstructed lower airways need time to empty . Fast rates and large tidal volumes stack air (auto-PEEP), raise intrathoracic pressure, drop venous return, and can cause PEA-like arrest physiology. Say out loud Slow rate, modest volume, long exhalation Shark-fin EtCO₂ = obstructive pattern Watch BP when positive pressure starts Silent chest = critical — not “improving” Street Physiology (Education) Air trapping — incomplete exhalation between breaths. Auto-PEEP — r","keywords":"Asthma & COPD Crisis Ventilation Ventilate severe asthma and COPD without stacking air: prolonged exhalation, cautious rates, auto-PEEP, and when bagging can cause arrest. Lesson asthma-copd-ventilation"},{"title":"Bougie Use in the Field","h1":"Bougie Use in the Field","description":"The bougie is a feel tool: tracheal clicks, hold-up, then railroad the tube. It is not a license for a fourth look.","url":"/learn/airway-breathing/bougie-first-intubation/","type":"Lesson","body":"Bougie Use in the Field · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Bougie Use in the Field Lesson Bougie Use in the Field 10 min Airway & Breathing Skip to quiz Objective: Use an introducer (bougie) the way you were trained — feel tracheal rings, railroad the tube, and stop if hold-up is absent and the view is gone. Why This Is Hard The epiglottis is a rim and the hole is not obvious. Crews poke, hope, and inflate a cuff in the esophagus. A bougie is a planned change of tool if you are trained and it is staged — not a national “every first pass” mandate. DAS includes an introducer as a change of plan, not extra identical looks. On this truck Have the bougie in your hand before the look, not in the outside pocket of the airway bag. Railroad the tube without losing the bougie depth. Someone holds it. Confirm with waveform. Clicks are a clue, not a substitut","keywords":"Bougie Use in the Field The bougie is a feel tool: tracheal clicks, hold-up, then railroad the tube. It is not a license for a fourth look. Lesson bougie-first-intubation"},{"title":"CPAP & Noninvasive Ventilation","h1":"CPAP & Noninvasive Ventilation","description":"Field CPAP and NIV for paramedics: CHF and COPD indications, contraindications, hypotension risk, and how it differs from BVM hyperventilation.","url":"/learn/airway-breathing/cpap-niv-field/","type":"Lesson","body":"CPAP & Noninvasive Ventilation · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / CPAP & Noninvasive Ventilation Lesson CPAP & Noninvasive Ventilation 12 min Airway & Breathing Objective: Decide when CPAP/NIV helps (wet lungs, COPD work of breathing) and when it is the wrong tool — vomiting, unresponsive, or hypotensive patients. Why This Is Hard CPAP looks like “just a mask.” It is positive pressure. It can unload wet lungs and stent open collapsing airways in COPD. It can also drop blood pressure, inflate the stomach, and dump vomit into the lungs if you pick the wrong patient. Say out loud Alert enough to protect the airway? Wet lungs / severe COPD work of breathing? No vomiting, no unprotected airway, no crashing hypotension Suction and BVM staged if CPAP fails Street Sequence Candidate: awake enough to protect the airway, working hard, wet or tight lungs, pr","keywords":"CPAP & Noninvasive Ventilation Field CPAP and NIV for paramedics: CHF and COPD indications, contraindications, hypotension risk, and how it differs from BVM hyperventilation. Lesson cpap-niv-field"},{"title":"Cricoid Pressure & Gastric Distention","h1":"Cricoid Pressure & Gastric Distention","description":"Sellick is not default BVM technique. Fast, forceful bagging fills the stomach. Slow the rate, two-person seal, and decompress if the belly is rising.","url":"/learn/airway-breathing/cricoid-pressure-gastric-distention/","type":"Lesson","body":"Cricoid Pressure & Gastric Distention · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Cricoid Pressure & Gastric Distention Lesson Cricoid Pressure & Gastric Distention 10 min Airway & Breathing Skip to quiz Objective: Stop default cricoid pressure, bag slowly enough that the chest (not the belly) rises, and treat gastric distention as a ventilation failure you can fix. Why This Is Hard Someone was taught “cricoid on every tube.” DAS and modern ALS teaching: routine cricoid can worsen the view and is not a proven aspiration shield. Meanwhile the real street killer is gastric insufflation from fast, hard bagging — especially with a leaky mask. The belly rises, the diaphragm goes up, and now you cannot ventilate. On this truck Two-person BVM, slow squeeze, watch the chest. If the epigastrium balloons, you are in the stomach. Do not apply cricoid as a reflex. If ","keywords":"Cricoid Pressure & Gastric Distention Sellick is not default BVM technique. Fast, forceful bagging fills the stomach. Slow the rate, two-person seal, and decompress if the belly is rising. Lesson cricoid-pressure-gastric-distention"},{"title":"Delayed Sequence Intubation Framing","h1":"Delayed Sequence Intubation Framing","description":"DSI is not RSI with a new name. It is dissociation to allow preoxygenation in a combative hypoxic patient — only if trained, authorized, and you still have a CICO plan.","url":"/learn/airway-breathing/delayed-sequence-intubation/","type":"Lesson","body":"Delayed Sequence Intubation Framing · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Delayed Sequence Intubation Framing Lesson Delayed Sequence Intubation Framing 10 min Airway & Breathing Skip to quiz Objective: Place DSI in the right box: ketamine-level calm so you can preoxygenate, not a shortcut around an airway exam. Why This Is Hard They will not tolerate a mask and SpO₂ is 70%. Crews skip straight to RSI and desaturate in 20 seconds. DSI is an ED-derived concept (Weingart): dissociate so you can preoxygenate, then decide. It is not a national EMS pathway in AHA or NASEMSO. Only use it if your protocol names it and you are trained. It is not “ketamine and go.” On this truck Only if your protocol names DSI. Otherwise it is RSI or BVM until destination. Suction, VL/DL, SGA, and a spoken CICO plan still come out before the drug. This site does not publish m","keywords":"Delayed Sequence Intubation Framing DSI is not RSI with a new name. It is dissociation to allow preoxygenation in a combative hypoxic patient — only if trained, authorized, and you still have a CICO plan. Lesson delayed-sequence-intubation"},{"title":"Difficult Airway Anticipation","h1":"Difficult Airway Anticipation","description":"Anticipate a difficult airway before the first look: LEMON-style predictors, scene clues, and a spoken backup oxygenation plan.","url":"/learn/airway-breathing/difficult-airway-anticipation/","type":"Lesson","body":"Difficult Airway Anticipation · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Difficult Airway Anticipation Lesson Difficult Airway Anticipation 12 min Airway & Breathing Objective: Spot difficult-airway predictors early and speak Plan A, B, and C — including pure oxygenation rescue — before the first attempt. Why This Is Hard Failed airway disasters often start as “this should be easy.” On the truck you do not get a full ENT workup. You get obesity, blood, vomit, trauma, limited neck motion, and a family screaming. Anticipation is a paramedic skill equal to intubation technique. Goal: every high-risk airway patient gets a Plan A / Plan B / Plan C spoken out loud before you commit — including pure oxygenation rescue if intubation fails. Say out loud External predictors I see (beard, trauma, obesity, neck) Plan A / Plan B / Plan C — including oxygenation rescue","keywords":"Difficult Airway Anticipation Anticipate a difficult airway before the first look: LEMON-style predictors, scene clues, and a spoken backup oxygenation plan. Lesson difficult-airway-anticipation"},{"title":"Drowning: Airway & Ventilation First","h1":"Drowning: Airway & Ventilation First","description":"AHA 2025 drowning: get them out, start rescue breaths early, expect vomit, and do not delay ventilation to drain the lungs.","url":"/learn/airway-breathing/drowning-airway-ventilation/","type":"Lesson","body":"Drowning: Airway & Ventilation First · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Drowning: Airway & Ventilation First Lesson Drowning: Airway & Ventilation First 10 min Airway & Breathing Skip to quiz Objective: Treat drowning as a hypoxia problem — rescue ventilation, high-quality CPR if pulseless, and suction — not a ritual lung-drain. Why This Is Hard Bystanders want abdominal thrusts “to get the water out.” AHA 2025 special circumstances: drowning is a hypoxic arrest. Ventilation matters early. Heimlich is not a drowning algorithm. On this truck Scene safety: water, current, cold, boat. You cannot save them if you become the second drowning. Expect vomit. Suction is part of the airway, not a later chore. If pulseless: CPR with ventilations. Compression-only CPR is the wrong default for drowning. Field Rules (Education) AHA 2025 Part 10: prioritize resc","keywords":"Drowning: Airway & Ventilation First AHA 2025 drowning: get them out, start rescue breaths early, expect vomit, and do not delay ventilation to drain the lungs. Lesson drowning-airway-ventilation"},{"title":"Ear-to-Sternal-Notch Positioning","h1":"Ear-to-Sternal-Notch Positioning","description":"Position the airway before the tube: ear-to-sternal-notch, ramp the obese and pregnant patient, and stop fighting a flexed neck on the floor.","url":"/learn/airway-breathing/ear-to-sternal-notch-positioning/","type":"Lesson","body":"Ear-to-Sternal-Notch Positioning · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Ear-to-Sternal-Notch Positioning Lesson Ear-to-Sternal-Notch Positioning 10 min Airway & Breathing Skip to quiz Objective: Put the external auditory canal level with the sternal notch so BVM, VL, and DL have a chance — especially when the occiput, pannus, or gravid uterus is in the way. Why This Is Hard You lie them flat because that is how the stretcher arrived. The tongue, the occiput, and a big belly all drop the airway axis. DAS and ASA difficult-airway teaching start with position. A pretty laryngoscope view you cannot get because the neck is flexed is a positioning problem, not a skill problem. On this truck You have blankets, a pillow, the head of the stretcher, and maybe a ramp built from trauma pads. You do not have an OR table with a built-in ramp. Build ear-to-sternal-n","keywords":"Ear-to-Sternal-Notch Positioning Position the airway before the tube: ear-to-sternal-notch, ramp the obese and pregnant patient, and stop fighting a flexed neck on the floor. Lesson ear-to-sternal-notch-positioning"},{"title":"Effective BVM Ventilation","h1":"Effective BVM Ventilation","description":"Prehospital BVM for paramedics: open the airway, two-person seal, modest volume, and rate discipline when SpO₂ will not climb.","url":"/learn/airway-breathing/effective-bvm-ventilation/","type":"Lesson","body":"Effective BVM Ventilation · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Effective BVM Ventilation Lesson Effective BVM Ventilation 10 min Airway & Breathing Objective: Use a BVM checklist — position, seal, rate, and volume — so assisted ventilation actually moves the chest. Why This Is Hard BVM looks basic and fails often: leaky seal, wrong head position, no adjunct, too fast, too deep. Low SpO₂ after “we’re bagging” is frequently a technique problem before it is a tube problem. On the truck, one-handed bagging while driving, talking, or suctioning multiplies error. Paramedic reality: BVM is both a bridge to advanced airway and a definitive skill when intubation is delayed, failed, or not indicated. Mastery here prevents hypoxic arrest more often than a fancy laryngoscope view. Say out loud Open → suction → position (ear-to-sternal-notch) Adjunct early · two","keywords":"Effective BVM Ventilation Prehospital BVM for paramedics: open the airway, two-person seal, modest volume, and rate discipline when SpO₂ will not climb. Lesson effective-bvm-ventilation"},{"title":"Failed Oxygenation: DOPE-S","h1":"Failed Oxygenation: DOPE-S","description":"Failed oxygenation for EMS: the DOPE-S pass (delivery, obstruction, pneumothorax, equipment, seal) so you change the plan, not the speed.","url":"/learn/airway-breathing/failed-oxygenation-dope-s/","type":"Lesson","body":"Failed Oxygenation: DOPE-S · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Failed Oxygenation: DOPE-S Lesson Failed Oxygenation: DOPE-S 10 min Airway & Breathing Objective: Run a structured DOPE-S check when oxygenation fails, then escalate per protocol instead of repeating the same failing step. Why This Is Hard Low SpO₂ creates tunnel vision. Crews re-bag the same way, turn up O₂ already at max, or jump devices without fixing why oxygen is not reaching the blood. On scene you may have seconds, not a textbook chapter — so you need a repeatable mental pass that covers patient and equipment. Failed oxygenation is not only “can’t intubate.” It is any situation where the patient is not getting adequate oxygen delivery despite your efforts: bad BVM, displaced tube, empty tank, severe shunt, tension physiology, or obstruction. Say out loud D — displacement / delive","keywords":"Failed Oxygenation: DOPE-S Failed oxygenation for EMS: the DOPE-S pass (delivery, obstruction, pneumothorax, equipment, seal) so you change the plan, not the speed. Lesson failed-oxygenation-dope-s"},{"title":"Foreign-Body Airway Obstruction","h1":"Foreign-Body Airway Obstruction","description":"AHA 2025 choking care for EMS: mild vs severe FBAO, 5 back blows then 5 abdominal thrusts, infant chest thrusts, and CPR when they go unresponsive.","url":"/learn/airway-breathing/fbao-choking/","type":"Lesson","body":"Foreign-Body Airway Obstruction · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Foreign-Body Airway Obstruction Lesson Foreign-Body Airway Obstruction 10 min Airway & Breathing Objective: Tell mild from severe choking, run the 2025 back-blow then thrust cycle, and switch to CPR the moment they become unresponsive. Why This Is Hard Bystanders want the Heimlich immediately. Mild obstruction just needs a cough. Severe obstruction needs a sequence — and the 2025 AHA adult and pediatric BLS updates start with back blows , not abdominal thrusts alone. If you freeze on an old “thrusts only” habit, you are a guideline behind. On this truck You already are EMS. Do not wait for “the ambulance.” Clear the airway where they stand, then package. Restaurant, daycare, and car-seat calls: you work in the space you have. Late pregnancy gets chest thrusts, not abdominal thrusts","keywords":"Foreign-Body Airway Obstruction AHA 2025 choking care for EMS: mild vs severe FBAO, 5 back blows then 5 abdominal thrusts, infant chest thrusts, and CPR when they go unresponsive. Lesson fbao-choking"},{"title":"Front-of-Neck Access","h1":"Front-of-Neck Access","description":"CICO (can't intubate, can't oxygenate): declare it, oxygenate, then trained surgical or needle front-of-neck access. Education only — not a procedure video.","url":"/learn/airway-breathing/front-of-neck-access/","type":"Lesson","body":"Front-of-Neck Access · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Front-of-Neck Access Lesson Front-of-Neck Access 12 min Airway & Breathing Objective: Recognize can't-intubate-can't-oxygenate early, say it out loud, and treat front-of-neck access as a trained last-resort oxygenation rescue — not a late panic cut. Why This Is Hard Failed airways kill in the minutes you spend hoping the next look will be prettier. Difficult Airway Society (DAS) and NAEMSP-aligned EMS teaching all say the same thing: when you cannot intubate and cannot oxygenate (CICO), you stop collecting laryngoscope views and you rescue oxygen — SGA, two-person BVM, then front-of-neck access if those fail and you are trained and authorized. This lesson is decision framing , not a surgical atlas and not permission to improvise. Protocol, training, and medical direction own whether you carry","keywords":"Front-of-Neck Access CICO (can't intubate, can't oxygenate): declare it, oxygenate, then trained surgical or needle front-of-neck access. Education only — not a procedure video. Lesson front-of-neck-access"},{"title":"Mainstem Intubation Recognition","h1":"Mainstem Intubation Recognition","description":"The tube can be in a mainstem bronchus: unilateral chest rise, high pressures, falling sat. Pull back to the noted depth and reconfirm with waveform.","url":"/learn/airway-breathing/mainstem-intubation-recognition/","type":"Lesson","body":"Mainstem Intubation Recognition · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Mainstem Intubation Recognition Lesson Mainstem Intubation Recognition 10 min Airway & Breathing Skip to quiz Objective: Catch a right-mainstem tube after every move — depth at the teeth, bilateral rise, and EtCO₂ that does not excuse a silent left lung. Why This Is Hard You had a waveform and a sat of 94%. After the move to the stretcher the left chest is quiet. Crews push PEEP and blame the patient. AHA confirmation teaching: waveform tells you the tube is in the airway tree, not that it is equally in both lungs. On this truck Note centimeter depth at the teeth or gums when you confirm, and after every major move. Look at both chests. Auscultate both axillae. The stomach still gets a listen. EtCO₂ present plus a silent left chest is mainstem or pneumothorax — not “good enough.” F","keywords":"Mainstem Intubation Recognition The tube can be in a mainstem bronchus: unilateral chest rise, high pressures, falling sat. Pull back to the noted depth and reconfirm with waveform. Lesson mainstem-intubation-recognition"},{"title":"OPA & NPA: Airway Adjuncts That Work","h1":"OPA & NPA: Airway Adjuncts That Work","description":"Oropharyngeal and nasopharyngeal airways for EMS: sizing, gag reflex, basilar-skull caution, and why an adjunct does not replace a two-person BVM seal.","url":"/learn/airway-breathing/opa-npa-adjuncts/","type":"Lesson","body":"OPA & NPA: Airway Adjuncts That Work · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / OPA & NPA: Airway Adjuncts That Work Lesson OPA & NPA: Airway Adjuncts That Work 10 min Airway & Breathing Objective: Pick and size an OPA or NPA so the BVM actually ventilates — and know when the adjunct is the wrong tool. Why This Is Hard Adjuncts look like beginner skills. They fail as often as BVM seals: wrong size, gagging an intact patient, an NPA shoved into a suspected basilar-skull fracture, or an OPA that sits on the tongue and worsens obstruction. The adjunct is a bridge for bagging , not a trophy airway. AHA 2025 adult BLS teaching still treats bag-mask ventilation as a two-person skill when a second rescuer is available — one opens and seals, one squeezes. The OPA or NPA makes that seal useful. It does not replace it. On this truck You bag in a tight cab, often wi","keywords":"OPA & NPA: Airway Adjuncts That Work Oropharyngeal and nasopharyngeal airways for EMS: sizing, gag reflex, basilar-skull caution, and why an adjunct does not replace a two-person BVM seal. Lesson opa-npa-adjuncts"},{"title":"Oxygen Titration, Not Maximum Flow","h1":"Oxygen Titration, Not Maximum Flow","description":"Prehospital oxygen titration for paramedics: treat hypoxia, avoid blasting every patient with a non-rebreather, and match targets to COPD, ACS, stroke, and ROSC.","url":"/learn/airway-breathing/oxygen-titration/","type":"Lesson","body":"Oxygen Titration, Not Maximum Flow · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Oxygen Titration, Not Maximum Flow Lesson Oxygen Titration, Not Maximum Flow 10 min Airway & Breathing Objective: Use oxygen as a drug: treat hypoxia, avoid unnecessary high-flow, and match the target to the patient — not the habit of 15 L on everyone. Why This Is Hard High-flow oxygen became a reflex. It is still essential for hypoxemia, carbon monoxide teaching contexts, and peri-airway crises. It is not a treat-all. Unnecessary hyperoxia can harm some patients, and a non-rebreather on a talking COPD patient who is already at their baseline SpO₂ is not “being thorough.” Paramedic job: look at the patient, the SpO₂ trend, and the disease — then pick a device and a target that match protocol. Say out loud Hypoxia first — treat the crashing patient now Device matches need (NC vs ","keywords":"Oxygen Titration, Not Maximum Flow Prehospital oxygen titration for paramedics: treat hypoxia, avoid blasting every patient with a non-rebreather, and match targets to COPD, ACS, stroke, and ROSC. Lesson oxygen-titration"},{"title":"Pediatric Airway Differences","h1":"Pediatric Airway Differences","description":"Why kids desaturate faster: occiput, tongue, anterior larynx, small FRC. Position, slow bagging, and AHA 2025 pediatric ventilation rates.","url":"/learn/airway-breathing/pediatric-airway-differences/","type":"Lesson","body":"Pediatric Airway Differences · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Pediatric Airway Differences Lesson Pediatric Airway Differences 12 min Airway & Breathing Objective: Treat the pediatric airway as anatomy plus time — position the head, bag gently, and expect a respiratory cause of collapse more often than a primary cardiac one. Why This Is Hard Adult airway muscle memory on a toddler is how you get a flexed neck, a huge bag squeeze, and a flatline you helped create. AHA/AAP 2025 pediatric BLS still leads with this: respiratory problems are the major cause of pediatric arrest . You win by supporting ventilation early, not by waiting for a “cardiac” look. Say out loud Shoulder roll / sniffing — big occiput flexes the neck if you do nothing Modest squeeze — visible chest rise, not adult tidal volume If they have a pulse but are not breathing: 20–30 br","keywords":"Pediatric Airway Differences Why kids desaturate faster: occiput, tongue, anterior larynx, small FRC. Position, slow bagging, and AHA 2025 pediatric ventilation rates. Lesson pediatric-airway-differences"},{"title":"Post-Intubation Care","h1":"Post-Intubation Care","description":"After the tube: confirm with waveform, secure depth, ventilate with discipline, watch blood pressure, and recheck after every move.","url":"/learn/airway-breathing/post-intubation-care/","type":"Lesson","body":"Post-Intubation Care · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Post-Intubation Care Lesson Post-Intubation Care 12 min Airway & Breathing Objective: Manage the minutes after the tube so confirmation, ventilation, blood pressure, and packaging do not undo a successful pass. Why This Is Hard Teams celebrate the tube and then lose it in packaging, hyperventilate the patient into hypotension, or miss esophageal placement because confirmation was a single glance. Post-intubation care is half the airway job. Say out loud Confirm — continuous waveform EtCO₂ Secure — note depth at teeth/gums Rate discipline — avoid hyperventilation Recheck after every major move Immediate Checklist (Education) Confirm — continuous waveform EtCO₂, bilateral sounds, chest rise; fix DOPE problems immediately. Secure — commercial tube holder or equivalent per training; note depth at","keywords":"Post-Intubation Care After the tube: confirm with waveform, secure depth, ventilate with discipline, watch blood pressure, and recheck after every move. Lesson post-intubation-care"},{"title":"Preoxygenation & Apneic Oxygenation","h1":"Preoxygenation & Apneic Oxygenation","description":"Preoxygenation and apneic oxygenation for EMS: position, denitrogenate, keep oxygen on during the look, and do not skip BVM rescue between attempts.","url":"/learn/airway-breathing/preoxygenation-apneic-oxygenation/","type":"Lesson","body":"Preoxygenation & Apneic Oxygenation · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Preoxygenation & Apneic Oxygenation Lesson Preoxygenation & Apneic Oxygenation 10 min Airway & Breathing Objective: Fill the tank before you take away the patient’s breaths. Position first, then a real seal (two-person BVM or tight mask). A nasal cannula during the attempt is an adjunct if protocol allows — it does not replace ventilation. Why This Is Hard Street intubation culture used to be “pull the NRB, take a look.” Desaturation clocks start the moment ventilation stops. Obese, pregnant, pediatric, septic, and already-hypoxic patients desaturate in seconds. The medic who preoxygenates well has time to be careful. The medic who does not gets a crash airway they created. On this truck You intubate on a stairwell, a bathroom floor, or a bouncing bench — not an OR with an anes","keywords":"Preoxygenation & Apneic Oxygenation Preoxygenation and apneic oxygenation for EMS: position, denitrogenate, keep oxygen on during the look, and do not skip BVM rescue between attempts. Lesson preoxygenation-apneic-oxygenation"},{"title":"Ramping the Obese Airway","h1":"Ramping the Obese Airway","description":"HELP / ramp position for the high-BMI airway on the truck: ear-to-sternal-notch is not enough if the chest is a hill. Build the ramp before the first look.","url":"/learn/airway-breathing/ramp-obese-airway-help/","type":"Lesson","body":"Ramping the Obese Airway · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Ramping the Obese Airway Lesson Ramping the Obese Airway 11 min Airway & Breathing Skip to quiz Objective: Build a head-elevated laryngoscopy position so the ear, sternal notch, and glottis line up in a high-BMI patient instead of fighting a flat mattress. Why This Is Hard The neck looks short because the chest is in the way. Crews flatten them “for intubation” and then cannot see. DAS difficult-airway teaching and HELP (head-elevated laryngoscopy position) evidence: ramping improves view and ventilation mechanics. Ear-to-sternal-notch still applies — you just have to build the geometry instead of hoping the mattress does it. On this truck Blankets, a second mattress, the head of the cot, or the patient sitting up if they can still breathe. Preoxygenate sitting or ramped. Laying a high-BM","keywords":"Ramping