SCFHS Paramedic Specialist Complete Review Guide 2026–2027

4. GCS = eyes (4) + verbal (5) + motor (6), maximum 15; for example eyes to voice 3 + confused 4 + localizes pain 5 = 12.
5. Highest-level trauma center criteria: systolic BP under 90 mmHg, a low GCS, and high-risk mechanisms such as ejection; an older patient on anticoagulants after head injury is transported despite looking well because of delayed bleeding risk.
6. Field principle: scene time for a critical patient is about 10 minutes or less; treat only hemorrhage, airway and chest decompression on scene, and do IV access and the secondary survey en route; reassess an unstable patient every 5 minutes, and any deterioration means repeating the primary survey.
7. Cushing's triad (hypertension, bradycardia, irregular breathing) signals raised intracranial pressure; herniation signs are falling GCS with a dilated sluggish pupil and extensor posturing, and only then is brief mild hyperventilation to ETCO2 30 to 35 mmHg allowed.
8. In severe brain injury a single episode of hypoxia or hypotension raises mortality, so prevent both; raise the stretcher head 30 degrees if BP is normal and no spinal injury is suspected. Bruising behind the ear (Battle's sign) is a late sign of basilar skull fracture.
9. Epidural hematoma: a lucid interval after a temporal blow, then rapid decline. Central cord syndrome: arms weaker than legs after hyperextension in an older adult. Abdominal breathing with intercostal paralysis suggests a lower cervical cord injury.
10. Neurogenic shock: hypotension with a slow or normal pulse and warm skin after spinal cord injury; first treatment is fluids and warmth, then a vasopressor per protocol.
11. Open pneumothorax (sucking wound): vented chest seal; if the patient worsens after an occlusive dressing, briefly open one edge. Flail chest: two or more adjacent ribs broken in two or more places with paradoxical movement; the key treatment in respiratory failure is positive-pressure ventilation.
12. Tension pneumothorax is decompressed with a needle in the second intercostal space, midclavicular line (over the top of the rib); if dyspnea returns the catheter may be kinked, so decompress again. An impaled object is stabilized in place unless it blocks the airway or CPR.
13. Arterial blood is bright red and spurts with the pulse. Junctional bleeding (groin, axilla, neck) is packed with gauze and pressed firmly. Hemostatic gauze needs firm pressure for at least 3 minutes. Tranexamic acid (TXA) is given within 3 hours of injury.
14. Blood loss: Class II has HR 100 to 120 with normal systolic BP, narrowed pulse pressure and anxiety; a 30% to 40% loss (about 1.5 to 2 L in a 70-kg adult) causes marked tachycardia, hypotension and confusion. With uncontrolled internal bleeding aim for systolic 80 to 90 mmHg unless there is a head injury.
15. Burn depth: superficial is red and dry; partial-thickness is red, moist, blistered and very painful; full-thickness is white, leathery and painless. Burns to the hands need a burn center. A circumferential chest burn (eschar) restricts breathing. High-voltage electrical injury damages deep tissue and the heart, so monitor.
16. Adult rule of nines: head 9, arm 9, anterior trunk 18, posterior 18, leg 18; for an infant, head 18% and arm 9%. Cool small burns under cool running water; large burns are covered with dry clean sheets and the patient kept warm. Parkland formula: 4 mL × kg × %TBSA, half in the first 8 hours from the time of burn.
17. Open fractures break the skin, so cover with a sterile dressing and splint without reducing the bone. Check pulse, motor and sensation before and after splinting. A splint includes the joint above and below the break. The most bleeding fractures are pelvis, then femur.
18. A traction splint is only for an isolated midshaft femur fracture; with another injury on the same leg or an unstable patient use a long rigid or vacuum splint and move fast. Posterior hip dislocation: flexed, adducted, internally rotated; femoral neck fracture in an older adult: shortened, externally rotated leg.
19. Compartment syndrome: pain out of proportion that worsens on passive stretch, with pulses often present. Crush syndrome: when a heavy load is lifted after hours, potassium release can cause arrhythmia, so give fluids and monitor the heart before release. Knee dislocation puts the popliteal artery at risk.

Common mistakes in this chapter

• ✕ The long backboard is now mainly an extrication and moving tool; a cooperative patient with neck pain can wear a collar and move to the stretcher with guidance.
• ✕ Tamponade, massive hemothorax and tension pneumothorax all cause shock; tamponade has distended neck veins with equal breath sounds, hemothorax has flat neck veins with dullness and absent sounds.
• ✕ Neurogenic shock shows hypotension with a slow or normal pulse and warm skin, but trauma patients can also bleed, so exclude hemorrhage first.
• ✕ A patient on a beta-blocker may not become tachycardic despite shock; do not rely on pulse alone in older patients.
• ✕ After a fall onto the feet, look for lumbar spine compression injury, not only heel and leg injuries.
• ✕ A knee dislocation can injure the popliteal artery even when a distal pulse is felt; the pulse alone is not reassuring.
• ✕ Dry chemicals are brushed off first, then flushed with plenty of water; alkali burns need continuous irrigation, including en route.
• ✕ Severe pain out of proportion that worsens with passive stretch is an early sign of compartment syndrome, and pulses may still be present; do not wait for a lost pulse.