the Obese Airway HELP / ramp position for the high-BMI airway on the truck: ear-to-sternal-notch is not enough if the chest is a hill. Build the ramp before the first look. Lesson ramp-obese-airway-help"},{"title":"Respiratory Arrest With a Pulse","h1":"Respiratory Arrest With a Pulse","description":"AHA 2025: not breathing normally but a pulse — 1 breath every 6 seconds in adults (10/min). Kids are 20–30/min. Do not start chest compressions on a beating heart.","url":"/learn/airway-breathing/respiratory-arrest-with-pulse/","type":"Lesson","body":"Respiratory Arrest With a Pulse · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Respiratory Arrest With a Pulse Lesson Respiratory Arrest With a Pulse 10 min Airway & Breathing Skip to quiz Objective: Tell respiratory arrest from cardiac arrest, bag at the right rate, and start CPR the moment the pulse is gone. Why This Is Hard Opioid OD, drowning, and peds can look dead and still have a pulse. Crews start compressions because the sat is 40%. AHA 2025 adult BLS: if they are not breathing normally but have a pulse, ventilate about 10/min. Compressions on a beating heart steal coronary filling and can cause injury. On this truck Feel a pulse for up to 10 seconds while you look for breathing. If unsure and no signs of life, start CPR. Adults with a pulse: 1 breath every 6 seconds (10/min), visible chest rise. Children/infants with a pulse: 20–30 breaths/min (ever","keywords":"Respiratory Arrest With a Pulse AHA 2025: not breathing normally but a pulse — 1 breath every 6 seconds in adults (10/min). Kids are 20–30/min. Do not start chest compressions on a beating heart. Lesson respiratory-arrest-with-pulse"},{"title":"Smoke Inhalation & the Airway Clock","h1":"Smoke Inhalation & the Airway Clock","description":"Closed-space fire: soot, voice change, and stridor mean the airway may not stay yours. Oxygen, early destination, and CO suspicion — not a long scene for a perfect exam.","url":"/learn/airway-breathing/smoke-inhalation-airway/","type":"Lesson","body":"Smoke Inhalation & the Airway Clock · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Smoke Inhalation & the Airway Clock Lesson Smoke Inhalation & the Airway Clock 10 min Airway & Breathing Skip to quiz Objective: Spot the inhalation airway that will swell, give oxygen, and move toward a facility that can manage a difficult burn airway. Why This Is Hard They walked out of the house talking. Twenty minutes later they cannot swallow. ABA and burn-center teaching: inhalation injury is a clinical suspicion (closed space, soot, carbonaceous sputum, voice change, singed hairs) — not a waiting game for a normal room-air sat. On this truck High-flow oxygen. CO makes pulse ox look better than the patient. Do not wait for a carboxyhemoglobin number you do not have. If the voice is changing, this is an airway-capable / burn-center destination, not a clinic. Field Rules (E","keywords":"Smoke Inhalation & the Airway Clock Closed-space fire: soot, voice change, and stridor mean the airway may not stay yours. Oxygen, early destination, and CO suspicion — not a long scene for a perfect exam. Lesson smoke-inhalation-airway"},{"title":"Stridor: Croup vs Epiglottitis vs FBAO","h1":"Stridor: Croup vs Epiglottitis vs FBAO","description":"Pediatric (and adult) stridor on the truck: keep them calm, oxygen if they tolerate it, and do not jam a tongue blade into a suspected epiglottitis.","url":"/learn/airway-breathing/stridor-croup-epiglottitis/","type":"Lesson","body":"Stridor: Croup vs Epiglottitis vs FBAO · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Stridor: Croup vs Epiglottitis vs FBAO Lesson Stridor: Croup vs Epiglottitis vs FBAO 10 min Airway & Breathing Skip to quiz Objective: Sort stridor into croup-like, epiglottitis-like, and choking — then choose calm positioning and a destination that can finish the airway. Why This Is Hard The toddler is barking and the parent wants you to “look in the throat.” AHA PALS and pediatric airway teaching: keep the child in a position of comfort. A forced look can finish the obstruction you have not caused yet. On this truck Position of comfort — usually in a parent’s lap. Do not lay them flat to “get a better look.” Oxygen if they tolerate it. Blow-by beats a fight that closes the airway. If this might be epiglottitis or bacterial tracheitis, you want an airway-capable pediatric d","keywords":"Stridor: Croup vs Epiglottitis vs FBAO Pediatric (and adult) stridor on the truck: keep them calm, oxygen if they tolerate it, and do not jam a tongue blade into a suspected epiglottitis. Lesson stridor-croup-epiglottitis"},{"title":"Suction That Actually Clears the Airway","h1":"Suction That Actually Clears the Airway","description":"Prehospital suction for paramedics: large-bore first for vomit, then the tube, and never suction longer than you can hold your own breath as a teaching cue.","url":"/learn/airway-breathing/suction-that-works/","type":"Lesson","body":"Suction That Actually Clears the Airway · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Suction That Actually Clears the Airway Lesson Suction That Actually Clears the Airway 10 min Airway & Breathing Skip to quiz Objective: Pick the right suction tip, clear the mouth before you bag, and know when suction is stealing oxygenation time. Why This Is Hard The airway is full of steak, blood, or pregnancy vomit and the BVM just sprays it. Crews grab a skinny catheter, suction for 20 seconds, then wonder why SpO 2 is 60%. AHA 2025 adult BLS: suction is part of opening the airway so ventilation works — it is not a substitute for position, seal, and oxygen. On this truck You have a portable suction, one Yankauer, and maybe a flexible catheter for an ETT/SGA. You do not have an OR Yankauer on continuous wall suction unless you are lucky. Clear the mouth first. Then bag.","keywords":"Suction That Actually Clears the Airway Prehospital suction for paramedics: large-bore first for vomit, then the tube, and never suction longer than you can hold your own breath as a teaching cue. Lesson suction-that-works"},{"title":"Supraglottic Airways in the Field","h1":"Supraglottic Airways in the Field","description":"Supraglottic airways in the field: when they fit, waveform confirmation, failure modes, and how they displace during packaging.","url":"/learn/airway-breathing/supraglottic-airways/","type":"Lesson","body":"Supraglottic Airways in the Field · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Supraglottic Airways in the Field Lesson Supraglottic Airways in the Field 10 min Airway & Breathing Objective: Place a supraglottic airway in the right decision context — rescue or primary per protocol — with waveform confirmation and displacement awareness. Why This Matters Supraglottic airways (SGAs) are not “fake tubes.” In many EMS systems they are primary or rescue advanced airways that can oxygenate faster than repeated failed laryngoscopy. They still require sizing, depth, seal, and continuous confirmation. Say out loud Size from manufacturer/training cues Suction, O₂, and waveform adapter ready first Confirm with chest rise + continuous EtCO₂ Recheck after every major move — SGAs displace When They Fit (Education) Cardiac arrest pathways where protocol prefers a rapid ad","keywords":"Supraglottic Airways in the Field Supraglottic airways in the field: when they fit, waveform confirmation, failure modes, and how they displace during packaging. Lesson supraglottic-airways"},{"title":"Tracheostomy Emergencies","h1":"Tracheostomy Emergencies","description":"Dislodged or plugged trach: inner cannula, suction, stoma vs oral airway, speaking-valve off, and why you do not bag a capped trach and call it failure.","url":"/learn/airway-breathing/tracheostomy-emergencies/","type":"Lesson","body":"Tracheostomy Emergencies · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Tracheostomy Emergencies Lesson Tracheostomy Emergencies 12 min Airway & Breathing Objective: Run a repeatable pass for a crashing tracheostomy patient — oxygenate the stoma, clear the tube, and do not treat a plugged cannula as “just COPD.” Why This Is Hard Home vents, speaking valves, and “they always look like that” delay the only moves that matter: oxygenate, open the tube, or replace the airway . A tracheostomy emergency is usually obstruction or dislodgement — not a mystery lung disease. NAEMSP-style EMS teaching and UK National Tracheostomy Safety Project algorithms all run the same pass: look at the neck, remove what does not belong, suction, and ventilate the stoma if the tube is gone. Say out loud Valve / cap off — you cannot bag through a speaking valve Inner cannula out and lo","keywords":"Tracheostomy Emergencies Dislodged or plugged trach: inner cannula, suction, stoma vs oral airway, speaking-valve off, and why you do not bag a capped trach and call it failure. Lesson tracheostomy-emergencies"},{"title":"Video Laryngoscopy in the Field","h1":"Video Laryngoscopy in the Field","description":"VL is a view, not a secured airway. Keep a DL plan, watch the tube pass the cords, and confirm with waveform capnography.","url":"/learn/airway-breathing/video-laryngoscopy-field/","type":"Lesson","body":"Video Laryngoscopy in the Field · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Video Laryngoscopy in the Field Lesson Video Laryngoscopy in the Field 10 min Airway & Breathing Skip to quiz Objective: Use video laryngoscopy as Plan A when trained and authorized — without abandoning BVM, bougie, and a spoken Plan B. Why This Is Hard The screen looks great and the SpO₂ is falling because nobody is bagging. DAS and ASA difficult-airway teaching: limit attempts, re-oxygenate, and do not keep doing the same failed move. Video is a tool. The truck is still a bathroom floor. On this truck Preoxygenate and position first. The camera does not fix a flexed neck. Fog, blood, and sunlight wash out the screen — have suction and a DL blade ready. You still confirm with continuous waveform capnography, not a pretty still image. Field Rules (Education) Watch the tube pass the","keywords":"Video Laryngoscopy in the Field VL is a view, not a secured airway. Keep a DL plan, watch the tube pass the cords, and confirm with waveform capnography. Lesson video-laryngoscopy-field"},{"title":"Waveform Capnography: The Gold Standard","h1":"Waveform Capnography: The Gold Standard","description":"Waveform capnography for EMS: ETCO₂ terms, 4-phase waveform, shark-fin and flat-line patterns, tube confirmation, and ROSC clues.","url":"/learn/airway-breathing/waveform-capnography-etco2/","type":"Lesson","body":"Waveform Capnography: The Gold Standard · Code 3 Workshop Skip to content Home / All lessons / Airway & Breathing / Waveform Capnography: The Gold Standard Lesson Waveform Capnography: The Gold Standard 12 min Airway & Breathing Objective: Read waveform capnography and ETCO₂ — why continuous waveform belongs on every advanced airway, and why you set the sensor up early. Street Context SpO₂ tells you about oxygenation at the fingertip. It does not prove the tube is in the trachea, that ventilation is effective, or how CO₂ is moving from tissues to lungs. Waveform capnography fills that gap: continuous CO₂ with a shape you can read on the truck. Non-negotiable teaching point: any time an advanced airway is placed (ETT, supraglottic, or device your protocol treats as advanced airway), plan continuous waveform capnography for confirmation and ongoing monitoring when equipment is available. C","keywords":"Waveform Capnography: The Gold Standard Waveform capnography for EMS: ETCO₂ terms, 4-phase waveform, shark-fin and flat-line patterns, tube confirmation, and ROSC clues. Lesson waveform-capnography-etco2"},{"title":"Atrial Fibrillation with RVR","h1":"Atrial Fibrillation with RVR","description":"AF with rapid ventricular response: irregularly irregular, rate vs rhythm, unstable cardioversion, and why adenosine is not the plan.","url":"/learn/cardiac/af-with-rvr/","type":"Lesson","body":"Atrial Fibrillation with RVR · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Atrial Fibrillation with RVR Lesson Atrial Fibrillation with RVR 12 min Cardiac & ECG Objective: Name AF with RVR as irregularly irregular, decide whether the rate is the emergency, and pick cardioversion versus rate-control framing — without treating it like regular SVT. Why This Is Hard AF with RVR is the common fast irregular rhythm. Crews either panic-cardiovert a talking 140 or push adenosine like it is SVT. AHA 2025 is blunt for the sick ones: if hemodynamic instability is attributable to AF/flutter with rapid rates, immediate electrical cardioversion . If they are perfusing, this is usually a rate-control and cause-hunt problem, not a “shock because the number is big” problem. Say out loud Irregularly irregular — no repeating pattern Is the rate the reason they are crashing — or is ","keywords":"Atrial Fibrillation with RVR AF with rapid ventricular response: irregularly irregular, rate vs rhythm, unstable cardioversion, and why adenosine is not the plan. Lesson af-with-rvr"},{"title":"Aortic Dissection: Field Suspicion","h1":"Aortic Dissection: Field Suspicion","description":"Tearing pain, pulse or BP difference, neuro deficit plus chest pain: this is not an aspirin-and-nitro reflex. Destination to a center that can operate on an aorta.","url":"/learn/cardiac/aortic-dissection-field/","type":"Lesson","body":"Aortic Dissection: Field Suspicion · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Aortic Dissection: Field Suspicion Lesson Aortic Dissection: Field Suspicion 10 min Cardiac & ECG Skip to quiz Objective: Suspect dissection, avoid the ACS reflex that drops preload, and choose a hospital that can actually fix an aorta. Why This Is Hard It feels like a STEMI and sometimes the 12-lead even shows one (if the root involved a coronary). Aspirin and nitro are the ACS habit. If this is dissection, you may be dropping the only blood pressure keeping the other true lumen open. On this truck Two-arm BPs and pulse check if the story is tearing or ripping, or if there is a neuro deficit with chest/back pain. Do not withhold oxygen for hypoxia. Do withhold the automatic nitro/aspirin reflex until the picture is ACS, not dissection — follow protocol/medical control. Destination: ","keywords":"Aortic Dissection: Field Suspicion Tearing pain, pulse or BP difference, neuro deficit plus chest pain: this is not an aspirin-and-nitro reflex. Destination to a center that can operate on an aorta. Lesson aortic-dissection-field"},{"title":"Asystole vs Fine VF","h1":"Asystole vs Fine VF","description":"Fine VF is still shockable. Verify pads, gain, and a second lead before calling asystole so you do not miss defibrillation.","url":"/learn/cardiac/asystole-vs-fine-vf/","type":"Lesson","body":"Asystole vs Fine VF · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Asystole vs Fine VF Lesson Asystole vs Fine VF 10 min Cardiac & ECG Objective: Separate true asystole from fine VF so you do not miss a shockable rhythm or call death on a technical flatline. Street Context In cardiac arrest, a nearly flat screen is a high-stakes fork. Fine VF is still VF — shockable in standard ACLS education. Asystole is not. The problem: fine VF can look almost flat, and a loose pad or dead battery cable can look like death. Your job is not to stare harder at one pixel. Your job is a quick, repeatable verification while CPR quality stays high. Long pauses for “what is that?” kill coronary perfusion pressure. What Each Means (Education) Asystole No usable organized ventricular activity producing a QRS. Teaching look: flat or near-flat baseline after you verify leads/pads, gain, a","keywords":"Asystole vs Fine VF Fine VF is still shockable. Verify pads, gain, and a second lead before calling asystole so you do not miss defibrillation. Lesson asystole-vs-fine-vf"},{"title":"AV Blocks: Three-Question Path","h1":"AV Blocks: Three-Question Path","description":"Tell first-degree, Mobitz I, Mobitz II, and complete heart block apart with a three-question path and CardioStrip examples.","url":"/learn/cardiac/av-blocks/","type":"Lesson","body":"AV Blocks: Three-Question Path · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / AV Blocks: Three-Question Path Lesson AV Blocks: Three-Question Path 12 min Cardiac & ECG Objective: Use a three-question path to tell first-degree, Mobitz I, Mobitz II, and complete heart block apart — with a CardioStrip example for each. Why This Matters on the Truck AV blocks all look like “something wrong between P and QRS.” Under stress, that makes them easy to mix up. You need a short checklist — not four memorized textbook photos only. Street rule: name the strip carefully, then assess the patient (pulse, perfusion, symptoms) and follow your bradycardia / block protocol. Higher-grade blocks (Mobitz II, complete block) deserve more urgency thinking in standard education frameworks. The 3-Question Path Does every P get a QRS? Yes → only decide if the PR is long (1° block) or normal.","keywords":"AV Blocks: Three-Question Path Tell first-degree, Mobitz I, Mobitz II, and complete heart block apart with a three-question path and CardioStrip examples. Lesson av-blocks"},{"title":"Cardiogenic Shock in the Field","h1":"Cardiogenic Shock in the Field","description":"Wet, cold, hypotensive after ACS or a big MI: this is not a trauma fluid problem. Airway, CPAP if they can, pressors only if authorized, PCI destination.","url":"/learn/cardiac/cardiogenic-shock-field/","type":"Lesson","body":"Cardiogenic Shock in the Field · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Cardiogenic Shock in the Field Lesson Cardiogenic Shock in the Field 10 min Cardiac & ECG Skip to quiz Objective: Recognize pump failure shock, avoid drowning them in saline, and choose a PCI-capable destination when ACS is the story. Why This Is Hard BP 78, crackles, JVD, inferior STE. Crews open two large-bores because “shock gets fluid.” AHA/ACC shock and ACS teaching: cardiogenic shock is a pump and afterload problem. Fluids can worsen pulmonary edema. Protocol owns pressors. On this truck 12-lead. If this is ACS, PCI-capable destination and a STEMI alert beat a hallway bed. Sit them up if mentation allows. CPAP only if they protect the airway and BP can tolerate it — see CPAP. Pressors/inotropes only if trained and authorized. Push-dose is not a substitute for destination. Field Rul","keywords":"Cardiogenic Shock in the Field Wet, cold, hypotensive after ACS or a big MI: this is not a trauma fluid problem. Airway, CPAP if they can, pressors only if authorized, PCI destination. Lesson cardiogenic-shock-field"},{"title":"Defibrillation Pads & Vector Change","h1":"Defibrillation Pads & Vector Change","description":"Pad placement is a current-delivery problem. Get anterolateral right the first time, keep pads off breast tissue, and know when protocol allows anterior-posterior vector change after failed shocks.","url":"/learn/cardiac/defibrillation-pads-vector-change/","type":"Lesson","body":"Defibrillation Pads & Vector Change · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Defibrillation Pads & Vector Change Lesson Defibrillation Pads & Vector Change 11 min Cardiac & ECG Skip to quiz Objective: Place adult pads anterolateral with a real cardiac vector, avoid breast tissue, and treat pad position as part of refractory VF — not an afterthought. Why This Is Hard Pads get slapped on the pecs an inch apart, or parked on breast tissue, and then the crew blames the joules. AHA 2025: optimized pad placement matters for shock success. Anterolateral remains the fast first position during CPR. Vector change to anterior-posterior after several failed shocks is a 2b / “usefulness not established” move in ALS — DSED is a separate lesson. Do not steal compression time to make it pretty on shock one. On this truck Right pad: below the right clavicle, right of the ste","keywords":"Defibrillation Pads & Vector Change Pad placement is a current-delivery problem. Get anterolateral right the first time, keep pads off breast tissue, and know when protocol allows anterior-posterior vector change after failed shocks. Lesson defibrillation-pads-vector-change"},{"title":"Double Sequential Defibrillation Framing","h1":"Double Sequential Defibrillation Framing","description":"AHA 2025: usefulness of double sequential defibrillation or vector change after ≥3 shocks is Class 2b — usefulness has not been established. Not a first-line street trick.","url":"/learn/cardiac/double-sequential-defibrillation/","type":"Lesson","body":"Double Sequential Defibrillation Framing · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Double Sequential Defibrillation Framing Lesson Double Sequential Defibrillation Framing 10 min Cardiac & ECG Skip to quiz Objective: Keep DSED/vector-change in the “only if trained and authorized after multiple failed shocks” box — never instead of CPR and the first defibrillation. Why This Is Hard Refractory VF videos make dual-sequence look like magic. AHA 2025 ALS: after three or more consecutive shocks, the usefulness of double sequential defibrillation or vector change has not been established (Class 2b). It is not first-line. On this truck You probably have one defibrillator. Vector-change (pad move) may be the realistic option if protocol includes it. Do not steal a second monitor from another crew as theater if it delays CPR. This site does not teach a pad diagram as a","keywords":"Double Sequential Defibrillation Framing AHA 2025: usefulness of double sequential defibrillation or vector change after ≥3 shocks is Class 2b — usefulness has not been established. Not a first-line street trick. Lesson double-sequential-defibrillation"},{"title":"High-Quality CPR","h1":"High-Quality CPR","description":"AHA 2025 high-quality CPR: 100–120/min, at least 5 cm (2 in), full recoil, pauses under 10 seconds, 30:2, then 10 breaths/min with an adult advanced airway.","url":"/learn/cardiac/high-quality-cpr/","type":"Lesson","body":"High-Quality CPR · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / High-Quality CPR Lesson High-Quality CPR 10 min Cardiac & ECG Objective: Run CPR as a measurable skill — rate, depth, recoil, short pauses, and ventilation discipline — not as background noise while someone stares at the monitor. Why This Is Hard Everyone “knows CPR.” On the bedroom floor the rate drifts, the recoiler leans, and someone stops compressions to argue about the strip. AHA 2025 still says the same foundation: adequate rate and depth, complete recoil, minimized interruptions, no excessive ventilation . Drugs and tubes do not outrank that. On this truck Two-person (or three) crew: one compresses, one bags/airway, switch every two minutes before the compressor dies. Moving to the stretcher is the pause that kills coronary perfusion. Plan the move; keep hands on the chest. A mechanical device ","keywords":"High-Quality CPR AHA 2025 high-quality CPR: 100–120/min, at least 5 cm (2 in), full recoil, pauses under 10 seconds, 30:2, then 10 breaths/min with an adult advanced airway. Lesson high-quality-cpr"},{"title":"Hyperkalemia on the Monitor","h1":"Hyperkalemia on the Monitor","description":"Peaked T waves, wide QRS, sine-wave, and bradycardic PEA: treat the membrane with calcium when ECG changes fit, and do not wait on a lab you do not have.","url":"/learn/cardiac/hyperkalemia-ecg/","type":"Lesson","body":"Hyperkalemia on the Monitor · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Hyperkalemia on the Monitor Lesson Hyperkalemia on the Monitor 12 min Cardiac & ECG Objective: Spot the hyperK ECG progression, treat it as a membrane emergency when the strip fits, and remember calcium does not lower the potassium — it buys a safer QRS. Why This Is Hard You do not get a potassium on most trucks. You get a dialysis patient who missed Tuesday, a crushed leg, an ACE-inhibitor plus a potassium-sparing diuretic, or a wide, slow, ugly strip that looks like VT and is not. AHA 2025 special-circumstances teaching still lists hyperkalemia among the Hs and Ts. The ECG can lag or lie — absence of peaked T waves does not rule hyperK out — but when the progression is there, treat the membrane. Say out loud Missed dialysis / crush / ACE+K-sparing / wide-slow-ugly Peaked T → flat P → wide","keywords":"Hyperkalemia on the Monitor Peaked T waves, wide QRS, sine-wave, and bradycardic PEA: treat the membrane with calcium when ECG changes fit, and do not wait on a lab you do not have. Lesson hyperkalemia-ecg"},{"title":"Hypothermic Cardiac Arrest","h1":"Hypothermic Cardiac Arrest","description":"AHA 2025: you are not dead until you are warm and dead — with limits. Handle gently, defibrillate per protocol, and do not TOR on the snowbank.","url":"/learn/cardiac/hypothermia-cardiac-arrest/","type":"Lesson","body":"Hypothermic Cardiac Arrest · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Hypothermic Cardiac Arrest Lesson Hypothermic Cardiac Arrest 10 min Cardiac & ECG Skip to quiz Objective: Recognize that severe hypothermia changes the arrest: gentle handling, delayed meds/shocks as protocol writes, and transport toward rewarming. Why This Is Hard They were in the river and the monitor looks like asystole. Crews either work them like a warm VF or give up because the chest is stiff. AHA 2025 Part 10: hypothermia arrest is a special circumstance. Pulse checks are hard. Gentle handling. Rewarming is the therapy. On this truck Scene safety and get them out of the cold. Wet clothes off, insulation on. If there are no signs of life after a brief pulse check (AHA BLS still caps this at about 10 seconds), start CPR. Do not hunt a pulse for a full minute while they stay apneic. Dest","keywords":"Hypothermic Cardiac Arrest AHA 2025: you are not dead until you are warm and dead — with limits. Handle gently, defibrillate per protocol, and do not TOR on the snowbank. Lesson hypothermia-cardiac-arrest"},{"title":"LVAD Emergencies: Is It Really Arrest?","h1":"LVAD Emergencies: Is It Really Arrest?","description":"Left ventricular assist device on the truck: listen for the hum, do not trust a missing pulse, map MAP/waveform, and only start CPR if the patient is truly unresponsive with no signs of circulation.","url":"/learn/cardiac/lvad-emergency-field/","type":"Lesson","body":"LVAD Emergencies: Is It Really Arrest? · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / LVAD Emergencies: Is It Really Arrest? Lesson LVAD Emergencies: Is It Really Arrest? 12 min Cardiac & ECG Skip to quiz Objective: Treat an LVAD patient as a device-plus-patient problem: confirm the pump is running, use MAP and mental status instead of a pulse, and follow AHA special-circumstances framing for when compressions start. Why This Is Hard There is no pulse, so someone starts CPR on a talking patient with a humming pump — or they delay CPR on a lifeless one while they hunt batteries. AHA 2025 special circumstances: continuous-flow LVADs often have no palpable pulse even when the device is supporting them. If they are unresponsive with no signs of perfusion, start CPR now and let a second medic assess/restart the controller. Do not serial-delay coronary flow for a device","keywords":"LVAD Emergencies: Is It Really Arrest? Left ventricular assist device on the truck: listen for the hum, do not trust a missing pulse, map MAP/waveform, and only start CPR if the patient is truly unresponsive with no signs of circulation. Lesson lvad-emergency-field"},{"title":"Opioid-Associated Cardiac Arrest","h1":"Opioid-Associated Cardiac Arrest","description":"AHA 2025: start CPR. Naloxone may be reasonable if it does not interrupt compressions. Respiratory arrest with a pulse is a different pathway.","url":"/learn/cardiac/opioid-associated-ohca/","type":"Lesson","body":"Opioid-Associated Cardiac Arrest · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Opioid-Associated Cardiac Arrest Lesson Opioid-Associated Cardiac Arrest 10 min Cardiac & ECG Skip to quiz Objective: Do not let naloxone delay CPR in pulseless opioid arrest — bag and compress first, antagonist second if it does not steal the pause. Why This Is Hard Everyone wants to spray naloxone and watch. AHA 2025: if they are in cardiac arrest, CPR comes first. An opioid antagonist may be reasonable if it does not interrupt high-quality CPR. Respiratory arrest with a pulse is bag-then-naloxone. On this truck If no pulse and no breathing: CPR and defibrillation as indicated. Someone can prepare naloxone without stopping the compressor. If there is a pulse: that is the respiratory-arrest lesson — bag at 10/min adult. Polysubstance is common. Naloxone will not fix a benzo/alcohol ap","keywords":"Opioid-Associated Cardiac Arrest AHA 2025: start CPR. Naloxone may be reasonable if it does not interrupt compressions. Respiratory arrest with a pulse is a different pathway. Lesson opioid-associated-ohca"},{"title":"PEA: Without a Pulse","h1":"PEA: Without a Pulse","description":"PEA is a condition, not a unique strip: organized electrical activity without a pulse. Name it, keep CPR, and hunt reversible causes.","url":"/learn/cardiac/pea-without-a-pulse/","type":"Lesson","body":"PEA: Without a Pulse · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / PEA: Without a Pulse Lesson PEA: Without a Pulse 10 min Cardiac & ECG Objective: Treat PEA as a condition — organized electrical activity without a pulse — and name morphology plus pulse status clearly for the team. What PEA Means PEA stands for Pulseless Electrical Activity . The monitor shows organized (or semi-organized) electrical activity, but the patient has no palpable central pulse — so that electricity is not producing effective cardiac output. The heart may still be “trying” electrically; the pump is not delivering perfusion to the brain and organs. In the truck this is a condition , not a single “PEA rhythm strip.” You can have sinus bradycardia with PEA, an idioventricular rhythm with PEA, junctional rhythm with PEA, or other morphologies with PEA. The shared feature is always: organiz","keywords":"PEA: Without a Pulse PEA is a condition, not a unique strip: organized electrical activity without a pulse. Name it, keep CPR, and hunt reversible causes. Lesson pea-without-a-pulse"},{"title":"Pit-Crew CPR Choreography","h1":"Pit-Crew CPR Choreography","description":"Two- and three-person arrest: compressor, airway, defibrillator. Switch every two minutes. Do not all stare at the monitor.","url":"/learn/cardiac/pit-crew-cpr/","type":"Lesson","body":"Pit-Crew CPR Choreography · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Pit-Crew CPR Choreography Lesson Pit-Crew CPR Choreography 10 min Cardiac & ECG Skip to quiz Objective: Assign roles out loud so high-quality CPR actually happens on a two-person truck. Why This Is Hard Three people kneel at the chest and nobody bags. AHA 2025: high-quality CPR is the intervention. Choreography is how a tiny crew delivers it. On this truck Two-person: compressor and airway/defib rotate. Say the switch before the two-minute mark. Pads on without stopping compressions. Charge during compressions if your device and protocol allow. One person talks: “compressing, charging, clear, shock, resume.” Field Rules (Education) AHA 2025 BLS/ALS: rate 100–120, depth at least 5 cm, full recoil, pauses under 10 seconds, switch about every 2 minutes. Airway person also runs the defibrillator ","keywords":"Pit-Crew CPR Choreography Two- and three-person arrest: compressor, airway, defibrillator. Switch every two minutes. Do not all stare at the monitor. Lesson pit-crew-cpr"},{"title":"Pre-Excited AF (WPW): Do Not Block the Node","h1":"Pre-Excited AF (WPW): Do Not Block the Node","description":"Irregular wide-complex tachycardia on the truck: assume WPW with pre-excited AF until proven otherwise. No adenosine, diltiazem, beta-blocker, or digoxin. Shock if unstable.","url":"/learn/cardiac/preexcited-af-wpw-field/","type":"Lesson","body":"Pre-Excited AF (WPW): Do Not Block the Node · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Pre-Excited AF (WPW): Do Not Block the Node Lesson Pre-Excited AF (WPW): Do Not Block the Node 12 min Cardiac & ECG Skip to quiz Objective: Recognize irregular wide-complex tachycardia as a possible WPW/AF emergency, withhold AV-nodal blockers, and cardiovert when perfusion is failing. Why This Is Hard It looks like AF with RVR, so crews reach for diltiazem or adenosine. If an accessory pathway is conducting, blocking the AV node funnels more impulses down the pathway and can precipitate VF. AHA 2025 ALS: treat irregular wide-complex tachycardia as dangerous — avoid AV-nodal blockers. Electricity is the clean street answer when they are unstable. On this truck Unstable (hypotension, shock, ischemic pain, AMS, acute heart failure): synchronized cardioversion per protocol — sa","keywords":"Pre-Excited AF (WPW): Do Not Block the Node Irregular wide-complex tachycardia on the truck: assume WPW with pre-excited AF until proven otherwise. No adenosine, diltiazem, beta-blocker, or digoxin. Shock if unstable. Lesson preexcited-af-wpw-field"},{"title":"Cardiac Arrest in Pregnancy","h1":"Cardiac Arrest in Pregnancy","description":"AHA 2025: high-quality CPR with left uterine displacement after ~20 weeks, same defibrillation, and a destination that can do resuscitative hysterotomy if that is your system.","url":"/learn/cardiac/pregnancy-cardiac-arrest/","type":"Lesson","body":"Cardiac Arrest in Pregnancy · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Cardiac Arrest in Pregnancy Lesson Cardiac Arrest in Pregnancy 10 min Cardiac & ECG Skip to quiz Objective: Displace the uterus, compress on the chest (not the belly), and move toward an obstetric-capable hospital without delaying shocks. Why This Is Hard The fundus is at the umbilicus and you are compressing the abdomen. AHA 2025 special circumstances: aortocaval compression kills venous return. Manual left uterine displacement during CPR. Defibrillation energy is unchanged. On this truck If the fundus is at/above the umbilicus (~20 weeks teaching), displace the uterus to the left during CPR. Pads as usual. Do not withhold shocks “because she is pregnant.” Early notification of an OB-capable / trauma-capable receiving team. Perimortem cesarean is not a truck procedure. Field Rules (Educati","keywords":"Cardiac Arrest in Pregnancy AHA 2025: high-quality CPR with left uterine displacement after ~20 weeks, same defibrillation, and a destination that can do resuscitative hysterotomy if that is your system. Lesson pregnancy-cardiac-arrest"},{"title":"Right-Sided & Posterior MI","h1":"Right-Sided & Posterior MI","description":"Inferior STEMI plus V4R for right ventricular infarct; ST depression in V1–V3 and posterior leads V7–V9. Nitro is not automatic.","url":"/learn/cardiac/right-posterior-mi/","type":"Lesson","body":"Right-Sided & Posterior MI · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Right-Sided & Posterior MI Lesson Right-Sided & Posterior MI 12 min Cardiac & ECG Objective: When the 12-lead looks inferior or has isolated anterior depression, add the right and posterior views your protocol allows — and do not dump preload in a right-ventricular infarct. Why This Is Hard The standard 12-lead is blind behind the heart and stingy on the right ventricle. Posterior occlusion hides as ST depression in V1–V3 and gets called “NSTEMI” while the artery is closed. Right-ventricular infarct rides with many inferior STEMIs and then someone sprays nitro. The 2025 ACC/AHA/ACEP/NAEMSP ACS guideline: posterior leads (V7–V9) when you suspect circumflex occlusion, especially isolated ST depression ≥0.5 mm in V1–V3 . Right-sided leads (V4R) belong with inferior patterns when your protocol i","keywords":"Right-Sided & Posterior MI Inferior STEMI plus V4R for right ventricular infarct; ST depression in V1–V3 and posterior leads V7–V9. Nitro is not automatic. Lesson right-posterior-mi"},{"title":"ROSC & Post-Arrest Care","h1":"ROSC & Post-Arrest Care","description":"ROSC and post-arrest care: airway, SpO₂ and CO₂ targets, blood pressure, 12-lead, fever prevention, and PCI destination.","url":"/learn/cardiac/rosc-post-arrest-care/","type":"Lesson","body":"ROSC & Post-Arrest Care · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / ROSC & Post-Arrest Care Lesson ROSC & Post-Arrest Care 12 min Cardiac & ECG Objective: Recognize ROSC quickly and run a structured post-arrest package without losing the airway, the pressure, or the destination clock. Why This Is Hard ROSC is not the end of the call — it is a new unstable patient. Re-arrest is common. Teams either under-treat (“we got pulses, we’re done”) or over-ventilate and crash the pressure. You need a calm package: airway, breathing, circulation, ECG, temperature awareness, and destination. Recognizing ROSC Organized rhythm with a palpable pulse (confirm carefully). Sudden sustained rise in EtCO₂ can support improving pulmonary blood flow — still confirm pulse per protocol. Spontaneous movement, breathing effort, improving color — helpful clues, not alone definitive. Post","keywords":"ROSC & Post-Arrest Care ROSC and post-arrest care: airway, SpO₂ and CO₂ targets, blood pressure, 12-lead, fever prevention, and PCI destination. Lesson rosc-post-arrest-care"},{"title":"Shockable Arrest: VF & pVT","h1":"Shockable Arrest: VF & pVT","description":"Shockable cardiac arrest for paramedics: VF and pulseless VT, defibrillation first, high-quality CPR, short pauses, and why stacked dual shocks are not a freestyle move.","url":"/learn/cardiac/shockable-arrest-vf-pvt/","type":"Lesson","body":"Shockable Arrest: VF & pVT · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Shockable Arrest: VF & pVT Lesson Shockable Arrest: VF & pVT 10 min Cardiac & ECG Objective: Fine or coarse VF and pulseless VT are shockable. Defibrillate, resume CPR immediately, keep pauses short, and do not miss fine VF by calling asystole. Why This Is Hard The shockable pathway is simple on a poster and messy on a bedroom floor. People pause to stare, argue about pad placement, or “charge while we check” for 20 seconds. Coronary perfusion pressure falls every time compressions stop. Fine VF gets called asystole (see that lesson). Your job is a repeatable shock-CPR cycle . The Cycle (Education) Confirm arrest. High-quality CPR while the defibrillator charges if your system does so. Clear, shock VF/pVT at protocol energy, immediately resume CPR — do not check a pulse after the shock until","keywords":"Shockable Arrest: VF & pVT Shockable cardiac arrest for paramedics: VF and pulseless VT, defibrillation first, high-quality CPR, short pauses, and why stacked dual shocks are not a freestyle move. Lesson shockable-arrest-vf-pvt"},{"title":"Stable vs Unstable Tachycardia","h1":"Stable vs Unstable Tachycardia","description":"Stable vs unstable tachycardia is a perfusion call, not a rate cutoff. Name the rhythm family, then pick the protocol pathway.","url":"/learn/cardiac/stable-unstable-tachycardia/","type":"Lesson","body":"Stable vs Unstable Tachycardia · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Stable vs Unstable Tachycardia Lesson Stable vs Unstable Tachycardia 12 min Cardiac & ECG Objective: Separate rate recognition from urgency by assessing perfusion — not the number on the monitor alone. Street Context Tachycardia on the monitor is not automatically an emergency cardioversion. A scared 28-year-old with sinus tach at 120 from pain and anxiety is not the same patient as a pale, hypotensive person with a regular wide-complex tachycardia at 190. Your job is to decide: is this rate causing (or about to cause) serious end-organ hypoperfusion? Prehospital pressure is high — family wants “the shock,” or the opposite, “don’t shock Mom.” Stability is a clinical judgment based on the whole patient, not a single number on the NIBP. What “Unstable” Usually Means (Education) Educational","keywords":"Stable vs Unstable Tachycardia Stable vs unstable tachycardia is a perfusion call, not a rate cutoff. Name the rhythm family, then pick the protocol pathway. Lesson stable-unstable-tachycardia"},{"title":"12-Lead STEMI Recognition","h1":"12-Lead STEMI Recognition","description":"Prehospital 12-lead and STEMI recognition: early acquisition, ST-elevation themes, mimics, transmission, and PCI destination. Education only — not a diagnosis.","url":"/learn/cardiac/stemi-12-lead/","type":"Lesson","body":"12-Lead STEMI Recognition · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / 12-Lead STEMI Recognition Lesson 12-Lead STEMI Recognition 12 min Cardiac & ECG Objective: Get a 12-lead early, recognize a STEMI-alert pattern, transmit, and choose a PCI-capable destination — without delaying a crashing patient for a perfect tracing. Why This Is Hard Time is muscle. The 12-lead you skip on scene is the 12-lead the ED does after registration. Mimics (early repol, pericarditis, LBBB, paced, hyperK, LVH with strain) make medics afraid to call anything. Your job is not to be an electrophysiologist. It is to acquire early, recognize a concerning pattern, transmit, and destination correctly . Street Sequence ABCs and a pulse. Cardiac arrest is not a 12-lead problem first. If ACS is on the table (pressure, radiation, diaphoresis, unexplained SOB, syncope, ROSC), get a 12-lead as s","keywords":"12-Lead STEMI Recognition Prehospital 12-lead and STEMI recognition: early acquisition, ST-elevation themes, mimics, transmission, and PCI destination. Education only — not a diagnosis. Lesson stemi-12-lead"},{"title":"STEMI Equivalents: Transmit Anyway","h1":"STEMI Equivalents: Transmit Anyway","description":"Prehospital 12-lead patterns that still need a STEMI-alert conversation: hyperacute T waves, de Winter, Wellens, isolated posterior, and LBBB/paced uncertainty. Education — not a diagnosis.","url":"/learn/cardiac/stemi-equivalents-field/","type":"Lesson","body":"STEMI Equivalents: Transmit Anyway · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / STEMI Equivalents: Transmit Anyway Lesson STEMI Equivalents: Transmit Anyway 12 min Cardiac & ECG Skip to quiz Objective: When the tracing is ugly in a territorial or equivalent pattern, transmit and use STEMI-alert language even if classic mm-elevation rules are not met. Why This Is Hard Crews wait for “real ST elevation” because they got burned on a mimic. 2025 ACC/AHA ACS: acquire and interpret a 12-lead within 10 minutes of first medical contact when ACS is on the table. Occlusion MI is not only the textbook STEMI millimeter rule. Your job is to transmit a concerning pattern and pick a PCI-capable destination — not to be the cath-lab reader. On this truck Get the 12-lead early. Serial if symptoms persist. Lead II is not a STEMI call. Transmit. Use your STEMI-alert language: “poss","keywords":"STEMI Equivalents: Transmit Anyway Prehospital 12-lead patterns that still need a STEMI-alert conversation: hyperacute T waves, de Winter, Wellens, isolated posterior, and LBBB/paced uncertainty. Education — not a diagnosis. Lesson stemi-equivalents-field"},{"title":"SVT & Adenosine Framing","h1":"SVT & Adenosine Framing","description":"Regular narrow-complex SVT for EMS: vagal maneuvers, adenosine framing, unstable cardioversion, and why irregular wide-complex “SVT” is a trap.","url":"/learn/cardiac/svt-adenosine-framing/","type":"Lesson","body":"SVT & Adenosine Framing · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / SVT & Adenosine Framing Lesson SVT & Adenosine Framing 12 min Cardiac & ECG Objective: Treat regular narrow-complex SVT as a perfusion problem first — vagal and adenosine when stable and authorized, synchronized cardioversion when the rate is the reason they are crashing. Why This Is Hard Everything fast and narrow gets called “SVT.” Some of it is sinus tach from sepsis or volume loss. Some of it is AF. Adenosine in the wrong rhythm is at best theater and at worst dangerous (pre-excited AF). Your job: regular vs irregular, narrow vs wide, stable vs unstable — then the protocol path. See also stable vs unstable tachycardia . Say out loud Pulse? If none, this is arrest — not SVT Regular and narrow? SVT pathway may fit Irregular? Think AF — adenosine is not the treatment Unstable from the rate → p","keywords":"SVT & Adenosine Framing Regular narrow-complex SVT for EMS: vagal maneuvers, adenosine framing, unstable cardioversion, and why irregular wide-complex “SVT” is a trap. Lesson svt-adenosine-framing"},{"title":"Symptomatic Bradycardia","h1":"Symptomatic Bradycardia","description":"Symptomatic bradycardia for EMS: perfusion vs rate, atropine vs pacing readiness, high-grade AV block concern, and when not to chase a number.","url":"/learn/cardiac/symptomatic-bradycardia/","type":"Lesson","body":"Symptomatic Bradycardia · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Symptomatic Bradycardia Lesson Symptomatic Bradycardia 10 min Cardiac & ECG Objective: Slow is only an emergency when perfusion is failing. Treat the patient, prepare pacing early for high-grade blocks, and do not delay TCP for a perfect strip debate. Why This Is Hard Bradycardia on the monitor is not automatically atropine. A well-perfused 55-year-old at 48 from a beta-blocker is not the same as a mottled, hypotensive complete block at 32. Instability is clinical — hypotension, AMS, shock, ischemic pain, acute failure — caused by the rate . Street Sequence Pulse? No pulse with organized slow complexes is PEA, not “stable brady.” ABCs, oxygen as indicated, 12-lead when feasible, IV, pads on early. Name the rhythm with your systematic approach (sinus brady vs block vs escape). If unstable from b","keywords":"Symptomatic Bradycardia Symptomatic bradycardia for EMS: perfusion vs rate, atropine vs pacing readiness, high-grade AV block concern, and when not to chase a number. Lesson symptomatic-bradycardia"},{"title":"Synchronized Cardioversion in the Field","h1":"Synchronized Cardioversion in the Field","description":"Unstable tachycardia with a pulse: sync on, shock, reassess. If they lose the pulse, it is defibrillation, not another sync debate.","url":"/learn/cardiac/synchronized-cardioversion-field/","type":"Lesson","body":"Synchronized Cardioversion in the Field · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Synchronized Cardioversion in the Field Lesson Synchronized Cardioversion in the Field 10 min Cardiac & ECG Skip to quiz Objective: Pick synchronized cardioversion for unstable tachyarrhythmia with a pulse, confirm sync marks, and switch to unsync if they become pulseless. Why This Is Hard They are hypotensive and the rate is 180. Crews push adenosine while the BP is 60 because “sync is scary.” AHA 2025: instability is a perfusion judgment. Unstable + pulse + tachyarrhythmia → cardioversion per protocol. On this truck Sedate if they are awake and protocol allows — this site does not publish the drug or the joules. See the sync marks on the R waves before you charge. If it will not sync, you may be in VF or the gain is wrong. If they lose pulses, unsynchronized defibrillation. Do","keywords":"Synchronized Cardioversion in the Field Unstable tachycardia with a pulse: sync on, shock, reassess. If they lose the pulse, it is defibrillation, not another sync debate. Lesson synchronized-cardioversion-field"},{"title":"Systematic ECG Approach","h1":"Systematic ECG Approach","description":"A six-step ECG method for paramedics: rate, regularity, P waves, PR, QRS, interpret — so street stress does not skip a critical finding.","url":"/learn/cardiac/systematic-approach/","type":"Lesson","body":"Systematic ECG Approach · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Systematic ECG Approach Lesson Systematic ECG Approach 10 min Cardiac & ECG Objective: Use the same six-step pass on every strip — rate, regularity, P waves, PR, QRS, interpret — so stress does not skip the finding that changes care. Street Context On a critical call the monitor becomes noise — family yelling, siren, motion artifact, automatic BP cycling. A fixed sequence protects you from jumping to a favorite diagnosis (“that’s VT”) and missing rate extremes, AV blocks, or wide complexes that change the pathway. Paramedic goal: every strip gets the same method, every time, until it is automatic. The sequence is a safety net, not busywork. Most street ECG errors are skipped steps , not exotic rhythms you never studied. Also remember: the strip is one data source. Pulse, mentation, skin, BP, an","keywords":"Systematic ECG Approach A six-step ECG method for paramedics: rate, regularity, P waves, PR, QRS, interpret — so street stress does not skip a critical finding. Lesson systematic-approach"},{"title":"Termination of Resuscitation","h1":"Termination of Resuscitation","description":"TOR rules exist so you do not transport futile traumatic or medical arrests blindly — and so you do not quit on a shockable rhythm in the driveway.","url":"/learn/cardiac/termination-of-resuscitation/","type":"Lesson","body":"Termination of Resuscitation · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Termination of Resuscitation Lesson Termination of Resuscitation 10 min Cardiac & ECG Skip to quiz Objective: Use your service TOR / medical-control rule as a rule, not a vibe — and know when you must keep going. Why This Is Hard The family is watching and the strip has been asystole. Crews either never stop or stop because they are tired. NAEMSP and AHA: TOR criteria are system rules. They are not your personal threshold. On this truck Know your medical and traumatic TOR protocols before the call. Shockable rhythm, hypothermia, and pregnancy usually mean you do not apply a basic BLS TOR rule. If you stop, document times, rhythm, who authorized, and what the family was told. Street Sequence Work the arrest you have: CPR quality, shocks if shockable, reversible causes. TOR is a written-rule","keywords":"Termination of Resuscitation TOR rules exist so you do not transport futile traumatic or medical arrests blindly — and so you do not quit on a shockable rhythm in the driveway. Lesson termination-of-resuscitation"},{"title":"Transcutaneous Pacing in the Field","h1":"Transcutaneous Pacing in the Field","description":"Unstable bradycardia: pads, capture, pulse. Atropine is less reliable in infranodal block — do not delay pacing for another round of hope.","url":"/learn/cardiac/transcutaneous-pacing-field/","type":"Lesson","body":"Transcutaneous Pacing in the Field · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Transcutaneous Pacing in the Field Lesson Transcutaneous Pacing in the Field 10 min Cardiac & ECG Skip to quiz Objective: Recognize when TCP is the move, confirm mechanical capture with a pulse, and sedate only if protocol allows. Why This Is Hard The strip is a third-degree block and the patient is crashing. Crews push atropine twice because pacing “looks mean.” AHA 2025 adult bradycardia: do not delay pacing in unstable high-grade block. On this truck Defib pads in a recommended position (anterior-lateral or anterior-posterior per your device). Set a rate per protocol, then increase milliamps until you see a QRS after every spike — then feel a pulse. Spikes without a femoral/carotid pulse is not capture. Turn up current or reposition; treat as PEA if pulseless. Street Sequence Unst","keywords":"Transcutaneous Pacing in the Field Unstable bradycardia: pads, capture, pulse. Atropine is less reliable in infranodal block — do not delay pacing for another round of hope. Lesson transcutaneous-pacing-field"},{"title":"Wide-Complex Tachycardia: VT vs Mimics","h1":"Wide-Complex Tachycardia: VT vs Mimics","description":"Treat regular wide-complex tachycardia as VT until proven otherwise. Spot hyperK, polymorphic, and WPW-related mimics before improvising drugs.","url":"/learn/cardiac/wide-complex-tachycardia-vt-vs-mimics/","type":"Lesson","body":"Wide-Complex Tachycardia: VT vs Mimics · Code 3 Workshop Skip to content Home / All lessons / Cardiac & ECG / Wide-Complex Tachycardia: VT vs Mimics Lesson Wide-Complex Tachycardia: VT vs Mimics 12 min Cardiac & ECG Objective: Approach regular wide-complex tachycardia with a VT-first safety mindset, recognize common mimics, and do not delay care to win a rhythm contest. Why This Is Hard Wide-complex tachycardia (WCT) forces a high-stakes call under time pressure. Most paramedics were taught: unstable regular WCT → treat as VT . That teaching saves lives because VT is common and dangerous. The trap is overconfidence in “it’s just SVT with aberrancy” when the patient is sick — or missing mimics like hyperkalemia that need a different drug path. Prehospital tools are limited: imperfect strips, motion, no full electrophysiology lab. Your job is safe defaults plus protocol discipline — not wi","keywords":"Wide-Complex Tachycardia: VT vs Mimics Treat regular wide-complex tachycardia as VT until proven otherwise. Spot hyperK, polymorphic, and WPW-related mimics before improvising drugs. Lesson wide-complex-tachycardia-vt-vs-mimics"},{"title":"Learn by Category","h1":"Learn by Category","description":"Browse 145 paramedic lessons in airway, cardiac, medical, meds, and trauma. Each session is 15 minutes or less with a check-your-understanding quiz.","url":"/learn/","type":"Hub","body":"Learn by Category · Code 3 Workshop Skip to content Home / Learn by Category Library Learn by Category One hundred forty-five EMS lessons of 15 minutes or less — twenty-nine per category. Pick a path, or scroll the full library. Five clinical paths Twenty-nine lessons in each path. Each category is the problem on the truck — the bag that isn’t moving, the monitor that’s talking, the “sick at home” that isn’t, the syringe, the bleed — not a topic dump. Airway & Breathing If the bag isn’t moving the chest, nothing else on this call matters. Suction, seal, VL — then a CICO plan you say out loud. 29 lessons Cardiac & ECG Two-person arrest, a 12-lead in ten minutes, and the chest-pain story that is not ACS. Pace, shock, or stop — on purpose. 29 lessons Medical “Sick at home” until it isn’t. Shock, stroke, sugar, sepsis — and the ones the pulse ox will lie about. 29 lessons Meds & Pharma Think","keywords":"Learn by Category Browse 145 paramedic lessons in airway, cardiac, medical, meds, and trauma. Each session is 15 minutes or less with a check-your-understanding quiz. Hub learn"},{"title":"Abdominal Pain Red Flags","h1":"Abdominal Pain Red Flags","description":"EMS does not diagnose appendicitis. You catch AAA, ectopic, perforation, and shock — then destination.","url":"/learn/medical/abdominal-pain-red-flags/","type":"Lesson","body":"Abdominal Pain Red Flags · Code 3 Workshop Skip to content Home / All lessons / Medical / Abdominal Pain Red Flags Lesson Abdominal Pain Red Flags 10 min Medical Skip to quiz Objective: Screen abdominal pain for life threats you can actually change: shock, AAA, ectopic, GI bleed, and a hard surgical abdomen. Why This Is Hard Everyone with a bellyache wants to stay home. Some of them have a rupturing AAA or an ectopic. ACEP and NASEMSO: prehospital abdominal pain is a risk screen plus supportive care, not a diagnosis. On this truck Ask pregnancy in every person who can be pregnant. Ectopic does not care that they “cannot be.” Two-arm pulses if tearing back/flank pain in an older patient. GI blood, black stool, syncope — that is the GI bleed lesson. Field Rules (Education) AAA theme: older, tearing back/flank, shock out of proportion, unequal femorals. Fluids per DCR if they are bleeding o","keywords":"Abdominal Pain Red Flags EMS does not diagnose appendicitis. You catch AAA, ectopic, perforation, and shock — then destination. Lesson abdominal-pain-red-flags"},{"title":"Adrenal Crisis in the Field","h1":"Adrenal Crisis in the Field","description":"Steroid-dependent vomiting plus shock is adrenal crisis until proven otherwise. Glucose, fluids, and steroid per protocol — not “just gastroenteritis.”","url":"/learn/medical/adrenal-crisis-field/","type":"Lesson","body":"Adrenal Crisis in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Adrenal Crisis in the Field Lesson Adrenal Crisis in the Field 11 min Medical Skip to quiz Objective: Recognize adrenal / Addisonian crisis from the medication list and shock picture, check glucose, give fluids, and get the steroid on board if your protocol allows it. Why This Is Hard They look like every other gastroenteritis. The bottle says hydrocortisone or prednisone or “adrenal insufficiency.” Crews treat nausea and leave a hypotensive steroid-dependent adult on the couch. Endocrine emergency teaching and NASEMSO-style pathways: adrenal crisis is shock plus missing cortisol. The steroid is the missing hormone. Fluids and glucose still matter. Dexamethasone can cover in some EMS systems if hydrocortisone is not on the truck — protocol owns the drug. On this truck Ask: steroid-dependent, Addi","keywords":"Adrenal Crisis in the Field Steroid-dependent vomiting plus shock is adrenal crisis until proven otherwise. Glucose, fluids, and steroid per protocol — not “just gastroenteritis.” Lesson adrenal-crisis-field"},{"title":"Alcohol Withdrawal in the Field","h1":"Alcohol Withdrawal in the Field","description":"Tremor, sweat, tachycardia, then seizure or DTs. This is a benzo-protocol and destination problem — not “let them sleep it off.”","url":"/learn/medical/alcohol-withdrawal-field/","type":"Lesson","body":"Alcohol Withdrawal in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Alcohol Withdrawal in the Field Lesson Alcohol Withdrawal in the Field 10 min Medical Skip to quiz Objective: Recognize withdrawal versus still-intoxicated, treat seizures as withdrawal seizures per protocol, and do not leave DTs on the sidewalk. Why This Is Hard They stopped drinking in jail yesterday and now they are seizing. Crews treat it like a first-time epileptic and miss the withdrawal clock. ASAM and NASEMSO: withdrawal seizures and DTs are medical emergencies. On this truck Ask last drink, usual amount, prior DTs/seizures. Glucose. Hypoglycemia mimics everything. Benzos are the treatment class for withdrawal seizures if protocol includes them — not phenytoin theater. Field Rules (Education) Intoxicated is still drunk. Withdrawal starts hours after the last drink: tremor, sweat, HR, ","keywords":"Alcohol Withdrawal in the Field Tremor, sweat, tachycardia, then seizure or DTs. This is a benzo-protocol and destination problem — not “let them sleep it off.” Lesson alcohol-withdrawal-field"},{"title":"Altered Mental Status Framework","h1":"Altered Mental Status Framework","description":"Prehospital AMS: a repeatable pass for glucose, oxygenation, toxidrome clues, stroke, sepsis, and trauma — so “just drunk” is never first.","url":"/learn/medical/altered-mental-status/","type":"Lesson","body":"Altered Mental Status Framework · Code 3 Workshop Skip to content Home / All lessons / Medical / Altered Mental Status Framework Lesson Altered Mental Status Framework 12 min Medical Objective: Work an AMS patient with a structured pass so treatable causes — glucose, airway, overdose, stroke, sepsis, trauma — are not missed. Why This Is Hard AMS is a symptom, not a diagnosis. The living room looks the same for hypoglycemia, opioid OD, stroke, post-ictal state, sepsis, and head trauma. You need a rapid, repeatable pass that finds fixable causes without tunnel vision. On this truck You have glucose, SpO₂, pupils, bottles on the nightstand, and a bystander. You do not have a CT or a tox screen. Fix what you can now (airway, glucose, naloxone for hypoventilation, trauma C-spine if the story fits) while you still destination as stroke/sepsis/TBI if those remain on the table. Document the last","keywords":"Altered Mental Status Framework Prehospital AMS: a repeatable pass for glucose, oxygenation, toxidrome clues, stroke, sepsis, and trauma — so “just drunk” is never first. Lesson altered-mental-status"},{"title":"Anaphylaxis Recognition","h1":"Anaphylaxis Recognition","description":"Recognize anaphylaxis without waiting for a full-body rash. IM epinephrine in the mid-anterolateral thigh comes first — not diphenhydramine.","url":"/learn/medical/anaphylaxis-recognition/","type":"Lesson","body":"Anaphylaxis Recognition · Code 3 Workshop Skip to content Home / All lessons / Medical / Anaphylaxis Recognition Lesson Anaphylaxis Recognition 10 min Medical Objective: Identify anaphylaxis early. First-line class is IM epinephrine in the mid-anterolateral thigh per protocol — do not wait for a textbook full-body rash. Why This Is Hard Anaphylaxis kills by airway swelling and distributive shock. Crews delay epinephrine waiting for hives or “more symptoms.” Some patients present with GI symptoms and hypotension after a known allergen — still anaphylaxis thinking. Working Field Picture Acute onset after exposure (food, sting, drug, latex) — exposure may be unknown. Skin/mucosal: hives, flushing, angioedema — helpful but not required in every definition pathway. Respiratory: wheeze, stridor, dyspnea, hypoxia. Cardiovascular: hypotension, syncope, collapse. GI: crampy pain, vomiting, diarrh","keywords":"Anaphylaxis Recognition Recognize anaphylaxis without waiting for a full-body rash. IM epinephrine in the mid-anterolateral thigh comes first — not diphenhydramine. Lesson anaphylaxis-recognition"},{"title":"Severe Agitation in the Field","h1":"Severe Agitation in the Field","description":"NAEMSP 2021: verbal de-escalation first, no prone/hobble, continuous monitoring after chemical restraint. Ketamine is one protocol option — not a personality.","url":"/learn/medical/behavioral-agitation-field/","type":"Lesson","body":"Severe Agitation in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Severe Agitation in the Field Lesson Severe Agitation in the Field 10 min Medical Skip to quiz Objective: Keep you and the patient alive: de-escalate, avoid positional asphyxia, monitor after sedation, and use only the agent your protocol names. Why This Is Hard They are in the street screaming and PD wants them “down.” Crews jump to ketamine and then leave them prone in the truck. NAEMSP/NASEMSO/NAEMT 2021: verbal de-escalation, no hobble/prone, continuous observation after chemical restraint. On this truck Scene safety. You cannot medicate from inside a punch. If you sedate, suction, BVM, SpO₂, EtCO₂ when available — you just created an airway patient. Never prone, never hobble, never a knee on the neck. Field Rules (Education) Verbal first: one voice, options, time if it is safe. Physical re","keywords":"Severe Agitation in the Field NAEMSP 2021: verbal de-escalation first, no prone/hobble, continuous monitoring after chemical restraint. Ketamine is one protocol option — not a personality. Lesson behavioral-agitation-field"},{"title":"Carbon Monoxide in the Field","h1":"Carbon Monoxide in the Field","description":"Headache, flu, multiple patients, generator, house fire: high-flow oxygen and a hospital that can measure COHb — pulse ox will lie.","url":"/learn/medical/carbon-monoxide-field/","type":"Lesson","body":"Carbon Monoxide in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Carbon Monoxide in the Field Lesson Carbon Monoxide in the Field 10 min Medical Skip to quiz Objective: Suspect CO, give high-flow oxygen, and do not trust SpO₂ to clear the exposure. Why This Is Hard The whole family has a headache and nausea. Crews call it food poisoning. CDC and ACEP teaching: CO is colorless. Standard two-wavelength pulse oximetry cannot tell COHb from oxyhemoglobin. On this truck Open windows, stop the generator, get them out. High-flow oxygen per protocol regardless of a pretty SpO₂. Multiple patients from one structure is CO or other airborne toxin until you have a better story. Field Rules (Education) Clues: winter, generator, furnace, house fire, several patients with headache/nausea/confusion, cherry-red is late and unreliable. CDC / ACEP: high-concentration oxygen unt","keywords":"Carbon Monoxide in the Field Headache, flu, multiple patients, generator, house fire: high-flow oxygen and a hospital that can measure COHb — pulse ox will lie. Lesson carbon-monoxide-field"},{"title":"CHF & Pulmonary Edema","h1":"CHF & Pulmonary Edema","description":"Acute cardiogenic pulmonary edema for EMS: sit-up, CPAP, nitroglycerin cautions, versus COPD, and why wide-open fluids are the wrong reflex.","url":"/learn/medical/chf-pulmonary-edema/","type":"Lesson","body":"CHF & Pulmonary Edema · Code 3 Workshop Skip to content Home / All lessons / Medical / CHF & Pulmonary Edema Lesson CHF & Pulmonary Edema 12 min Medical Objective: Tell wet-lung pump failure from COPD when you can, sit them up, use CPAP when it fits, and do not drown a cardiogenic patient in fluids. Why This Is Hard Wheeze is not a diagnosis. Cardiac asthma, COPD, pneumonia, and PE all make people work to breathe. The CHF picture is often nocturnal dyspnea, orthopnea, wet crackles, hypertension, JVD, and a cardiac history. Get it wrong and you either bag an obstructive lung like a CHF or flood a failing pump with saline. On this truck You have: sitting them up, oxygen for hypoxia, CPAP if they protect the airway, a 12-lead, and nitrates only if protocol and BP allow. You do not have: BNP, chest x-ray, or an ICU ventilator. Do not wait for those to treat the work of breathing. You decide:","keywords":"CHF & Pulmonary Edema Acute cardiogenic pulmonary edema for EMS: sit-up, CPAP, nitroglycerin cautions, versus COPD, and why wide-open fluids are the wrong reflex. Lesson chf-pulmonary-edema"},{"title":"Diabetic Emergencies: Hypo & Hyper","h1":"Diabetic Emergencies: Hypo & Hyper","description":"Hypoglycemia can mimic stroke. Check glucose early, treat hypo per protocol (often D10), and do not field-insulin DKA or HHS.","url":"/learn/medical/diabetic-emergencies/","type":"Lesson","body":"Diabetic Emergencies: Hypo & Hyper · Code 3 Workshop Skip to content Home / All lessons / Medical / Diabetic Emergencies: Hypo & Hyper Lesson Diabetic Emergencies: Hypo & Hyper 12 min Medical Objective: Catch hypoglycemia that looks like stroke or intoxication, treat per protocol, and support hyperglycemic crises without field insulin unless authorized. Why This Is Hard Hypoglycemia can look like stroke, intoxication, or psychosis. Hyperglycemic crises can look like sepsis or dehydration. A fingerstick (or approved meter) early prevents wrong pathways — and still is not the whole exam. Street Sequence Glucose early in AMS, seizure, stroke-like, or “just drunk.” Low and they can swallow safely: oral glucose. Cannot swallow: IM glucagon or IV dextrose per what you carry. Recheck glucose and the exam. Residual focal deficit after correction still runs a stroke pathway. High sugar: ABCs, vol","keywords":"Diabetic Emergencies: Hypo & Hyper Hypoglycemia can mimic stroke. Check glucose early, treat hypo per protocol (often D10), and do not field-insulin DKA or HHS. Lesson diabetic-emergencies"},{"title":"Dialysis Emergencies","h1":"Dialysis Emergencies","description":"Missed dialysis: fluid, potassium, and access. The wide, slow strip is hyperK until you prove otherwise. Do not fluid-dump a patient who missed Tuesday’s run.","url":"/learn/medical/dialysis-emergency/","type":"Lesson","body":"Dialysis Emergencies · Code 3 Workshop Skip to content Home / All lessons / Medical / Dialysis Emergencies Lesson Dialysis Emergencies 10 min Medical Skip to quiz Objective: Recognize missed-dialysis crisis — pulmonary edema, hyperK ECG, bleeding fistula — and treat the cause, not a generic “sick renal” label. Why This Is Hard They missed dialysis and now cannot stand. Crews open fluids because the BP is 90. The lungs are already full and the ECG is a sine wave. AHA 2025 special circumstances: hyperkalemia is a reversible arrest cause. Volume overload is a CPAP problem, not a trauma line. On this truck Ask when they last dialyzed and whether the fistula is their only access. 12-lead. Wide and slow in this patient is hyperK until the receiving team says otherwise. Do not use the fistula or graft as a routine IV. Field Rules (Education) HyperK: peaked T, wide QRS, sine wave, bradycardia, a","keywords":"Dialysis Emergencies Missed dialysis: fluid, potassium, and access. The wide, slow strip is hyperK until you prove otherwise. Do not fluid-dump a patient who missed Tuesday’s run. Lesson dialysis-emergency"},{"title":"Eclampsia & Preeclampsia","h1":"Eclampsia & Preeclampsia","description":"Seizure in pregnancy or up to 6 weeks postpartum is eclampsia until you have another cause. Magnesium is first-line. Benzos are not the opening move.","url":"/learn/medical/eclampsia-preeclampsia/","type":"Lesson","body":"Eclampsia & Preeclampsia · Code 3 Workshop Skip to content Home / All lessons / Medical / Eclampsia & Preeclampsia Lesson Eclampsia & Preeclampsia 12 min Medical Objective: Treat new seizure in pregnancy or early postpartum as eclampsia until proven otherwise — magnesium first per protocol, left-lateral positioning, OB-capable destination. Why This Is Hard You get a seizure call, you reach for a benzo. In pregnancy and up to 6 weeks postpartum , ACOG / NAEMSP model EMS guidance says magnesium sulfate is first-line for presumed eclampsia. BP may not even be high when you arrive. Glucose still gets checked. This is not “just a seizure” and not a trauma-in-pregnancy copy (that lesson is here ). Say out loud Pregnant or postpartum ≤6 weeks? Glucose, airway, left lateral / uterus off the cava Magnesium is the eclamptic drug class — benzos if it will not stop OB-capable destination, not “close","keywords":"Eclampsia & Preeclampsia Seizure in pregnancy or up to 6 weeks postpartum is eclampsia until you have another cause. Magnesium is first-line. Benzos are not the opening move. Lesson eclampsia-preeclampsia"},{"title":"GI Bleed in the Field","h1":"GI Bleed in the Field","description":"Upper and lower GI bleeding for EMS: airway if they are vomiting blood, shock before the color of the stool, no nitro, and a hospital that can scope or operate.","url":"/learn/medical/gi-bleed-field/","type":"Lesson","body":"GI Bleed in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / GI Bleed in the Field Lesson GI Bleed in the Field 10 min Medical Objective: Treat GI bleeding as a hemorrhage and airway problem — not a PPI problem — and do not be fooled by a “normal” first blood pressure. Why This Is Hard Coffee-ground emesis on the carpet looks “old.” Melena looks like tar, not Hollywood bleeding. Variceal patients can exsanguinate into the gut and still talk. This is hypovolemic shock with an airway threat if they are vomiting blood — see shock categories and syncope . Say out loud Hematemesis / coffee-ground / melena / maroon stool — plus liver, NSAID, anticoagulant, alcohol stories Airway first if they are vomiting blood Shock can present as syncope with a “normal” first BP No nitro, no unnecessary anticoagulation stories — this is not ACS candy Upper vs Lower (Enough for the T","keywords":"GI Bleed in the Field Upper and lower GI bleeding for EMS: airway if they are vomiting blood, shock before the color of the stool, no nitro, and a hospital that can scope or operate. Lesson gi-bleed-field"},{"title":"Heat Stroke vs Heat Exhaustion","h1":"Heat Stroke vs Heat Exhaustion","description":"Heat stroke is CNS dysfunction plus hyperthermia. Cool first — cold-water immersion when you can. Do not wait for the ED to start cooling.","url":"/learn/medical/heat-stroke/","type":"Lesson","body":"Heat Stroke vs Heat Exhaustion · Code 3 Workshop Skip to content Home / All lessons / Medical / Heat Stroke vs Heat Exhaustion Lesson Heat Stroke vs Heat Exhaustion 12 min Medical Objective: Tell heat exhaustion from heat stroke, start cooling on scene, and treat this as a time-critical brain-and-organ emergency — not “they just need water.” Why This Is Hard Football practice, warehouse, elderly apartment with no AC — crews delay cooling to “get a temperature” or start an IV. Wilderness Medical Society and AHA 2025 hyperthermia teaching: heat stroke is a clinical diagnosis (hyperthermia with CNS dysfunction). Cooling is the treatment. Delay cooks the brain and the liver. Say out loud Altered + hot environment / hot skin → heat stroke until you have a better story Cool now with what you have — do not wait for a tub Sweat can still be present — “dry skin required” is a myth Glucose, naloxo","keywords":"Heat Stroke vs Heat Exhaustion Heat stroke is CNS dysfunction plus hyperthermia. Cool first — cold-water immersion when you can. Do not wait for the ED to start cooling. Lesson heat-stroke"},{"title":"Hypertensive Emergency vs High BP","h1":"Hypertensive Emergency vs High BP","description":"High blood pressure is not an emergency by itself. End-organ damage is. Do not chase asymptomatic hypertension with field antihypertensives.","url":"/learn/medical/hypertensive-emergency/","type":"Lesson","body":"Hypertensive Emergency vs High BP · Code 3 Workshop Skip to content Home / All lessons / Medical / Hypertensive Emergency vs High BP Lesson Hypertensive Emergency vs High BP 10 min Medical Objective: Separate a scary cuff number from hypertensive emergency — treat the organ, not the number — and do not drop asymptomatic high BP on the porch. Why This Is Hard The monitor says 220/120 and everyone stares at the cuff. Most of those patients have chronic hypertension and a headache. A true hypertensive emergency is severe BP plus acute end-organ damage (brain, heart, aorta, kidney, pregnancy). AHA/ACC hypertension guidance and EMS model guidelines agree: do not acutely lower asymptomatic severe hypertension in the field with random clonidine, extra nitro, or “a little labetalol because the number is ugly.” On this truck Recheck the cuff (right size, right arm) before you treat a number. You ","keywords":"Hypertensive Emergency vs High BP High blood pressure is not an emergency by itself. End-organ damage is. Do not chase asymptomatic hypertension with field antihypertensives. Lesson hypertensive-emergency"},{"title":"Hypoglycemia Refusal & Capacity","h1":"Hypoglycemia Refusal & Capacity","description":"Waking up after glucose is not automatic capacity. Long-acting sulfonylureas, alcohol, and no food plan are bounce-back calls.","url":"/learn/medical/hypoglycemia-refusal-capacity/","type":"Lesson","body":"Hypoglycemia Refusal & Capacity · Code 3 Workshop Skip to content Home / All lessons / Medical / Hypoglycemia Refusal & Capacity Lesson Hypoglycemia Refusal & Capacity 10 min Medical Skip to quiz Objective: After D10 or oral glucose, decide who can actually refuse: oriented, fed, not on a long-acting secretagogue, and protocol-legal. Why This Is Hard They woke up mean and want you gone. ADA teaching treats symptomatic glucose <70 as hypoglycemia. Refusal after treatment is a capacity plus bounce-back risk problem — not a signature on a blank. On this truck Recheck glucose and orientation after treatment. Ask the actual med: insulin vs sulfonylurea. Long-acting oral agents bounce back. They need a food plan they can actually swallow. If they will not eat, they ride. Field Rules (Education) Capacity: oriented, understands the risk of going back down, not still drunk, not post-ictal. High-r","keywords":"Hypoglycemia Refusal & Capacity Waking up after glucose is not automatic capacity. Long-acting sulfonylureas, alcohol, and no food plan are bounce-back calls. Lesson hypoglycemia-refusal-capacity"},{"title":"Accidental Hypothermia (Not Arrest)","h1":"Accidental Hypothermia (Not Arrest)","description":"Wet, cold, altered: strip wet clothes, insulate, handle gently, and do not declare them dead because they are stiff.","url":"/learn/medical/hypothermia-accidental/","type":"Lesson","body":"Accidental Hypothermia (Not Arrest) · Code 3 Workshop Skip to content Home / All lessons / Medical / Accidental Hypothermia (Not Arrest) Lesson Accidental Hypothermia (Not Arrest) 10 min Medical Skip to quiz Objective: Stage hypothermia on the truck, prevent further heat loss, and know when gentle handling and a rewarming destination matter. Why This Is Hard They are “just drunk” in a doorway. Core temp is 28 °C and the next rough roll throws them into VF. AHA 2025 and WMS: accidental hypothermia is a staged disease. Handle gently. Rewarm as you can. On this truck Scene: get them out of wind and wet. Cut wet clothes, dry insulation, hat, vapor barrier if you have it. Glucose. Hypoglycemia and hypothermia travel together. Field Rules (Education) Mild: shivering, talking — passive rewarming, shelter, calories if they can swallow. Moderate/severe: altered, little shivering — gentle handling","keywords":"Accidental Hypothermia (Not Arrest) Wet, cold, altered: strip wet clothes, insulate, handle gently, and do not declare them dead because they are stiff. Lesson hypothermia-accidental"},{"title":"Meningitis & Fever With Stiff Neck","h1":"Meningitis & Fever With Stiff Neck","description":"Fever, headache, stiff neck, petechiae: you will not tap them. You will protect yourself, treat shock, and not delay destination for a perfect Brudzinski demo.","url":"/learn/medical/meningitis-fever-stiff-neck/","type":"Lesson","body":"Meningitis & Fever With Stiff Neck · Code 3 Workshop Skip to content Home / All lessons / Medical / Meningitis & Fever With Stiff Neck Lesson Meningitis & Fever With Stiff Neck 10 min Medical Skip to quiz Objective: Spot the meningococcal-looking crash, use PPE, treat septic shock, and move — do not wait for a hospital LP. Why This Is Hard College dorm, fever, headache, a rash that does not fade. Crews linger for a full neuro exam. Surviving Sepsis and pediatric septic-shock teaching: this is time-critical infection plus shock. PPE protects the next patient — you. On this truck Mask/eye protection per service infection control. Treat septic shock: oxygen, fluids per protocol with caution, early alert. Photophobia and stiff neck are clues, not a requirement. Infants may only be irritable or hypotonic. Field Rules (Education) Clues: fever, headache, neck pain/stiffness, photophobia, AMS, n","keywords":"Meningitis & Fever With Stiff Neck Fever, headache, stiff neck, petechiae: you will not tap them. You will protect yourself, treat shock, and not delay destination for a perfect Brudzinski demo. Lesson meningitis-fever-stiff-neck"},{"title":"Overdose & Toxidrome Thinking","h1":"Overdose & Toxidrome Thinking","description":"Sort overdoses by toxidrome — opioid, sympathomimetic, anticholinergic, cholinergic — then airway first, antidotes only as authorized.","url":"/learn/medical/overdose-toxidromes/","type":"Lesson","body":"Overdose & Toxidrome Thinking · Code 3 Workshop Skip to content Home / All lessons / Medical / Overdose & Toxidrome Thinking Lesson Overdose & Toxidrome Thinking 12 min Medical Objective: Sort overdose presentations into high-yield toxidrome patterns and prioritize airway, scene safety, and protocol antidotes. Why This Is Hard Polysubstance use is common. Bottles lie. Patients cannot history. Toxidrome thinking gives you a pattern language so you protect the airway and choose the right antidote pathway without inventing hospital toxicology in the truck. On this truck Airway and ventilation first. Naloxone restores breathing — it is not a consciousness contest. You will not get a comprehensive tox screen. Bring the bottles, patches, and bystander story. Hot, agitated, and hyperthermic is a cooling-and-benzo problem per protocol, not a “let them ride it out” problem. Scene safety still own","keywords":"Overdose & Toxidrome Thinking Sort overdoses by toxidrome — opioid, sympathomimetic, anticholinergic, cholinergic — then airway first, antidotes only as authorized. Lesson overdose-toxidromes"},{"title":"Pulmonary Embolism: Field Suspicion","h1":"Pulmonary Embolism: Field Suspicion","description":"Prehospital PE is a pattern: sudden dyspnea, hypoxia, syncope, shock, RV strain — not a CT. Support ABCs, 12-lead, and destination. Education only.","url":"/learn/medical/pe-field-suspicion/","type":"Lesson","body":"Pulmonary Embolism: Field Suspicion · Code 3 Workshop Skip to content Home / All lessons / Medical / Pulmonary Embolism: Field Suspicion Lesson Pulmonary Embolism: Field Suspicion 12 min Medical Objective: Suspect PE from story and exam, treat hypoxia and obstructive shock, and do not wait for a hospital CT to take a crashing patient seriously. Why This Is Hard PE looks like anxiety, ACS, pneumonia, and “just a faint.” You will not diagnose it with D-dimer on the porch. Your job is to keep it on the list , support oxygenation and blood pressure, get a 12-lead, and not dump fluids like it is sepsis if this is obstructive shock (see shock categories ). Say out loud Sudden dyspnea / hypoxia / syncope / arrest out of proportion to lung sounds Risk: surgery, cancer, immobilization, estrogen, prior VTE, pregnancy, COVID-era/hypercoagulable stories Clear lungs + hypoxia is a clue, not a rule-ou","keywords":"Pulmonary Embolism: Field Suspicion Prehospital PE is a pattern: sudden dyspnea, hypoxia, syncope, shock, RV strain — not a CT. Support ABCs, 12-lead, and destination. Education only. Lesson pe-field-suspicion"},{"title":"Pediatric Septic Shock in the Field","h1":"Pediatric Septic Shock in the Field","description":"The quiet kid who is just “tired and febrile” can be compensated shock. PALS 2025: recognize, oxygen, access, careful fluid boluses with reassessment, and a pediatric-capable destination.","url":"/learn/medical/pediatric-septic-shock-field/","type":"Lesson","body":"Pediatric Septic Shock in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Pediatric Septic Shock in the Field Lesson Pediatric Septic Shock in the Field 12 min Medical Skip to quiz Objective: Spot pediatric septic shock before hypotension, give oxygen and access, reassess after every fluid bolus, and do not wait for an adult BP number. Why This Is Hard The BP is 90 and the parent says they are sleepy. Adult hypotension cutoffs do not apply. PALS: compensated shock is tachycardia, delayed cap refill, cool extremities (or warm/flash refill in distributive shock), and altered mentation with a still-recordable BP. Hypotension is late. SSC pediatric guidance and PALS both want early recognition and repeated small-to-moderate fluid challenges with lung and perfusion checks — not a 30 mL/kg slam “because sepsis.” On this truck Work of breathing, mental status, cap ref","keywords":"Pediatric Septic Shock in the Field The quiet kid who is just “tired and febrile” can be compensated shock. PALS 2025: recognize, oxygen, access, careful fluid boluses with reassessment, and a pediatric-capable destination. Lesson pediatric-septic-shock-field"},{"title":"Seizure & Status Epilepticus","h1":"Seizure & Status Epilepticus","description":"Prehospital seizure and status epilepticus: airway, glucose, timing, benzodiazepine framing, and post-ictal vs stroke. Education only — not dosing orders.","url":"/learn/medical/seizure-status/","type":"Lesson","body":"Seizure & Status Epilepticus · Code 3 Workshop Skip to content Home / All lessons / Medical / Seizure & Status Epilepticus Lesson Seizure & Status Epilepticus 12 min Medical Objective: Protect the airway, check glucose, time the seizure, and treat status per protocol — then do not call every post-ictal deficit “just a seizure” without a stroke/trauma look. Why This Is Hard Bystanders want you to “stop it.” Shoving objects in the mouth causes dental trauma. Status epilepticus (ongoing seizure or recurrent seizures without recovery) is an airway and brain emergency. Post-ictal Todd’s paralysis looks like a stroke. Hypoglycemia looks like a seizure. Your sequence has to be boring and the same every time. Street Sequence Protect the airway, recovery position, suction ready. Do not pry the jaw. Glucose. Still convulsing past your protocol window (often ~5 minutes): benzo per protocol, IM/IN i","keywords":"Seizure & Status Epilepticus Prehospital seizure and status epilepticus: airway, glucose, timing, benzodiazepine framing, and post-ictal vs stroke. Education only — not dosing orders. Lesson seizure-status"},{"title":"Sepsis Recognition in the Field","h1":"Sepsis Recognition in the Field","description":"Sepsis in the field: infection plus organ dysfunction or shock. Skip qSOFA as a rule-out. Support ABCs and alert early.","url":"/learn/medical/sepsis-recognition/","type":"Lesson","body":"Sepsis Recognition in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Sepsis Recognition in the Field Lesson Sepsis Recognition in the Field 12 min Medical Objective: Spot suspected infection plus hypoperfusion or new organ dysfunction early, alert the hospital, and do not use qSOFA as a rule-out. Why This Is Hard Sepsis does not always look like a textbook “hot, hypotensive, infected” patient. Older adults may present with confusion only. Hypothermia can be as ominous as fever. BP may still be “okay” while lactate and organ failure are rising (you may not have lactate in the field). The paramedic win is early suspicion + supportive care + destination/notification — not waiting for a hospital stamp. Working Definition (Education) Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection. Septic shock is a subset with profound c","keywords":"Sepsis Recognition in the Field Sepsis in the field: infection plus organ dysfunction or shock. Skip qSOFA as a rule-out. Support ABCs and alert early. Lesson sepsis-recognition"},{"title":"Shock Categories","h1":"Shock Categories","description":"Map shock as hypovolemic, distributive, cardiogenic, or obstructive so fluids, pressors, and destination match the problem — not a habit.","url":"/learn/medical/shock-categories/","type":"Lesson","body":"Shock Categories · Code 3 Workshop Skip to content Home / All lessons / Medical / Shock Categories Lesson Shock Categories 12 min Medical Objective: Sort shock into volume, vessel, pump, or obstruction using field clues, then match interventions to the category — fluids are not universal. Why This Is Hard Shock is inadequate tissue perfusion — not just “low blood pressure.” Patients can be in shock with a “normal” cuff reading while compensating with tachycardia and vasoconstriction. On the truck you must recognize shock early, guess the dominant category, and match interventions without locking into the wrong fluid or pressor path. Mixed shock is real (trauma + sepsis, cardiogenic + distributive after ROSC). Categories are a teaching map, not a perfect label machine. Four Buckets (Teaching Model) Hypovolemic — not enough volume in the tank (blood loss, dehydration, burns). Distributive ","keywords":"Shock Categories Map shock as hypovolemic, distributive, cardiogenic, or obstructive so fluids, pressors, and destination match the problem — not a habit. Lesson shock-categories"},{"title":"Sickle Cell Crisis in the Field","h1":"Sickle Cell Crisis in the Field","description":"Pain is real. Stroke, ACS, and infection are the killers. Oxygen for hypoxia, not a default NRB, and destination — not “drug-seeking.”","url":"/learn/medical/sickle-cell-crisis-field/","type":"Lesson","body":"Sickle Cell Crisis in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Sickle Cell Crisis in the Field Lesson Sickle Cell Crisis in the Field 10 min Medical Skip to quiz Objective: Treat sickle cell pain as real, screen for stroke/ACS/infection, and avoid the judgment that delays care. Why This Is Hard They want pain medicine and someone in the crew mutters “frequent flyer.” NHLBI and ACEP: vaso-occlusive pain is real. Acute chest, stroke, and splenic sequestration are time-critical. On this truck Ask their usual crisis vs this one. New focal neuro is a stroke until proven otherwise. Oxygen if hypoxic. Not every talking patient needs a NRB. Fever plus sickle cell is infection until the hospital says no. Field Rules (Education) Vaso-occlusive pain: their pain is the disease. Analgesia per protocol. Do not withhold because of stigma. Acute chest: chest pain, fever","keywords":"Sickle Cell Crisis in the Field Pain is real. Stroke, ACS, and infection are the killers. Oxygen for hypoxia, not a default NRB, and destination — not “drug-seeking.” Lesson sickle-cell-crisis-field"},{"title":"Stroke Mimics: Still Protect the Clock","h1":"Stroke Mimics: Still Protect the Clock","description":"Hypoglycemia, seizure, migraine, and Todd’s paralysis mimic stroke. Check glucose, still activate the stroke pathway if disabling deficits persist, and do not cancel a team for a “maybe.”","url":"/learn/medical/stroke-mimics-field/","type":"Lesson","body":"Stroke Mimics: Still Protect the Clock · Code 3 Workshop Skip to content Home / All lessons / Medical / Stroke Mimics: Still Protect the Clock Lesson Stroke Mimics: Still Protect the Clock 11 min Medical Skip to quiz Objective: Catch the mimics you can treat on the truck (especially glucose), then still run last-known-well and destination as a stroke if the deficit remains. Why This Is Hard You have been burned by a migraine and by a seizure. So you under-call. 2026 AHA/ASA acute ischemic stroke: EMS should screen with a validated tool, check glucose, keep scene short, and triage to the right stroke hospital. Hypoglycemia mimics stroke and must be treated — but if disabling deficits persist after correction, the stroke pathway still runs. On this truck Glucose on every focal deficit. Treat severe hypoglycemia. Recheck the exam. Last known well, time of discovery, anticoagulants, seizure ","keywords":"Stroke Mimics: Still Protect the Clock Hypoglycemia, seizure, migraine, and Todd’s paralysis mimic stroke. Check glucose, still activate the stroke pathway if disabling deficits persist, and do not cancel a team for a “maybe.” Lesson stroke-mimics-field"},{"title":"Stroke Recognition & Last Known Well","h1":"Stroke Recognition & Last Known Well","description":"Prehospital stroke: BEFAST cues, true last known well, glucose, LVO screening when required, NPO, and a short scene time.","url":"/learn/medical/stroke-recognition-lkw/","type":"Lesson","body":"Stroke Recognition & Last Known Well · Code 3 Workshop Skip to content Home / All lessons / Medical / Stroke Recognition & Last Known Well Lesson Stroke Recognition & Last Known Well 12 min Medical Objective: Recognize suspected stroke, document last known well accurately, check glucose, and move toward the right destination without avoidable delay. Why This Is Hard Stroke is a clock disease. Wrong last-known-well (LKW) times, missed posterior signs, and long scenes steal treatment windows. Paramedics win by recognition, glucose, rapid packaging, and clear hospital notification — not by running a full neurology exam in the living room. Recognition Themes (Education) Face / Arm / Speech tools (Cincinnati-style) catch many anterior strokes. BEFAST-style additions: Balance, Eyes (vision), Face, Arms, Speech, Time — helps catch more presentations. Posterior clues: sudden severe dizziness/ver","keywords":"Stroke Recognition & Last Known Well Prehospital stroke: BEFAST cues, true last known well, glucose, LVO screening when required, NPO, and a short scene time. Lesson stroke-recognition-lkw"},{"title":"Syncope in the Field","h1":"Syncope in the Field","description":"Prehospital syncope: cardiac red flags, 12-lead, glucose, GI bleed and ectopic clues, and why “they woke up so it’s fine” is not a plan.","url":"/learn/medical/syncope-field-approach/","type":"Lesson","body":"Syncope in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Syncope in the Field Lesson Syncope in the Field 10 min Medical Objective: Syncope is a symptom. Find the dangerous causes — cardiac, bleed, stroke, glucose — with a 12-lead and a history that asks what they were doing when they went down. Why This Is Hard The patient is talking, embarrassed, and wants to sign off. Some of those patients have complete heart block, GI bleeding, ruptured AAA, ectopic pregnancy, or a PE. Syncope means transient loss of consciousness with spontaneous recovery. Your job is a high-risk screen , not a 40-minute neurology consult. High-Risk Themes Cardiac: exertional syncope, chest pain, palpitations, family sudden death, abnormal 12-lead (blocks, Brugada-pattern teaching, long QT, ischemia, WPW), heart failure history. Bleed / volume: GI blood, black stools, AAA back/flank pai","keywords":"Syncope in the Field Prehospital syncope: cardiac red flags, 12-lead, glucose, GI bleed and ectopic clues, and why “they woke up so it’s fine” is not a plan. Lesson syncope-field-approach"},{"title":"Thunderclap Headache & SAH","h1":"Thunderclap Headache & SAH","description":"Worst headache of life, peak in seconds, neck stiffness, or a new neuro deficit is a stroke-clock problem. Glucose, short scene, CT-capable destination — not “migraine cocktail on the couch.”","url":"/learn/medical/thunderclap-headache-sah/","type":"Lesson","body":"Thunderclap Headache & SAH · Code 3 Workshop Skip to content Home / All lessons / Medical / Thunderclap Headache & SAH Lesson Thunderclap Headache & SAH 11 min Medical Skip to quiz Objective: Treat sudden-onset worst headache as possible subarachnoid hemorrhage: protect the clock, check glucose, and do not downgrade it because the neuro exam is “normal.” Why This Is Hard They are 42, photophobic, and “get migraines.” Crews give ondansetron and dim the lights. AHA/ASA aneurysmal SAH teaching: thunderclap headache — sudden, maximal within seconds to a minute — is the classic warning. A normal GCS does not clear an aneurysm. Sentinel leaks get sent home and then rebleed. Your job is suspicion and the right door, not a diagnosis. On this truck Onset story is the exam: seconds vs hours, worst of life, exertion/sex/Valsalva, neck stiffness, vomiting, seizure at onset, photophobia. Glucose. Foc","keywords":"Thunderclap Headache & SAH Worst headache of life, peak in seconds, neck stiffness, or a new neuro deficit is a stroke-clock problem. Glucose, short scene, CT-capable destination — not “migraine cocktail on the couch.” Lesson thunderclap-headache-sah"},{"title":"Vaginal Bleeding in the Field","h1":"Vaginal Bleeding in the Field","description":"Pregnancy first. Shock from ectopic or postpartum hemorrhage is a surgical/OB emergency. Pads in, uterus massage if postpartum per protocol, destination.","url":"/learn/medical/vaginal-bleeding-field/","type":"Lesson","body":"Vaginal Bleeding in the Field · Code 3 Workshop Skip to content Home / All lessons / Medical / Vaginal Bleeding in the Field Lesson Vaginal Bleeding in the Field 10 min Medical Skip to quiz Objective: Ask pregnancy, treat shock, and know the two scenes that kill: ectopic and postpartum hemorrhage. Why This Is Hard They say it is a heavy period. BP is 78. ACOG and NAEMSP: suspected ectopic and postpartum hemorrhage are time-critical. You will not speculum on the truck. On this truck Pregnancy in anyone who can be pregnant. External pads, not packing the vagina. Postpartum: feel the fundus if trained — atony is a massage and protocol-med problem (oxytocin if you carry it). Field Rules (Education) Ectopic theme: pelvic pain, bleeding (can be light), syncope, shock. Shoulder pain. Known IUD or prior ectopic raises risk. Miscarriage can still bleed enough to shock. Treat shock. Postpartum: wi","keywords":"Vaginal Bleeding in the Field Pregnancy first. Shock from ectopic or postpartum hemorrhage is a surgical/OB emergency. Pads in, uterus massage if postpartum per protocol, destination. Lesson vaginal-bleeding-field"},{"title":"Activated Charcoal Framing","h1":"Activated Charcoal Framing","description":"Charcoal is not a default for every overdose. Airway first. It is time- and toxin-specific — and many EMS systems do not carry it.","url":"/learn/meds-pharma/activated-charcoal-field/","type":"Lesson","body":"Activated Charcoal Framing · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Activated Charcoal Framing Lesson Activated Charcoal Framing 10 min Meds & Pharma Skip to quiz Objective: Keep charcoal in a small box: cooperative patient, recent selected ingestion, protected airway — never as a punishment drink. Why This Is Hard The teenager ate pills and someone wants charcoal in the driveway. AAPCC and poison-center teaching: single-dose charcoal may help some recent ingestions in a protected airway. It is not for hydrocarbons, metals, or the vomiting unresponsive patient. On this truck Call poison control / follow protocol. Do not invent a toxin list. If they are altered, they do not get charcoal. If you do not carry it, you are not failing the call — you are protecting the airway and destining. Field Rules (Education) Maybe: recent (often within about an hour teaching","keywords":"Activated Charcoal Framing Charcoal is not a default for every overdose. Airway first. It is time- and toxin-specific — and many EMS systems do not carry it. Lesson activated-charcoal-field"},{"title":"Albuterol & Bronchodilators","h1":"Albuterol & Bronchodilators","description":"Nebulized albuterol for EMS: asthma and COPD, continuous vs intermittent, hyperkalemia shift, and why stridor is not a bronchodilator contest.","url":"/learn/meds-pharma/albuterol-bronchodilators/","type":"Lesson","body":"Albuterol & Bronchodilators · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Albuterol & Bronchodilators Lesson Albuterol & Bronchodilators 10 min Meds & Pharma Objective: Use albuterol as a lower-airway drug — wheeze and air trapping, not stridor — and know it also shifts potassium. Why This Matters Albuterol is the most-given EMS respiratory drug and one of the easiest to aim at the wrong tube. It relaxes bronchial smooth muscle (beta-2). That helps asthma and many COPD flares. It does not stent a swollen upper airway. GINA and NAEPP-style asthma teaching still wants bronchodilators early in bronchospasm — alongside oxygen and, when they are really sick, the rest of your protocol (ipratropium, steroids, mag, CPAP/NIV, epinephrine themes). Say out loud Wheeze / prolonged exhalation / silent chest — lower airway Stridor — upper airway; albuterol is not the first too","keywords":"Albuterol & Bronchodilators Nebulized albuterol for EMS: asthma and COPD, continuous vs intermittent, hyperkalemia shift, and why stridor is not a bronchodilator contest. Lesson albuterol-bronchodilators"},{"title":"Amiodarone & Lidocaine in Arrest","h1":"Amiodarone & Lidocaine in Arrest","description":"AHA 2025: amiodarone or lidocaine for shock-refractory VF/pVT. Neither is a PEA/asystole drug. HyperK wide-complex is not an amio problem.","url":"/learn/meds-pharma/amiodarone-lidocaine-arrest/","type":"Lesson","body":"Amiodarone & Lidocaine in Arrest · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Amiodarone & Lidocaine in Arrest Lesson Amiodarone & Lidocaine in Arrest 10 min Meds & Pharma Objective: Put amiodarone and lidocaine on the shock-refractory VF/pVT shelf — not on asystole, not on sine-wave hyperK, and not instead of defibrillation. Why This Is Hard The arrest bag has “the antiarrhythmic.” Crews push it into asystole, into sine-wave hyperK, and before the second shock. AHA 2025 ALS: for VF/pVT unresponsive to defibrillation, amiodarone or lidocaine may be considered . Data are insufficient to say one is better. Neither replaces high-quality CPR and defibrillation (see shockable arrest and high-quality CPR ). Say out loud Still VF/pVT after shocks? Then the antiarrhythmic class may fit Asystole / PEA — this is not that drug Wide and slow in a dialysis patient — think ca","keywords":"Amiodarone & Lidocaine in Arrest AHA 2025: amiodarone or lidocaine for shock-refractory VF/pVT. Neither is a PEA/asystole drug. HyperK wide-complex is not an amio problem. Lesson amiodarone-lidocaine-arrest"},{"title":"Aspirin in ACS","h1":"Aspirin in ACS","description":"Aspirin for suspected ACS in EMS: early chewable dose per protocol, true allergy and bleed cautions, and why tearing back pain is not an ACS reflex.","url":"/learn/meds-pharma/aspirin-acs/","type":"Lesson","body":"Aspirin in ACS · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Aspirin in ACS Lesson Aspirin in ACS 10 min Meds & Pharma Objective: Chewable aspirin is high-yield in suspected ACS when protocol allows — and it is still a drug with bleed and dissection cautions, not candy. Why This Matters Aspirin is one of the few prehospital drugs with strong outcome evidence in ACS. The 2025 ACC/AHA/ACEP/NAEMSP ACS guideline recommends an initial oral loading dose (Class 1). It is still given by habit to people who are dissecting, vomiting blood, or already took a full load at home. Your job is indication → cautions → protocol dose/route (usually chewed) → document what they already took. This site does not publish milligrams. Street Sequence ACS on the table, they can chew, no major GI bleed/allergy: aspirin per protocol early. Say the dose and route you actually gave. Chewed, n","keywords":"Aspirin in ACS Aspirin for suspected ACS in EMS: early chewable dose per protocol, true allergy and bleed cautions, and why tearing back pain is not an ACS reflex. Lesson aspirin-acs"},{"title":"Atropine in the Field","h1":"Atropine in the Field","description":"AHA 2025: atropine for unstable bradycardia may work at the AV node and often will not in Mobitz II/complete block. Do not delay pacing. Not an organophosphate megadose lesson.","url":"/learn/meds-pharma/atropine-field-framing/","type":"Lesson","body":"Atropine in the Field · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Atropine in the Field Lesson Atropine in the Field 10 min Meds & Pharma Skip to quiz Objective: Put atropine in the bradycardia box, know when it is a delay, and keep organophosphate atropine as a different protocol. Why This Is Hard The rate is 38 and they are hypotensive. Crews give atropine, wait, give it again, and never open the pacer. AHA 2025: atropine is reasonable; it is less effective in infranodal block. Pacing should not wait. On this truck This is not a milligram lesson. Protocol owns the dose and repeat. If they are crashing in complete block, pads go on now. Organophosphate / SLUDGE atropine is a hazmat/protocol megadose pathway — not the ACLS bradycardia syringe by habit. Field Rules (Education) Bradycardia: atropine may reverse vagal / AV-nodal slowing. Unstable patients still ne","keywords":"Atropine in the Field AHA 2025: atropine for unstable bradycardia may work at the AV node and often will not in Mobitz II/complete block. Do not delay pacing. Not an organophosphate megadose lesson. Lesson atropine-field-framing"},{"title":"Benzodiazepines in the Field","h1":"Benzodiazepines in the Field","description":"Benzodiazepines for EMS: seizure/status and severe-agitation frames, airway and ventilation monitoring, and why they are not a pain medicine or a dose from memory.","url":"/learn/meds-pharma/benzodiazepines-field-framing/","type":"Lesson","body":"Benzodiazepines in the Field · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Benzodiazepines in the Field Lesson Benzodiazepines in the Field 10 min Meds & Pharma Objective: Benzos stop seizures and can calm severe agitation — and they take the drive to breathe with them. Airway first, protocol indication only, no stacking with opioids without a plan. Why This Matters Midazolam, diazepam, and lorazepam show up in seizure, pacing sedation, and behavioral protocols. They are GABA agonists: they sedate and they depress ventilation. Combined with alcohol, opioids, or head injury they are unforgiving. This lesson is framing — not a formulary. Common EMS Contexts Seizure / status: first-line class in most protocols when the seizure is not stopping (see seizure lesson). IM midazolam is an evidence-based route when no IV is available (RAMPART) — protocol owns the drug, rou","keywords":"Benzodiazepines in the Field Benzodiazepines for EMS: seizure/status and severe-agitation frames, airway and ventilation monitoring, and why they are not a pain medicine or a dose from memory. Lesson benzodiazepines-field-framing"},{"title":"Calcium for HyperK ECG Toxicity","h1":"Calcium for HyperK ECG Toxicity","description":"Calcium stabilizes the membrane when the ECG is toxic. It does not lower potassium. Shift and remove are different protocol steps.","url":"/learn/meds-pharma/calcium-hyperk-framing/","type":"Lesson","body":"Calcium for HyperK ECG Toxicity · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Calcium for HyperK ECG Toxicity Lesson Calcium for HyperK ECG Toxicity 10 min Meds & Pharma Skip to quiz Objective: Give calcium a job: ECG toxicity (wide, sine, bradycardia in the right patient) — not a routine “renal” additive. Why This Is Hard Peaked T waves and someone wants calcium “just in case.” AHA 2025 special circumstances: calcium is for cardiotoxicity from hyperK (wide QRS, sine, unstable). It buys time. It does not fix the potassium. On this truck 12-lead. Peaked T alone in a stable patient is not automatically the crash syringe. Dialysis, crush, ACE-I plus K-sparing, succs history — the story matters. Do not mix calcium with bicarb in the same line. Flush. Field Rules (Education) Stabilize: calcium (chloride vs gluconate is a protocol/concentration issue — they are not mL-","keywords":"Calcium for HyperK ECG Toxicity Calcium stabilizes the membrane when the ECG is toxic. It does not lower potassium. Shift and remove are different protocol steps. Lesson calcium-hyperk-framing"},{"title":"Dexamethasone & Field Steroids","h1":"Dexamethasone & Field Steroids","description":"Steroids on the truck are adjuncts with a delayed onset: croup, asthma/COPD, adrenal crisis, and sometimes anaphylaxis. They do not replace epinephrine, bronchodilators, or magnesium when those are the clock.","url":"/learn/meds-pharma/dexamethasone-field-steroids/","type":"Lesson","body":"Dexamethasone & Field Steroids · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Dexamethasone & Field Steroids Lesson Dexamethasone & Field Steroids 10 min Meds & Pharma Skip to quiz Objective: Name the job (croup, bronchospasm, adrenal, anaphylaxis adjunct) before you open dexamethasone or methylprednisolone, and do not delay the fast drugs for a steroid. Why This Is Hard Crews either forget steroids entirely or give them first while the kid is still stridulous and the adult is still silent-chested. GINA/NASEMSO-style asthma care and AHA special-circumstances anaphylaxis: epinephrine and bronchodilators are the minutes; corticosteroids are the hours. Adrenal crisis is the exception where steroid is the missing hormone — still support shock. On this truck Know which steroid you carry (dexamethasone IM/IV/PO vs methylprednisolone IV vs prednisone PO) and which indica","keywords":"Dexamethasone & Field Steroids Steroids on the truck are adjuncts with a delayed onset: croup, asthma/COPD, adrenal crisis, and sometimes anaphylaxis. They do not replace epinephrine, bronchodilators, or magnesium when those are the clock. Lesson dexamethasone-field-steroids"},{"title":"Dextrose: D10 Framing","h1":"Dextrose: D10 Framing","description":"IV dextrose for hypoglycemia: D10 is easier to titrate and kinder on tissue than D50. Airway first for oral glucose. Recheck the number.","url":"/learn/meds-pharma/dextrose-d10-framing/","type":"Lesson","body":"Dextrose: D10 Framing · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Dextrose: D10 Framing Lesson Dextrose: D10 Framing 10 min Meds & Pharma Objective: Treat symptomatic hypoglycemia with a concentration your protocol stocks — prefer titration (often D10) over a single D50 slam — and reassess glucose and mentation. Why This Matters D50 is hypertonic, easy to extravasate into a necrotic arm, and easy to overshoot into 400 mg/dL. Prehospital studies (including a randomized comparison and later observational D10 cohorts) found D10 corrects hypoglycemia with less post-treatment hyperglycemia and a cleaner safety story. Many U.S. systems and UK JRCALC-style guidelines now prefer 10% dextrose titrated to effect . Use what your protocol stocks — this is framing, not a formulary. Say out loud Glucose early in AMS, seizure, stroke-like deficits Airway protected before any ","keywords":"Dextrose: D10 Framing IV dextrose for hypoglycemia: D10 is easier to titrate and kinder on tissue than D50. Airway first for oral glucose. Recheck the number. Lesson dextrose-d10-framing"},{"title":"Diltiazem in AF with RVR","h1":"Diltiazem in AF with RVR","description":"Diltiazem is a rate-control drug for stable irregular narrow-complex tachycardia, not a shock substitute and not for pre-excited AF. Hypotension is the trap.","url":"/learn/meds-pharma/diltiazem-af-rvr-field/","type":"Lesson","body":"Diltiazem in AF with RVR · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Diltiazem in AF with RVR Lesson Diltiazem in AF with RVR 12 min Meds & Pharma Skip to quiz Objective: Give diltiazem only to the stable irregular narrow-complex patient your protocol names, watch the BP, and never use it on an irregular wide-complex rhythm. Why This Is Hard The monitor says AF at 160, so diltiazem comes out before anyone asked about perfusion or QRS width. AHA 2025 ALS and the 2023 AF guideline: unstable gets electricity. Irregular wide is possible pre-excited AF — AV-nodal blockers are contraindicated. Hypotension after diltiazem is the usual self-inflicted wound. Protocol owns the dose; your job is the indication. On this truck Unstable (shock, severe ischemic pain, AMS, acute heart failure from the rate): synchronized cardioversion, not a calcium-channel blocker. QRS wide a","keywords":"Diltiazem in AF with RVR Diltiazem is a rate-control drug for stable irregular narrow-complex tachycardia, not a shock substitute and not for pre-excited AF. Hypotension is the trap. Lesson diltiazem-af-rvr-field"},{"title":"Diphenhydramine Cautions","h1":"Diphenhydramine Cautions","description":"Benadryl is not anaphylaxis care. It is sedating, anticholinergic, and a QT plus elderly-fall problem. Epi still wins the airway.","url":"/learn/meds-pharma/diphenhydramine-field-cautions/","type":"Lesson","body":"Diphenhydramine Cautions · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Diphenhydramine Cautions Lesson Diphenhydramine Cautions 10 min Meds & Pharma Skip to quiz Objective: Keep diphenhydramine off the anaphylaxis first-line throne and off the elderly agitation syringe unless protocol really wants it. Why This Is Hard Hives and wheeze, and the only drug anyone draws is diphenhydramine. AAAAI/ACAAI 2023: epinephrine IM is first-line anaphylaxis. Antihistamines are adjuncts and do not treat shock or airway edema. On this truck If this is anaphylaxis, epi IM in the thigh first. Diphenhydramine is optional adjunct per protocol — not a reason to skip epi. Elderly + diphenhydramine = delirium and falls. Think twice. Field Rules (Education) Anaphylaxis: epi, oxygen, fluids, albuterol for wheeze. Antihistamine later if protocol includes it. Dystonia from antipsychotics i","keywords":"Diphenhydramine Cautions Benadryl is not anaphylaxis care. It is sedating, anticholinergic, and a QT plus elderly-fall problem. Epi still wins the airway. Lesson diphenhydramine-field-cautions"},{"title":"Droperidol & Haloperidol in the Field","h1":"Droperidol & Haloperidol in the Field","description":"Butyrophenones for severe agitation: they are not benzos and not ketamine. Watch the QT, the airway, and the real medical cause. Protocol owns the syringe.","url":"/learn/meds-pharma/droperidol-haloperidol-field/","type":"Lesson","body":"Droperidol & Haloperidol in the Field · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Droperidol & Haloperidol in the Field Lesson Droperidol & Haloperidol in the Field 11 min Meds & Pharma Skip to quiz Objective: Use droperidol or haloperidol only for the agitated patient your protocol names, screen for QT/medical mimics, and do not combine blindly with other sedatives. Why This Is Hard The patient is screaming, so someone reaches for whatever sedative is closest. Droperidol and haloperidol are antipsychotics with QT prolongation and EPS — ACEP/NAEMSP agitation teaching supports droperidol in many EMS systems after the old black-box panic, but they are not ketamine and not midazolam. The street deaths are stacked sedatives plus an unwatched airway, or a medical cause (hypoglycemia, hypoxia, head bleed) treated as “psych.” On this truck Glucose, oxygen, and a real ","keywords":"Droperidol & Haloperidol in the Field Butyrophenones for severe agitation: they are not benzos and not ketamine. Watch the QT, the airway, and the real medical cause. Protocol owns the syringe. Lesson droperidol-haloperidol-field"},{"title":"Epinephrine: Anaphylaxis & Arrest","h1":"Epinephrine: Anaphylaxis & Arrest","description":"Separate anaphylaxis IM epinephrine from arrest IV/IO epinephrine. Read mg/mL labels every time — old 1:1,000 ratio notation is retired.","url":"/learn/meds-pharma/epinephrine-anaphylaxis-arrest/","type":"Lesson","body":"Epinephrine: Anaphylaxis & Arrest · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Epinephrine: Anaphylaxis & Arrest Lesson Epinephrine: Anaphylaxis & Arrest 12 min Meds & Pharma Objective: Separate anaphylaxis IM epinephrine from arrest IV/IO epinephrine so concentration and route never get swapped. Why This Is Hard Epinephrine is one drug label with multiple emergency personalities. Confusing anaphylaxis IM dosing with cardiac arrest IV concentrations is a classic, deadly med error theme. Your job is indication → concentration → route → protocol dose → monitor . Street Sequence Name the job out loud: anaphylaxis IM vs arrest IV/IO. Read the vial. Anaphylaxis: IM mid-anterolateral thigh per protocol, then airway and fluids. Do not wait for IV or a full-body rash. Arrest: CPR first, epi on the ACLS cycle per protocol — different concentration habits than IM. Partner","keywords":"Epinephrine: Anaphylaxis & Arrest Separate anaphylaxis IM epinephrine from arrest IV/IO epinephrine. Read mg/mL labels every time — old 1:1,000 ratio notation is retired. Lesson epinephrine-anaphylaxis-arrest"},{"title":"Fentanyl for Pain Management","h1":"Fentanyl for Pain Management","description":"Fentanyl analgesia for EMS: life threats first, protocol indications, respiratory monitoring, titration, and naloxone for true hypoventilation.","url":"/learn/meds-pharma/fentanyl-for-pain-management/","type":"Lesson","body":"Fentanyl for Pain Management · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Fentanyl for Pain Management Lesson Fentanyl for Pain Management 10 min Meds & Pharma Objective: Use a clear framework for fentanyl analgesia — indications, safety checks, respiratory monitoring, and reassessment — inside protocol. Street Context Severe pain is a real emergency for the patient even when vital signs look “stable.” Uncontrolled pain drives tachycardia, hypertension, anxiety, and bad outcomes after trauma. Fentanyl is a potent synthetic opioid used in many EMS systems for analgesia. Under-treatment and over-sedation are both risks. Your job is not to memorize a website dose. Your job is: life threats cleared → indication → cautions → protocol dose/route → monitor → reassess . What Fentanyl Is (Education) A synthetic opioid agonist with relatively rapid onset and shorter durat","keywords":"Fentanyl for Pain Management Fentanyl analgesia for EMS: life threats first, protocol indications, respiratory monitoring, titration, and naloxone for true hypoventilation. Lesson fentanyl-for-pain-management"},{"title":"Glucagon When There Is No IV","h1":"Glucagon When There Is No IV","description":"ADA/EMS: if you cannot get glucose into a vein and they cannot swallow, IM/IN glucagon may raise glucose — then they still need sugar and a recheck.","url":"/learn/meds-pharma/glucagon-hypoglycemia/","type":"Lesson","body":"Glucagon When There Is No IV · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Glucagon When There Is No IV Lesson Glucagon When There Is No IV 10 min Meds & Pharma Skip to quiz Objective: Use glucagon as a bridge when there is no IV and no safe oral route — and know it can fail in empty liver glycogen. Why This Is Hard The glucose is 28, they are seizing, and the IV is not happening. Crews keep fishing a vein while the brain cooks. ADA: treat symptomatic hypoglycemia. Glucagon is a field option when IV dextrose is not available. On this truck IM or IN per your packaging. This site does not publish milligrams. Turn them when they vomit. Glucagon makes people sick. After they wake, they still need carbohydrate. Glucagon used liver stores. Field Rules (Education) Best: protected airway plus oral glucose, or IV D10 titrated. See D10 and diabetic lessons. Glucagon when y","keywords":"Glucagon When There Is No IV ADA/EMS: if you cannot get glucose into a vein and they cannot swallow, IM/IN glucagon may raise glucose — then they still need sugar and a recheck. Lesson glucagon-hypoglycemia"},{"title":"Hydroxocobalamin for Smoke Cyanide","h1":"Hydroxocobalamin for Smoke Cyanide","description":"Closed-space fire, soot, and unexplained shock or arrest: cyanide is a field diagnosis of suspicion. Hydroxocobalamin if your protocol carries it — oxygen and a burn/critical destination still lead.","url":"/learn/meds-pharma/hydroxocobalamin-smoke-cn/","type":"Lesson","body":"Hydroxocobalamin for Smoke Cyanide · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Hydroxocobalamin for Smoke Cyanide Lesson Hydroxocobalamin for Smoke Cyanide 11 min Meds & Pharma Skip to quiz Objective: Link closed-space smoke plus unexplained lactic-looking shock or arrest to cyanide suspicion, and know what hydroxocobalamin is for — without delaying airway and destination. Why This Is Hard Pulse ox lies in CO, and cyanide does not have a field test. Crews treat “just smoke inhalation” while the patient is vasodilated, seizing, or in PEA. AHA 2025 special circumstances: for suspected cyanide poisoning (including smoke), hydroxocobalamin is the antidote many EMS systems carry. It is not a reason to skip the airway clock or a burn center. On this truck Closed-space fire, soot in airway, altered, seizure, unexplained hypotension or arrest — think cyanide plus CO. H","keywords":"Hydroxocobalamin for Smoke Cyanide Closed-space fire, soot, and unexplained shock or arrest: cyanide is a field diagnosis of suspicion. Hydroxocobalamin if your protocol carries it — oxygen and a burn/critical destination still lead. Lesson hydroxocobalamin-smoke-cn"},{"title":"Ipratropium With Albuterol","h1":"Ipratropium With Albuterol","description":"GINA/GOLD: add an anticholinergic neb in severe bronchospasm when protocol includes it. It is not a substitute for oxygen, CPAP, or epinephrine in anaphylaxis.","url":"/learn/meds-pharma/ipratropium-anticholinergic/","type":"Lesson","body":"Ipratropium With Albuterol · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Ipratropium With Albuterol Lesson Ipratropium With Albuterol 10 min Meds & Pharma Skip to quiz Objective: Add ipratropium to severe asthma/COPD nebs if authorized — and never use it as the anaphylaxis drug. Why This Is Hard The neb is albuterol-only because that is what was drawn in 2012. GINA and GOLD support short-acting anticholinergic added in severe exacerbations. Anaphylaxis still dies without epinephrine. On this truck DuoNeb / added ipratropium is a protocol checkbox, not improvisation. Keep oxygen and position. A neb does not replace BVM if they are tiring. If this is anaphylaxis (hives, shock, stridor), epi IM first. Field Rules (Education) Role: anticholinergic bronchodilator add-on in severe asthma/COPD. Not: the drug for pulmonary edema, anaphylaxis, or foreign body. Glaucoma/so","keywords":"Ipratropium With Albuterol GINA/GOLD: add an anticholinergic neb in severe bronchospasm when protocol includes it. It is not a substitute for oxygen, CPAP, or epinephrine in anaphylaxis. Lesson ipratropium-anticholinergic"},{"title":"Ketamine in the Field","h1":"Ketamine in the Field","description":"Ketamine for analgesia, severe agitation, or RSI only when authorized. Analgesic and induction ranges are not interchangeable. Suction ready.","url":"/learn/meds-pharma/ketamine-field-framing/","type":"Lesson","body":"Ketamine in the Field · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Ketamine in the Field Lesson Ketamine in the Field 10 min Meds & Pharma Objective: Place ketamine in the right prehospital frame — analgesia, severe agitation, or induction only when authorized, with airway vigilance. Why This Matters Many systems added ketamine for analgesia, DAI/RSI, or severe agitation. It is powerful and unforgiving when mis-applied. This lesson is framing only: indications themes, monitoring, and pitfalls — not a formulary. On this truck You may have one bottle and three protocol lines (pain, severe agitation, induction). They are not interchangeable. You do not have an anesthesiologist or a recovery bay. After IM ketamine for agitation you still have a moving patient, a small cabin, and an airway to watch. Stage suction and a BVM before sedation-level use. Do not leave them","keywords":"Ketamine in the Field Ketamine for analgesia, severe agitation, or RSI only when authorized. Analgesic and induction ranges are not interchangeable. Suction ready. Lesson ketamine-field-framing"},{"title":"Magnesium: Three Field Uses","h1":"Magnesium: Three Field Uses","description":"Magnesium sulfate in EMS: eclampsia first-line, torsades, and some severe asthma. Three indications, one toxicity — watch the drive to breathe.","url":"/learn/meds-pharma/magnesium-field-uses/","type":"Lesson","body":"Magnesium: Three Field Uses · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Magnesium: Three Field Uses Lesson Magnesium: Three Field Uses 12 min Meds & Pharma Objective: Keep magnesium’s three EMS jobs separate — eclampsia, torsades, severe asthma — and treat it as a respiratory depressant, not a benign mineral. Why This Matters Magnesium sulfate shows up in three very different protocols. Mixing the eclampsia infusion with the “push it like adenosine” reflex is how you drop a blood pressure and a respiratory drive. AHA 2025: mag may be considered for polymorphic VT with a long QT (torsades) ; routine mag is not recommended for polymorphic VT with a normal QT, and intra-arrest mag does not improve outcomes as a generic antiarrhythmic. On this truck Name the job before you open the vial: eclamptic seizure, long-QT torsades, or severe asthma per protocol. Eclampsia ","keywords":"Magnesium: Three Field Uses Magnesium sulfate in EMS: eclampsia first-line, torsades, and some severe asthma. Three indications, one toxicity — watch the drive to breathe. Lesson magnesium-field-uses"},{"title":"Medication Rights & Safety Culture","h1":"Medication Rights & Safety Culture","description":"Field medication safety: the rights of administration, closed-loop communication, restarting interrupted math, and reporting near-misses.","url":"/learn/meds-pharma/medication-rights-safety/","type":"Lesson","body":"Medication Rights & Safety Culture · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Medication Rights & Safety Culture Lesson Medication Rights & Safety Culture 10 min Meds & Pharma Objective: Apply a rights-based medication habit and closed-loop communication so field drug errors are caught before they reach the patient. Why This Is Hard EMS medications happen in moving trucks with alarms, family, and fatigue. Most errors are system and process failures — wrong concentration, wrong patient assumptions, interrupted math — not “bad medics.” Safety culture is a skill. On this truck You often have two people, a bouncing bench, look-alike vials, and more than one epinephrine concentration. You do not have a pharmacist, a Pyxis double-check, or a quiet med room. You decide: read the label, closed-loop with your partner, restart if interrupted, and document time/route/res","keywords":"Medication Rights & Safety Culture Field medication safety: the rights of administration, closed-loop communication, restarting interrupted math, and reporting near-misses. Lesson medication-rights-safety"},{"title":"Naloxone: Smart Use","h1":"Naloxone: Smart Use","description":"Use naloxone to restore ventilation, not full abrupt wakefulness. Bag first if apneic; titrate when protocol allows.","url":"/learn/meds-pharma/naloxone-smart-use/","type":"Lesson","body":"Naloxone: Smart Use · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Naloxone: Smart Use Lesson Naloxone: Smart Use 10 min Meds & Pharma Objective: Use naloxone to restore adequate breathing while supporting the airway — not to force full wakefulness with a maximal first dose. Why This Is Hard Naloxone saves lives when used for opioid-induced respiratory depression. Problems appear when crews chase full alertness with huge first doses, precipitate violent withdrawal, or forget that BVM beats naloxone for the apneic patient in the first seconds. Goals of Therapy Restore adequate spontaneous ventilation and airway protection. Not necessarily a fully awake, angry patient on the sidewalk. Buy time for transport and further care; fentanyl analogs may need repeated dosing per protocol. Street Sequence Scene safety; standard precautions per service policy. Open airway, suc","keywords":"Naloxone: Smart Use Use naloxone to restore ventilation, not full abrupt wakefulness. Bag first if apneic; titrate when protocol allows. Lesson naloxone-smart-use"},{"title":"Nitroglycerin Cautions","h1":"Nitroglycerin Cautions","description":"Nitroglycerin for EMS education: preload drop, hypotension, right-sided/inferior MI caution, PDE5 inhibitors, and why a 12-lead belongs before the spray when you can.","url":"/learn/meds-pharma/nitroglycerin-cautions/","type":"Lesson","body":"Nitroglycerin Cautions · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Nitroglycerin Cautions Lesson Nitroglycerin Cautions 10 min Meds & Pharma Objective: Nitroglycerin drops preload. That helps some ischemic and wet-lung patients and wrecks right-ventricular infarcts, PDE5 users, and anyone already hypotensive. Why This Is Hard Nitro is a habit drug: chest pain, spray, repeat. It is a venodilator. Patients who depend on preload — right-ventricular infarct, hypotensive ACS, volume-depleted — can crash. PDE5 inhibitors (erectile-dysfunction and some pulmonary-hypertension meds) plus nitro can produce refractory hypotension. Street Sequence Chest pain plus ACS pathway: 12-lead first if it will not delay. SBP and PDE-5 history before the spray. Inferior/right-ventricular infarct suspicion: nitro can dump preload — follow your card, get the right-sided tracing. Give o","keywords":"Nitroglycerin Cautions Nitroglycerin for EMS education: preload drop, hypotension, right-sided/inferior MI caution, PDE5 inhibitors, and why a 12-lead belongs before the spray when you can. Lesson nitroglycerin-cautions"},{"title":"Ondansetron in the Field","h1":"Ondansetron in the Field","description":"Ondansetron helps vomiting so you can transport. It is not a diagnosis. QT caution exists. Treat the cause of the vomit.","url":"/learn/meds-pharma/ondansetron-antiemetic/","type":"Lesson","body":"Ondansetron in the Field · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Ondansetron in the Field Lesson Ondansetron in the Field 10 min Meds & Pharma Skip to quiz Objective: Use ondansetron as a comfort and aspiration-prevention tool — after you thought about ACS, head injury, and the QT. Why This Is Hard They vomit and someone wants ondansetron before a 12-lead. Inferior STE and a head injury both vomit. The drug is fine when the protocol says so. The diagnosis still comes first. On this truck 12-lead if this could be ACS. Glucose if this could be hypo. ODT vs IV is packaging. This site does not publish milligrams. QT-prolonging polypharmacy (other antiemetics, some psych meds) is a caution — follow your card. Field Rules (Education) Use: nausea/vomiting to protect the airway and make transport possible. Not a substitute for turning them, suction, or treating sho","keywords":"Ondansetron in the Field Ondansetron helps vomiting so you can transport. It is not a diagnosis. QT caution exists. Treat the cause of the vomit. Lesson ondansetron-antiemetic"},{"title":"Oral Analgesics in the Field","h1":"Oral Analgesics in the Field","description":"Lindbeck 2023: oral acetaminophen or NSAIDs are acceptable when the oral route is preferred. They do not replace splinting — or opioids when pain is severe and protocol includes them.","url":"/learn/meds-pharma/oral-analgesics-field/","type":"Lesson","body":"Oral Analgesics in the Field · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Oral Analgesics in the Field Lesson Oral Analgesics in the Field 10 min Meds & Pharma Skip to quiz Objective: Use oral acetaminophen/NSAIDs as real analgesia for the right patient, and know when the oral route is the wrong route. Why This Is Hard The ankle is deformed and someone says “just ibuprofen at home.” Oligoanalgesia is still an EMS problem. The 2023 prehospital pain EBG supports oral APAP or NSAIDs when the oral route is preferred — and opioids/ketamine when pain is severe. On this truck Splint, ice, position — non-drug care is still care. They must be able to swallow and protect the airway. NSAIDs: bleeding, kidney, pregnancy, allergy cautions. APAP: liver failure caution. Field Rules (Education) Lindbeck 2023: conditional recommendation for oral APAP or oral NSAIDs when oral is ","keywords":"Oral Analgesics in the Field Lindbeck 2023: oral acetaminophen or NSAIDs are acceptable when the oral route is preferred. They do not replace splinting — or opioids when pain is severe and protocol includes them. Lesson oral-analgesics-field"},{"title":"Oxytocin in Postpartum Hemorrhage","h1":"Oxytocin in Postpartum Hemorrhage","description":"ACOG: uterine atony gets fundal massage and a uterotonic if you carry it. Oxytocin is not a trauma TXA substitute and is not for third-trimester bleeding before delivery.","url":"/learn/meds-pharma/oxytocin-postpartum/","type":"Lesson","body":"Oxytocin in Postpartum Hemorrhage · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Oxytocin in Postpartum Hemorrhage Lesson Oxytocin in Postpartum Hemorrhage 10 min Meds & Pharma Skip to quiz Objective: Use oxytocin only for postpartum atony as protocol writes — after fundal massage, never for an undelivered pregnancy bleed. Why This Is Hard Home birth, baby crying, mom soaking the bed. Crews look for TXA and forget the fundus. ACOG: atony is the leading cause of PPH. Mechanical massage first. Uterotonics if authorized. On this truck Baby out. Feel the fundus if trained. Massage a boggy uterus. Oxytocin IM/IV per protocol only after delivery of the fetus. This site does not publish units. Do not give oxytocin for third-trimester bleeding with the baby still in. Field Rules (Education) Atony: soft, boggy fundus, ongoing bleeding after delivery. Massage is a procedure","keywords":"Oxytocin in Postpartum Hemorrhage ACOG: uterine atony gets fundal massage and a uterotonic if you carry it. Oxytocin is not a trauma TXA substitute and is not for third-trimester bleeding before delivery. Lesson oxytocin-postpartum"},{"title":"Push-Dose Pressors","h1":"Push-Dose Pressors","description":"Push-dose pressors are a brief BP bridge where trained and authorized — not for hemorrhage. Dilute from a mixing card and label the syringe.","url":"/learn/meds-pharma/push-dose-pressors/","type":"Lesson","body":"Push-Dose Pressors · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Push-Dose Pressors Lesson Push-Dose Pressors 12 min Meds & Pharma Objective: Understand push-dose pressors as a temporary BP bridge for authorized hypotension pathways — with meticulous dilution and labeling. Why This Is Hard Push-dose epinephrine or phenylephrine (service-dependent) can temporize life-threatening hypotension. Mixing errors and wrong indications turn a bridge into a catastrophe. Many systems restrict these to critical care or special training — know your scope. Concept (Education) Small, repeated IV doses to support BP briefly while treating cause or starting a drip. Not a substitute for fluids in pure hypovolemia or for hemorrhage control. Not for stable patients with mild low readings. Safety Pillars Authorized only — training + protocol + correct clinical picture. Dilution discip","keywords":"Push-Dose Pressors Push-dose pressors are a brief BP bridge where trained and authorized — not for hemorrhage. Dilute from a mixing card and label the syringe. Lesson push-dose-pressors"},{"title":"Sodium Bicarbonate Framing","h1":"Sodium Bicarbonate Framing","description":"AHA 2025: routine bicarb in arrest is not recommended. It still appears for selected toxicologic and hyperK/acidosis pathways — protocol only.","url":"/learn/meds-pharma/sodium-bicarbonate-framing/","type":"Lesson","body":"Sodium Bicarbonate Framing · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Sodium Bicarbonate Framing Lesson Sodium Bicarbonate Framing 10 min Meds & Pharma Skip to quiz Objective: Stop dumping bicarb into every arrest, and keep it for the poison/hyperK cards that actually name it. Why This Is Hard The arrest bag has bicarb and it feels like doing something. AHA 2025 ALS: routine sodium bicarbonate is not recommended in cardiac arrest. Special circumstances still list it for certain poisonings and selected metabolic crises. On this truck Do not open bicarb because the arrest is going poorly. TCA / sodium-channel blocker overdose with wide QRS is a classic protocol use — alongside airway and benzos for seizures. Bicarb precipitates with calcium. Flush the line. Field Rules (Education) Not routine in arrest. High-quality CPR, defibrillation, epinephrine timing, rever","keywords":"Sodium Bicarbonate Framing AHA 2025: routine bicarb in arrest is not recommended. It still appears for selected toxicologic and hyperK/acidosis pathways — protocol only. Lesson sodium-bicarbonate-framing"},{"title":"Tranexamic Acid in Trauma","h1":"Tranexamic Acid in Trauma","description":"NAEMSP/ACEP/ACS-COT 2025: prehospital TXA may help adult hemorrhagic shock after life-saving interventions, within 3 hours of injury. Not a tourniquet.","url":"/learn/meds-pharma/txa-field-framing/","type":"Lesson","body":"Tranexamic Acid in Trauma · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Tranexamic Acid in Trauma Lesson Tranexamic Acid in Trauma 10 min Meds & Pharma Objective: Place TXA after bleeding control, only with clinical shock, only inside a 3-hour window — and never as a substitute for a tourniquet or an operating room. Why This Matters CRASH-2 showed a mortality benefit when TXA was given within 3 hours of injury for bleeding trauma patients. PATCH (prehospital, mature trauma systems) did not show better 6-month functional survival. STAAMP was mixed. The 2025 NAEMSP / ACEP / ACS-COT joint statement splits the difference: prehospital TXA may reduce mortality in adult hemorrhagic shock when given after life-saving interventions , appears safe, and should be given only with clinical signs of shock and no later than 3 hours post-injury . If your service does not carry i","keywords":"Tranexamic Acid in Trauma NAEMSP/ACEP/ACS-COT 2025: prehospital TXA may help adult hemorrhagic shock after life-saving interventions, within 3 hours of injury. Not a tourniquet. Lesson txa-field-framing"},{"title":"Weight-Based Dosing Safety","h1":"Weight-Based Dosing Safety","description":"Weight-based dosing without tenfold errors: convert to kg, apply mg/kg, check concentration, draw volume, and say every unit out loud.","url":"/learn/meds-pharma/weight-based-dosing-safety/","type":"Lesson","body":"Weight-Based Dosing Safety · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma / Weight-Based Dosing Safety Lesson Weight-Based Dosing Safety 10 min Meds & Pharma Objective: Run a safe dosing sequence — weight in kg, mg/kg, concentration, volume — with unit checks that catch tenfold errors. Why This Is Hard Field math fails under stress: pounds vs kilograms, mg vs mcg, wrong concentration, decimal slips. Interruption mid-calculation multiplies error. Weight-based drugs (many emergency meds) turn a unit mistake into a tenfold overdose or underdose in seconds. This lesson is about a safe process , not a formulary. Code 3 Workshop does not authorize any dose. Safe Sequence (Education) Confirm the protocol line — drug name, indication, dose (mg/kg or fixed), route, max/min if listed, redosing interval. Weight in kilograms — if given pounds: lb ÷ 2.2 ≈ kg (practice with the s","keywords":"Weight-Based Dosing Safety Weight-based dosing without tenfold errors: convert to kg, apply mg/kg, check concentration, draw volume, and say every unit out loud. Lesson weight-based-dosing-safety"},{"title":"Abdominal Evisceration","h1":"Abdominal Evisceration","description":"Moist sterile cover, do not shove bowel back, keep them warm, and destinate to surgery. It looks worse than the MARCH you still have to run.","url":"/learn/trauma/abdominal-evisceration/","type":"Lesson","body":"Abdominal Evisceration · Code 3 Workshop Skip to content Home / All lessons / Trauma / Abdominal Evisceration Lesson Abdominal Evisceration 10 min Trauma Skip to quiz Objective: Cover eviscerated bowel correctly and not delay hemorrhage and airway care because of the visual. Why This Is Hard Bowel on the abdominal wall hijacks the crew. Meanwhile an artery is open in the thigh. ATLS: cover with moist sterile dressings, do not reduce, keep warm. Then the rest of trauma care. On this truck Saline-moistened sterile dressings, then an occlusive outer layer to keep it moist — not dry gauze on mucosa. Do not poke it back in. Treat shock. This is a surgical abdomen. Field Rules (Education) Do not reduce eviscerated bowel in the field. Moist, then protect from drying and heat loss. MARCH still applies. Spectacular bowel does not outrank a femoral bleed. Destination: trauma surgery, not a clinic.","keywords":"Abdominal Evisceration Moist sterile cover, do not shove bowel back, keep them warm, and destinate to surgery. It looks worse than the MARCH you still have to run. Lesson abdominal-evisceration"},{"title":"Amputation & Parts","h1":"Amputation & Parts","description":"Tourniquet the stump, bag the part dry-then-cold, do not freeze it in ice water, and destinate to a replant-capable center if the system has one.","url":"/learn/trauma/amputation-field-care/","type":"Lesson","body":"Amputation & Parts · Code 3 Workshop Skip to content Home / All lessons / Trauma / Amputation & Parts Lesson Amputation & Parts 10 min Trauma Skip to quiz Objective: Stop stump bleeding first, package the part so it might be usable, and do not delay the living patient for a finger hunt. Why This Is Hard The finger is in the grass and the stump is spraying. Crews hunt the part while the patient bleeds out. TCCC/ATLS: hemorrhage first. The part is second. On this truck Tourniquet or pressure on the stump until it stops. Part: rinse gross dirt if protocol allows, dry gauze, plastic bag, then that bag on ice — not soaking in ice water. Label time. Notify a replant-capable destination if your system uses one. Field Rules (Education) Life over limb. MARCH. Then the part. Cooling: avoid direct ice on tissue and avoid freezing. Ice water macerates. Partial amputation: splint in place, do not com","keywords":"Amputation & Parts Tourniquet the stump, bag the part dry-then-cold, do not freeze it in ice water, and destinate to a replant-capable center if the system has one. Lesson amputation-field-care"},{"title":"Anticoagulated Trauma: The Bleed You Cannot See","h1":"Anticoagulated Trauma: The Bleed You Cannot See","description":"Warfarin, DOACs, and antiplatelets turn a standing-height fall into a trauma-center problem. GCS can lie. Destination and a medication list beat a “normal” exam.","url":"/learn/trauma/anticoagulated-trauma-field/","type":"Lesson","body":"Anticoagulated Trauma: The Bleed You Cannot See · Code 3 Workshop Skip to content Home / All lessons / Trauma / Anticoagulated Trauma: The Bleed You Cannot See Lesson Anticoagulated Trauma: The Bleed You Cannot See 11 min Trauma Skip to quiz Objective: Treat anticoagulant plus head or torso trauma as high-risk even when the exam is reassuring, and do not delay a trauma or stroke-capable CT for a long scene. Why This Is Hard They walked to the chair. GCS 15. The family says “he’s on a blood thinner.” Crews cancel trauma because ATLS look-normal. BTF prehospital TBI and ACS geriatric trauma teaching: anticoagulants raise the risk of delayed intracranial hemorrhage. DOACs (apixaban, rivaroxaban, dabigatran) do not have a field INR. You cannot “clear” this on a porch. On this truck Ask every trauma and every fall: anticoagulants, antiplatelets, last dose if known. Photograph the bottles. GCS","keywords":"Anticoagulated Trauma: The Bleed You Cannot See Warfarin, DOACs, and antiplatelets turn a standing-height fall into a trauma-center problem. GCS can lie. Destination and a medication list beat a “normal” exam. Lesson anticoagulated-trauma-field"},{"title":"Blast Injury in the Field","h1":"Blast Injury in the Field","description":"TCCC/CDC blast: scene safety, MARCH, lungs and hollow organs, and the second device. Tympanic membranes are a clue, not a workup.","url":"/learn/trauma/blast-injury-field/","type":"Lesson","body":"Blast Injury in the Field · Code 3 Workshop Skip to content Home / All lessons / Trauma / Blast Injury in the Field Lesson Blast Injury in the Field 10 min Trauma Skip to quiz Objective: Survive the scene, run MARCH, and expect lung and bowel injury even when the skin looks intact. Why This Is Hard The explosion is over and everyone is filming. Secondary devices and structural collapse are still in play. TCCC: care under fire vs tactical field care. Civilian translation: do not stand in the kill zone to bandage a scratch. On this truck If the scene is not safe, it is not your patient yet. MARCH still orders the medicine: massive hemorrhage, airway, respirations, circulation, hypothermia. Blast lung: dyspnea, hypoxia, cough after a blast — oxygen, careful PPV, destination. Field Rules (Education) Primary blast: gas-filled organs — ears, lungs, gut. Intact skin does not mean intact lungs. ","keywords":"Blast Injury in the Field TCCC/CDC blast: scene safety, MARCH, lungs and hollow organs, and the second device. Tympanic membranes are a clue, not a workup. Lesson blast-injury-field"},{"title":"Burn Assessment","h1":"Burn Assessment","description":"Burn care that does not miss the airway: stop the burning, cool small burns, keep large TBSA warm, estimate TBSA, and choose the right destination.","url":"/learn/trauma/burn-assessment/","type":"Lesson","body":"Burn Assessment · Code 3 Workshop Skip to content Home / All lessons / Trauma / Burn Assessment Lesson Burn Assessment 12 min Trauma Objective: Assess burns with airway vigilance, honest TBSA, and hypothermia prevention so early care and destination match severity. Why This Is Hard Burns distract with dramatic skin findings while the airway swells silently and hypothermia creeps in. Early priorities are stop the burning process, protect airway, prevent hypothermia, estimate size, and choose the right destination — not perfect Lund-Browder artistry on scene. Immediate Priorities Scene safety (fire, electrical, chemical). Stop the burning: extinguish, remove smoldering clothes/jewelry, chemical brush/flush per type and protocol. Airway: soot, singed hair, hoarseness, enclosed space — early advanced airway readiness. Breathing/circulation; CO/cyanide thinking in structure fires per protocol","keywords":"Burn Assessment Burn care that does not miss the airway: stop the burning, cool small burns, keep large TBSA warm, estimate TBSA, and choose the right destination. Lesson burn-assessment"},{"title":"Compartment Syndrome in the Field","h1":"Compartment Syndrome in the Field","description":"Pain out of proportion, a tight compartment, and a pulse that is still there. Splint, elevate slightly, destination — do not wait for pulselessness and do not ice a closed compartment.","url":"/learn/trauma/compartment-syndrome-field/","type":"Lesson","body":"Compartment Syndrome in the Field · Code 3 Workshop Skip to content Home / All lessons / Trauma / Compartment Syndrome in the Field Lesson Compartment Syndrome in the Field 10 min Trauma Skip to quiz Objective: Spot limb compartment syndrome before the pulse disappears, distinguish it from crush-release hyperkalemia, and move toward a surgeon instead of reassuring them. Why This Is Hard The dorsalis pedis is there, so crews write “CMS intact.” Compartment syndrome is a pressure diagnosis. Pulselessness is late. Crush syndrome (release, hyperK, fluids) is a different clock — see that lesson. This one is the closed limb that is dying from the inside after tibia, forearm, crush-without-release, burn, or a cast that is too tight. On this truck The 5/6 P’s teaching: pain (especially on passive stretch) is the early one. Pallor, paresthesia, paralysis, pulselessness are late. Poikilothermia is","keywords":"Compartment Syndrome in the Field Pain out of proportion, a tight compartment, and a pulse that is still there. Splint, elevate slightly, destination — do not wait for pulselessness and do not ice a closed compartment. Lesson compartment-syndrome-field"},{"title":"Crush Syndrome","h1":"Crush Syndrome","description":"Prolonged entrapment: fluids before lift when you can, hyperK after release, no potassium in the bag, and a sudden PEA that is chemistry not “just trauma.”","url":"/learn/trauma/crush-syndrome/","type":"Lesson","body":"Crush Syndrome · Code 3 Workshop Skip to content Home / All lessons / Trauma / Crush Syndrome Lesson Crush Syndrome 12 min Trauma Objective: Treat a prolonged crush as a hyperkalemia and rhabdomyolysis time bomb — volume before or as you lift when protocol allows, and calcium when the strip goes wide after extrication. Why This Is Hard The limb looks quiet under the slab. When you lift, potassium, myoglobin, and acid dump into the circulation. Sudden PEA after extrication is a classic crush death. Field teaching (NAEMSP/disaster and ATLS-adjacent): start IV fluid before or as soon as access exists, preferably before full release , avoid potassium-containing fluids, and treat hyperK when the ECG goes ugly (see hyperkalemia ). Say out loud How long have they been trapped? Access and fluid before the full lift when you can No K + in the bag (skip LR debates if your protocol says NS for crus","keywords":"Crush Syndrome Prolonged entrapment: fluids before lift when you can, hyperK after release, no potassium in the bag, and a sudden PEA that is chemistry not “just trauma.” Lesson crush-syndrome"},{"title":"Damage-Control Resuscitation","h1":"Damage-Control Resuscitation","description":"Limit crystalloid in hemorrhagic shock, keep them warm, and do not apply permissive hypotension to TBI. Blood if you carry it. TXA only in the window.","url":"/learn/trauma/damage-control-resuscitation/","type":"Lesson","body":"Damage-Control Resuscitation · Code 3 Workshop Skip to content Home / All lessons / Trauma / Damage-Control Resuscitation Lesson Damage-Control Resuscitation 12 min Trauma Objective: Resuscitate bleeding trauma with restraint — stop the bleed, restrict crystalloid, prevent hypothermia, and never run “permissive hypotension” on a brain injury. Why This Is Hard Two liters of saline in a bleeder dilutes clot, drops temperature, and pops the plug. ACS/AAST damage-control resuscitation and NAEMSP trauma statements: early hemorrhage control, hypotensive/restrictive resuscitation until bleeding is controlled, balanced blood products when available, and hypothermia prevention . The exception that kills if you copy-paste: TBI does not get permissive hypotension (see TBI ). Say out loud Bleed first — TQ, pack, binder, seal Crystalloid is a bridge, not a treatment Warm — lethal diamond: hypothermia","keywords":"Damage-Control Resuscitation Limit crystalloid in hemorrhagic shock, keep them warm, and do not apply permissive hypotension to TBI. Blood if you carry it. TXA only in the window. Lesson damage-control-resuscitation"},{"title":"Electrical & Lightning Injury","h1":"Electrical & Lightning Injury","description":"AHA 2025: scene is live until it is not. Reverse triage in lightning — treat the apparently dead first. CPR and defibrillation as indicated.","url":"/learn/trauma/electrical-lightning-injury/","type":"Lesson","body":"Electrical & Lightning Injury · Code 3 Workshop Skip to content Home / All lessons / Trauma / Electrical & Lightning Injury Lesson Electrical & Lightning Injury 10 min Trauma Skip to quiz Objective: Make the scene dead, reverse-triage lightning victims who look dead, and run the arrest you have. Why This Is Hard The wire is down and someone is already a patient. If you grab them you are next. AHA 2025: electrical/lightning is a special circumstance. Lightning reverse triage is real — the ones who look dead may be salvageable VF/asystole. On this truck Do not touch until the line is dead or they are no longer in the circuit. Utility, not heroics. Lightning mass casualty: treat the pulseless first (reverse triage). After ROSC they can still have trauma from being thrown, burns, and a spine. Field Rules (Education) Electrical: high vs low voltage, entrance/exit burns, rhabdo/hyperK later, C","keywords":"Electrical & Lightning Injury AHA 2025: scene is live until it is not. Reverse triage in lightning — treat the apparently dead first. CPR and defibrillation as indicated. Lesson electrical-lightning-injury"},{"title":"Chemical Eye Injury","h1":"Chemical Eye Injury","description":"Irrigate now. Alkalis keep burning. Contact poison control / protocol. Do not chase a pH you cannot measure by delaying the flush.","url":"/learn/trauma/eye-chemical-burn/","type":"Lesson","body":"Chemical Eye Injury · Code 3 Workshop Skip to content Home / All lessons / Trauma / Chemical Eye Injury Lesson Chemical Eye Injury 10 min Trauma Skip to quiz Objective: Start irrigation on scene for chemical splash to the eye and keep it going — alkali is worse than acid in the field. Why This Is Hard They want a dressing and a clinic. Alkali (drain cleaner, lime) keeps saponifying the cornea after you leave. Poison-center and ophthalmology teaching: immediate, copious irrigation beats a 10-minute visual acuity test. On this truck Flush with whatever clean water or saline you have, now. Contacts out if they come easily. Morgan lens is usually an ED tool — not a porch requirement. No garage neutralizers. Remove contacts if they come easily. Do not dig. Take the container if it is safe. Poison control. Field Rules (Education) Alkali > acid for ongoing damage. Both get irrigated. Start now.","keywords":"Chemical Eye Injury Irrigate now. Alkalis keep burning. Contact poison control / protocol. Do not chase a pH you cannot measure by delaying the flush. Lesson eye-chemical-burn"},{"title":"Facial Trauma and the Airway","h1":"Facial Trauma and the Airway","description":"Blood, teeth, and a broken midface: sit them up if the spine allows, suction, and think SGA/intubation early. An NPA may be the wrong hole.","url":"/learn/trauma/facial-trauma-airway/","type":"Lesson","body":"Facial Trauma and the Airway · Code 3 Workshop Skip to content Home / All lessons / Trauma / Facial Trauma and the Airway Lesson Facial Trauma and the Airway 10 min Trauma Skip to quiz Objective: Keep the facial-trauma airway open with suction and position, and avoid forcing an NPA through a smashed midface. Why This Is Hard Le Fort-looking faces bleed into the airway. Crews lie them flat for the collar and they drown. DAS/ATLS: airway first. SMR should not kill the airway. On this truck Suction on and tested. Teeth and blood will keep coming. If protocol allows sitting-up SMR, use it so they can drain. NPA through a possible cribriform/midface injury is a protocol caution — see OPA/NPA. Field Rules (Education) Position: recovery or sitting if the spine story allows. Flat-on-a-board plus a facial smash is a suction marathon. OPA if no gag. SGA can rescue when DL is a bloodbath — still co","keywords":"Facial Trauma and the Airway Blood, teeth, and a broken midface: sit them up if the spine allows, suction, and think SGA/intubation early. An NPA may be the wrong hole. Lesson facial-trauma-airway"},{"title":"Flail Chest & Pulmonary Contusion","h1":"Flail Chest & Pulmonary Contusion","description":"Paradoxical chest wall motion is a ventilation problem. Oxygen, pain, and watch for the lung bruise. Sandbags on the flail segment are outdated.","url":"/learn/trauma/flail-chest-field/","type":"Lesson","body":"Flail Chest & Pulmonary Contusion · Code 3 Workshop Skip to content Home / All lessons / Trauma / Flail Chest & Pulmonary Contusion Lesson Flail Chest & Pulmonary Contusion 10 min Trauma Skip to quiz Objective: Recognize flail chest, oxygenate, treat pain so they can breathe, and expect the contusion to get worse in the truck. Why This Is Hard A segment floats the wrong way and someone wants to tape a IV bag to it. ATLS: the pulmonary contusion under the flail is what kills. Oxygen, ventilation support, pain control so they can cough and breathe. On this truck High-flow oxygen. CPAP/PPV if they tiring and protocol allows — watch for pneumothorax. Pain control per protocol. Splinting with a pillow they hold is comfort, not a sandbag. This is a trauma-center chest. Field Rules (Education) Flail: two or more ribs broken in two or more places, segment moves paradoxically. Contusion worsens o","keywords":"Flail Chest & Pulmonary Contusion Paradoxical chest wall motion is a ventilation problem. Oxygen, pain, and watch for the lung bruise. Sandbags on the flail segment are outdated. Lesson flail-chest-field"},{"title":"Geriatric Trauma","h1":"Geriatric Trauma","description":"ACS 2021: in adults 65 and older, SBP under 110 may already be shock. Anticoagulation, falls, and undertriage kill more quietly than a spectacular wreck.","url":"/learn/trauma/geriatric-trauma/","type":"Lesson","body":"Geriatric Trauma · Code 3 Workshop Skip to content Home / All lessons / Trauma / Geriatric Trauma Lesson Geriatric Trauma 12 min Trauma Objective: Stop giving older trauma patients a pass because the wreck “wasn’t that fast” — their blood pressure, brain, and blood thinners lie. Why This Is Hard A ground-level fall looks like a lift assist. ACS/CDC 2021 Field Triage: in adults ≥65 years, SBP <110 mm Hg may already represent shock . Beta-blockers hide tachycardia. Anticoagulants turn a scalp lac into an ICH. Undertriage to a non-trauma hospital is the quiet failure mode. See also trauma triage . Say out loud Age ≥65 — the shock floor may be 110, not 90 What blood thinner? What was their last well? Head strike + anticoagulant = time-critical even if GCS is 15 Mechanism can be “just a fall” and still be red-criteria anatomy later Why Older Adults Lie BP: “Normal” 118 systolic can be a crash","keywords":"Geriatric Trauma ACS 2021: in adults 65 and older, SBP under 110 may already be shock. Anticoagulation, falls, and undertriage kill more quietly than a spectacular wreck. Lesson geriatric-trauma"},{"title":"Helmet Removal for Airway","h1":"Helmet Removal for Airway","description":"Sports and motorcycle helmets: two-person removal when you need the airway. Do not cut the chin strap and yank. Pad the void if the helmet stays.","url":"/learn/trauma/helmet-removal-airway/","type":"Lesson","body":"Helmet Removal for Airway · Code 3 Workshop Skip to content Home / All lessons / Trauma / Helmet Removal for Airway Lesson Helmet Removal for Airway 10 min Trauma Skip to quiz Objective: Decide when the helmet comes off for airway/SMR, and take it off with two people so the neck does not flex. Why This Is Hard The full-face helmet hides the mouth and the sat is falling. One person yanks it and the neck goes with it. NATA/ATLS teaching: two rescuers, one holds the head, one expands the helmet, slide off, then a collar. On this truck If you cannot bag or look, the helmet is in the way — it comes off. Two people. One in-line, one removes. Football helmet plus shoulder pads: if the helmet comes off, the pads often need a plan so the neck does not extend. Field Rules (Education) Remove when: airway/ventilation problem, the helmet is loose, or you cannot stabilize with it on. Two-person techni","keywords":"Helmet Removal for Airway Sports and motorcycle helmets: two-person removal when you need the airway. Do not cut the chin strap and yank. Pad the void if the helmet stays. Lesson helmet-removal-airway"},{"title":"Impaled Objects","h1":"Impaled Objects","description":"Stabilize in place unless it blocks the airway or CPR. You do not pull a knife in the parking lot to see how deep it is.","url":"/learn/trauma/impaled-object-field/","type":"Lesson","body":"Impaled Objects · Code 3 Workshop Skip to content Home / All lessons / Trauma / Impaled Objects Lesson Impaled Objects 10 min Trauma Skip to quiz Objective: Leave it in, stabilize, and only remove if it kills the airway or you cannot compress — then be ready for the bleed. Why This Is Hard The rebar is through the thigh and bystanders want it out. ATLS/TCCC: the object may be tamponading. Pulling it in the field can start a bleed you cannot stop. On this truck Bulky dressing to stabilize. Do not wiggle it to grade the wound. Shorten only if you must to move them, and only if trained/protocol. If it is in the cheek and they cannot breathe, that is an airway exception — be ready to suction. Field Rules (Education) Leave it. Stabilize, control around it, go. Remove if: it prevents airway/ventilation or prevents CPR, or it is in the cheek and obstructing — then expect bleeding. Eye: stabiliz","keywords":"Impaled Objects Stabilize in place unless it blocks the airway or CPR. You do not pull a knife in the parking lot to see how deep it is. Lesson impaled-object-field"},{"title":"Massive Hemorrhage First","h1":"Massive Hemorrhage First","description":"Catastrophic bleeding first: MARCH order, tourniquets, wound packing, pelvic binder thinking, hypothermia prevention, and rapid transport for internal bleed.","url":"/learn/trauma/massive-hemorrhage-first/","type":"Lesson","body":"Massive Hemorrhage First · Code 3 Workshop Skip to content Home / All lessons / Trauma / Massive Hemorrhage First Lesson Massive Hemorrhage First 10 min Trauma Objective: Prioritize life-threatening external hemorrhage before airway when blood loss is catastrophic, using a MARCH-style order. Why This Is Hard Classic ABC was drilled for years. In catastrophic bleeding, checking the airway while arterial blood pools can be the wrong first move. Modern trauma education often uses MARCH or XABC : stop massive external hemorrhage first. Seconds of arterial spurting can empty a patient before you ever open an airway kit. This is not “ignore the airway forever.” It is order of operations when life-threatening external bleeding is present. MARCH (Teaching Order) M — Massive hemorrhage Direct pressure with both hands and effective packing materials. Wound packing for deep/junctional bleeding per ","keywords":"Massive Hemorrhage First Catastrophic bleeding first: MARCH order, tourniquets, wound packing, pelvic binder thinking, hypothermia prevention, and rapid transport for internal bleed. Lesson massive-hemorrhage-first"},{"title":"Open Chest Wounds & Seals","h1":"Open Chest Wounds & Seals","description":"Open (sucking) chest wounds for EMS: vented chest seals preferred, non-vented fallback plus tension watch, and why you do not pack a thoracic hole like a junctional bleed.","url":"/learn/trauma/open-chest-wounds/","type":"Lesson","body":"Open Chest Wounds & Seals · Code 3 Workshop Skip to content Home / All lessons / Trauma / Open Chest Wounds & Seals Lesson Open Chest Wounds & Seals 10 min Trauma Objective: An open chest wound is an airway-and-breathing problem, not a dressing contest. Seal it so air cannot keep entering, watch for tension, and do not pack the hole like a junctional bleed. Why This Is Hard A hole in the chest wall lets air in on inspiration and can build a tension pneumothorax if you tape it airtight on all four sides and walk away. TCCC/TECC teaching prefers a vented chest seal . If a vented seal is not available, use a non-vented occlusive seal and watch closely. The old three-sided “flutter valve” dressing is a fallback teaching idea, not co-equal with a commercial vented seal. You must reassess for tension and be ready to burp or remove the dressing, or decompress per protocol. Street Sequence MARCH","keywords":"Open Chest Wounds & Seals Open (sucking) chest wounds for EMS: vented chest seals preferred, non-vented fallback plus tension watch, and why you do not pack a thoracic hole like a junctional bleed. Lesson open-chest-wounds"},{"title":"Pediatric Trauma in the Field","h1":"Pediatric Trauma in the Field","description":"Kids compensate then crash. ACS/CDC field triage: pediatric physiologic criteria and destination to a pediatric-capable trauma center when the system has one.","url":"/learn/trauma/pediatric-trauma-field/","type":"Lesson","body":"Pediatric Trauma in the Field · Code 3 Workshop Skip to content Home / All lessons / Trauma / Pediatric Trauma in the Field Lesson Pediatric Trauma in the Field 10 min Trauma Skip to quiz Objective: Use pediatric vital-sign red flags, keep them warm, and do not undertriage a quiet child. Why This Is Hard The 4-year-old looks okay after a 40 mph MVC because the BP is “normal.” Then they arrest in the truck. ACS/CDC 2021 field triage: pediatric physiologic criteria exist because adult numbers lie. On this truck Use a length-based tape for weight and equipment. Guessing is how tubes miss. Keep them warm. Hypothermia plus bleeding is deadly. A silent child after trauma is a red flag, not a well child. Field Rules (Education) Compensate then fall off a cliff. Tachycardia and delayed cap refill show up before hypotension. Field triage: abnormal peds GCS/vitals, penetrating torso/head/neck, che","keywords":"Pediatric Trauma in the Field Kids compensate then crash. ACS/CDC field triage: pediatric physiologic criteria and destination to a pediatric-capable trauma center when the system has one. Lesson pediatric-trauma-field"},{"title":"Pelvic Injury & Binder Thinking","h1":"Pelvic Injury & Binder Thinking","description":"Suspect unstable pelvic injury from mechanism and shock. Bind at the greater trochanters — not the iliac crests — and do not spring the pelvis.","url":"/learn/trauma/pelvic-binder-thinking/","type":"Lesson","body":"Pelvic Injury & Binder Thinking · Code 3 Workshop Skip to content Home / All lessons / Trauma / Pelvic Injury & Binder Thinking Lesson Pelvic Injury & Binder Thinking 10 min Trauma Objective: Suspect unstable pelvic fractures from mechanism and shock, and apply a binder at the greater trochanters as hemorrhage control — not a belt on the iliac crests. Why This Is Hard Pelvic fractures can hide massive retroperitoneal bleeding. Rocking the pelvis for “stability testing” can worsen bleeding. Modern teaching: if mechanism and shock fit, bind and move — do not grind the ring for curiosity. On this truck You have a commercial binder or a sheet. The landmark is the greater trochanters — the bony hips, not a belt on the belly. You do not have an x-ray. Shock plus a high-energy mechanism is enough to bind. Do not delay the binder for IVs. Document the time. This is hemorrhage control, then a tra","keywords":"Pelvic Injury & Binder Thinking Suspect unstable pelvic injury from mechanism and shock. Bind at the greater trochanters — not the iliac crests — and do not spring the pelvis. Lesson pelvic-binder-thinking"},{"title":"Penetrating Neck Trauma","h1":"Penetrating Neck Trauma","description":"Holes in the neck: airway first, do not probe, do not clamp blindly, and hold direct pressure. Expanding hematoma and bubbling wounds leave now for a trauma center.","url":"/learn/trauma/penetrating-neck-trauma-field/","type":"Lesson","body":"Penetrating Neck Trauma · Code 3 Workshop Skip to content Home / All lessons / Trauma / Penetrating Neck Trauma Lesson Penetrating Neck Trauma 11 min Trauma Skip to quiz Objective: Treat penetrating neck trauma as an airway-and-hemorrhage problem: pressure, no probing, early destination, and a CICO plan if the neck is swelling. Why This Is Hard The wound looks small. Crews peek inside, pull clots, and then cannot stop the fountain. NAEMSP/trauma teaching: hard signs (airway compromise, expanding hematoma, bubbling, pulsatile bleeding, stroke-like findings) go now. Soft signs still need a trauma center. Zone trivia does not change the street plan. On this truck Direct pressure with a gloved hand or packing that you can still watch the airway around. Do not blindly clamp. Sit up if they can. Suction. Be ready to lose the airway to hematoma. C-spine is a mechanism conversation; a crashing a","keywords":"Penetrating Neck Trauma Holes in the neck: airway first, do not probe, do not clamp blindly, and hold direct pressure. Expanding hematoma and bubbling wounds leave now for a trauma center. Lesson penetrating-neck-trauma-field"},{"title":"Trauma in Pregnancy","h1":"Trauma in Pregnancy","description":"Pregnant trauma patients for EMS: left uterine displacement, maternal ABCs first, fundal height clues, and destination to a trauma center with obstetric capability.","url":"/learn/trauma/pregnant-trauma-patient/","type":"Lesson","body":"Trauma in Pregnancy · Code 3 Workshop Skip to content Home / All lessons / Trauma / Trauma in Pregnancy Lesson Trauma in Pregnancy 12 min Trauma Objective: Two patients, one stretcher. Displace the uterus off the vena cava, run the trauma first, and go to a place that can manage both mother and fetus. Why This Is Hard Anatomy lies. The mother can look “pretty good” while she is bleeding into a belly that hides a liter. Supine hypotension from a gravid uterus on the IVC looks like mystery shock. Teams freeze between “don’t hurt the baby” and MARCH. The evidence-based order is unchanged: save the mother . Fetal survival follows maternal perfusion. Street Physiology After about 20 weeks (fundus at or above the umbilicus as a field clue), supine position can drop venous return. Manually displace the uterus to the left, or tilt the board/stretcher if spine rules allow. Blood volume is up; she","keywords":"Trauma in Pregnancy Pregnant trauma patients for EMS: left uterine displacement, maternal ABCs first, fundal height clues, and destination to a trauma center with obstetric capability. Lesson pregnant-trauma-patient"},{"title":"Prehospital Blood: If Your Truck Carries It","h1":"Prehospital Blood: If Your Truck Carries It","description":"NAEMSP 2025: blood over crystalloid for life-threatening traumatic bleeding when your system can support a program. LTOWB (low-titer O whole blood) first. Hemorrhage control still leads.","url":"/learn/trauma/prehospital-blood-transfusion/","type":"Lesson","body":"Prehospital Blood: If Your Truck Carries It · Code 3 Workshop Skip to content Home / All lessons / Trauma / Prehospital Blood: If Your Truck Carries It Lesson Prehospital Blood: If Your Truck Carries It 12 min Trauma Skip to quiz Objective: Know when prehospital blood is for (life-threatening traumatic bleed with shock physiology), what product is preferred, and that it never replaces a tourniquet or a short scene. Why This Is Hard Most trucks still do not carry blood. The ones that do sometimes give it late, after a liter of saline, or instead of a tourniquet. NAEMSP 2025 trauma compendium: in systems that can support a quality program, blood products over crystalloid for life-threatening traumatic bleeding, and low-titer group O whole blood as first choice. ACEP: blood must not delay hemorrhage control or transport. If you do not carry it, this lesson is still the crystalloid-restraint","keywords":"Prehospital Blood: If Your Truck Carries It NAEMSP 2025: blood over crystalloid for life-threatening traumatic bleeding when your system can support a program. LTOWB (low-titer O whole blood) first. Hemorrhage control still leads. Lesson prehospital-blood-transfusion"},{"title":"Spinal Motion Restriction Decisions","h1":"Spinal Motion Restriction Decisions","description":"Selective spinal motion restriction: protect high-risk patients with a collar and stretcher, and stop using longboards as a transport device.","url":"/learn/trauma/spinal-motion-restriction/","type":"Lesson","body":"Spinal Motion Restriction Decisions · Code 3 Workshop Skip to content Home / All lessons / Trauma / Spinal Motion Restriction Decisions Lesson Spinal Motion Restriction Decisions 10 min Trauma Objective: Apply selective spinal motion restriction so high-risk patients are protected without using a longboard as a transport device. Why This Is Hard Full spinal immobilization on longboards for every “possible” trauma was traditional. Modern EMS education favors selective spinal motion restriction (SMR) : protect patients who need it, avoid harming those who do not. Protocols differ — know yours. Risk Themes (Education) High-risk mechanism (e.g., axial load, high-speed MVC, fall from height) plus unreliable exam. Midline spinal pain/tenderness, neurologic deficits, altered mentation, intoxication, distracting injury. Age and baseline frailty may change thresholds in some protocols. What SMR O","keywords":"Spinal Motion Restriction Decisions Selective spinal motion restriction: protect high-risk patients with a collar and stretcher, and stop using longboards as a transport device. Lesson spinal-motion-restriction"},{"title":"Tension Pneumothorax Recognition","h1":"Tension Pneumothorax Recognition","description":"Spot tension pneumothorax as obstructive shock. Do not wait for tracheal deviation. A lateral needle site is preferred in adults.","url":"/learn/trauma/tension-pneumothorax/","type":"Lesson","body":"Tension Pneumothorax Recognition · Code 3 Workshop Skip to content Home / All lessons / Trauma / Tension Pneumothorax Recognition Lesson Tension Pneumothorax Recognition 10 min Trauma Objective: Identify progressive obstructive shock from tension pneumothorax using mechanism and unilateral findings — without waiting for late signs. Why This Is Hard Classic textbook signs appear late. Waiting for tracheal deviation means waiting too long. Tension physiology is obstructive shock : rising intrapleural pressure collapses the lung, shifts the mediastinum, kinks venous return, and drops cardiac output. Patients die from shock, not from an interesting x-ray finding you will never see in the field. Positive-pressure ventilation (BVM or ventilator) can convert a simple pneumothorax into tension physiology — keep that in mind after intubation in trauma and severe asthma/COPD. Pattern Recognition (","keywords":"Tension Pneumothorax Recognition Spot tension pneumothorax as obstructive shock. Do not wait for tracheal deviation. A lateral needle site is preferred in adults. Lesson tension-pneumothorax"},{"title":"Tourniquets That Actually Work","h1":"Tourniquets That Actually Work","description":"TCCC/TECC tourniquets: high-and-tight in chaos, then 2–3 inches above the wound on skin. Not over a joint. Windlass locked. Note the time.","url":"/learn/trauma/tourniquet-application/","type":"Lesson","body":"Tourniquets That Actually Work · Code 3 Workshop Skip to content Home / All lessons / Trauma / Tourniquets That Actually Work Lesson Tourniquets That Actually Work 10 min Trauma Objective: Put a tourniquet on so arterial bleeding actually stops — deliberate placement on skin 2–3 inches above the wound, not a loose “venous only” band. Why This Is Hard A tourniquet that looks applied and still spurts is a venous tourniquet — it can make bleeding worse. TCCC/TECC teaching is mechanical and boring: tight enough that the distal pulse and the bleed both stop . CoTCCC: in tactical field care, place a recommended limb tourniquet directly on the skin 2–3 inches above the bleeding site . Not over the elbow or knee. If the first one fails, a second goes side-by-side, proximal. On this truck Write the time on the TQ or the forehead. The receiving trauma team will ask. Do not loosen it on the ramp “t","keywords":"Tourniquets That Actually Work TCCC/TECC tourniquets: high-and-tight in chaos, then 2–3 inches above the wound on skin. Not over a joint. Windlass locked. Note the time. Lesson tourniquet-application"},{"title":"Trauma Triage & Destination","h1":"Trauma Triage & Destination","description":"ACS 2021 field triage: high-risk vitals and anatomy go to the highest-level trauma center. Age, anticoagulation, and pregnancy can still change destination.","url":"/learn/trauma/trauma-triage-destination/","type":"Lesson","body":"Trauma Triage & Destination · Code 3 Workshop Skip to content Home / All lessons / Trauma / Trauma Triage & Destination Lesson Trauma Triage & Destination 10 min Trauma Objective: Use ACS-style field triage to match injury severity to the right trauma center — the closest hospital is not always the right hospital. Why This Is Hard The closest hospital is not always the right hospital. Undertriage delays hemorrhage control and neurosurgery; overtriage floods centers. The ACS/CDC 2021 Field Triage Guideline (and your state variant) still walks high-risk findings first: mental status and vitals → anatomy → then mechanism and special considerations. Step Themes (Education) High-risk (red) physiologic: inability to follow commands (ACS 2021: motor GCS <6), respiratory distress or extreme rate, hypoxia, hypotension — highest-level trauma center. In adults ≥65 years, SBP <110 mmHg may already r","keywords":"Trauma Triage & Destination ACS 2021 field triage: high-risk vitals and anatomy go to the highest-level trauma center. Age, anticoagulation, and pregnancy can still change destination. Lesson trauma-triage-destination"},{"title":"Traumatic Brain Injury","h1":"Traumatic Brain Injury","description":"Prehospital TBI: prevent hypoxia and hypotension, ventilate toward normal EtCO₂, reserve hyperventilation for herniation, and choose the right center.","url":"/learn/trauma/traumatic-brain-injury/","type":"Lesson","body":"Traumatic Brain Injury · Code 3 Workshop Skip to content Home / All lessons / Trauma / Traumatic Brain Injury Lesson Traumatic Brain Injury 12 min Trauma Objective: Protect the injured brain by preventing hypoxia and hypotension, ventilating toward a normal EtCO₂, and recognizing herniation red flags. Why This Is Hard The brain hates hypoxia and hypotension. Secondary injury after the initial trauma is where EMS can help or harm. Aggressive hyperventilation as routine “brain treatment” is outdated for most patients — reserved for signs of herniation in many education frameworks. Field Priorities Airway protection — vomiting and decreased LOC are common. Oxygenation. The 2023 Brain Trauma Foundation (BTF) prehospital guideline (3rd edition): treat hypoxemia (SpO₂ <90%) immediately. Suspected severe TBI should receive continuous supplemental oxygen (strong recommendation) to prevent that i","keywords":"Traumatic Brain Injury Prehospital TBI: prevent hypoxia and hypotension, ventilate toward normal EtCO₂, reserve hyperventilation for herniation, and choose the right center. Lesson traumatic-brain-injury"},{"title":"Traumatic Cardiac Arrest","h1":"Traumatic Cardiac Arrest","description":"Traumatic arrest for EMS: hemorrhage, least-invasive airway, and tension first. Empiric bilateral decompression is not indicated without chest-trauma concern. Education only.","url":"/learn/trauma/traumatic-cardiac-arrest/","type":"Lesson","body":"Traumatic Cardiac Arrest · Code 3 Workshop Skip to content Home / All lessons / Trauma / Traumatic Cardiac Arrest Lesson Traumatic Cardiac Arrest 12 min Trauma Objective: Medical ACLS on a torso full of holes wastes the only minutes that matter. Reverse the reversible — airway, tension, hemorrhage — and move toward a surgeon, or follow your TOR rules. Why This Is Hard The monitor shows PEA and the team reaches for epinephrine by habit. In blunt or penetrating trauma, empty vessels, a kinked vena cava from tension, and an unsecured airway kill faster than a missed amiodarone. Some of these patients are salvageable if you fix what you can in seconds and leave. Some are not — and your termination-of-resuscitation rules exist so you do not create a second tragedy on a highway. Priorities (Education) The 2025 NAEMSP / ACS-COT / ACEP statement on traumatic out-of-hospital circulatory arrest (T","keywords":"Traumatic Cardiac Arrest Traumatic arrest for EMS: hemorrhage, least-invasive airway, and tension first. Empiric bilateral decompression is not indicated without chest-trauma concern. Education only. Lesson traumatic-cardiac-arrest"},{"title":"Wound Packing & Junctional Bleed","h1":"Wound Packing & Junctional Bleed","description":"Pack junctional wounds to bone with hemostatic gauze when you have it, hold pressure about 3 minutes, and never pack a chest hole like a groin.","url":"/learn/trauma/wound-packing-junctional/","type":"Lesson","body":"Wound Packing & Junctional Bleed · Code 3 Workshop Skip to content Home / All lessons / Trauma / Wound Packing & Junctional Bleed Lesson Wound Packing & Junctional Bleed 12 min Trauma Objective: Pack deep and junctional bleeding to the source, hold real pressure, and keep packing out of the chest — that hole gets a seal, not a roll of gauze. Why This Is Hard Limb tourniquets do not reach the groin, axilla, or neck. Those junctional bleeds hide under clothing and kill as fast as a femoral. CoTCCC: hemostatic dressing (Combat Gauze or equivalent) packed into the wound, at least 3 minutes of direct pressure (optional for XStat), then a pressure bandage. If a junctional tourniquet is available and the site fits, apply it — do not wait to finish a pretty pack first if the device is ready. On this truck Expose clothing. The hole is often under a belt or in the groin crease — not where the firs","keywords":"Wound Packing & Junctional Bleed Pack junctional wounds to bone with hemostatic gauze when you have it, hold pressure about 3 minutes, and never pack a chest hole like a groin. Lesson wound-packing-junctional"},{"title":"Medical Lessons","h1":"Medical","description":"Twenty-nine medical lessons: “sick at home” until it isn’t — shock, stroke, sugar, sepsis, and look-alikes like CO, dialysis, and agitation.","url":"/medical/","type":"Category","body":"Medical Lessons · Code 3 Workshop Skip to content Home / All lessons / Medical Category Medical Most of these start as “sick at home.” Work shock, sepsis, stroke, and sugar — then the look-alikes: carbon monoxide (the pulse ox lies), dialysis, agitation, withdrawal, sickle cell, GI bleed, PE, heat, eclampsia, and the refusal after glucose that is not capacity yet. Lessons Modules in This Category Twenty-nine medical modules. Suggested path from shock types to refusal-after-glucose — or jump to tonight’s differential. Lesson Shock Categories 12 min Volume, pipes, pump, or obstruction — fluids are not universal. Start lesson → Lesson Sepsis Recognition in the Field 12 min Infection plus new organ failure or shock — alert early. qSOFA is not a rule-out. Start lesson → Lesson Stroke Recognition & Last Known Well 12 min Last known well, glucose, short scene, right destination — not a living-r","keywords":"Medical Lessons Twenty-nine medical lessons: “sick at home” until it isn’t — shock, stroke, sugar, sepsis, and look-alikes like CO, dialysis, and agitation. Category medical"},{"title":"Meds & Pharma Lessons","h1":"Meds & Pharma","description":"Twenty-nine medication lessons: think the syringe before you push it. Not a formulary — protocol owns the milligrams.","url":"/meds-pharma/","type":"Category","body":"Meds & Pharma Lessons · Code 3 Workshop Skip to content Home / All lessons / Meds & Pharma Category Meds & Pharma This is not a milligram book. It is how to think about EMS drugs: rights, concentration traps, and high-risk agents — atropine vs pacing, calcium for hyperK ECG toxicity, bicarb that is not routine, glucagon when there is no IV, TXA, oxytocin — with protocol and medical direction owning the dose. Lessons Modules in This Category Twenty-nine meds modules. Safety first, then the high-risk drugs — never a milligram order from this site. Lesson Medication Rights & Safety Culture 10 min Read the label, close the loop, restart if interrupted — then document. Start lesson → Lesson Weight-Based Dosing Safety 10 min Kg first, then mg/kg, concentration, milliliters — audit the units out loud. Start lesson → Lesson Fentanyl for Pain Management 10 min Pain is real — after ABCs. Monitor b","keywords":"Meds & Pharma Lessons Twenty-nine medication lessons: think the syringe before you push it. Not a formulary — protocol owns the milligrams. Category meds-pharma"},{"title":"Trauma Lessons","h1":"Trauma","description":"Twenty-nine trauma lessons: the bleed you can see, the one you can’t, then the center that can fix it. Destination is a treatment.","url":"/trauma/","type":"Category","body":"Trauma Lessons · Code 3 Workshop Skip to content Home / All lessons / Trauma Category Trauma Blood on the floor first. Then airway, then the hospital that can operate. Tourniquets, packing, binders, TBI, peds and geriatric undertriage, blast, amputation, electrical injury, flail — and destination as a treatment, not the closest parking lot. Lessons Modules in This Category Twenty-nine trauma modules. Hemorrhage first, then the decisions that change destination. Lesson Massive Hemorrhage First 10 min Stop the bleed before the airway when blood loss is torrential. Start lesson → Lesson Tension Pneumothorax Recognition 10 min Shock plus unilateral findings — act. Tracheal deviation is late. Start lesson → Lesson Spinal Motion Restriction Decisions 10 min Match restriction to risk. Boards are for extrication, not a long ride. Start lesson → Lesson Traumatic Brain Injury 12 min Avoid hypoxia ","keywords":"Trauma Lessons Twenty-nine trauma lessons: the bleed you can see, the one you can’t, then the center that can fix it. Destination is a treatment. Category trauma"}]