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Medical & OB/GYN

The 'which drug, which dose, which diagnosis' domain.

42 exam questions
6 drug cards
5 field cases
4 skills

High-yield before the exam

  • Altered mental status: check glucose early. Hypoglycemia is the most fixable coma on the truck.
  • Seizures: benzos stop them (midazolam IM works without an IV); eclampsia gets magnesium.
  • Anaphylaxis: epi IM in the thigh — waiting for IV access loses the airway.
  • OB: third-trimester bleeding = placenta previa/abruption; crowning + contractions = you're delivering on scene.
  • Sepsis: fever + hypotension + altered = fluids, early notification, and time-sensitive transport.

Drug cards
6

Epinephrine
Catecholamine / alpha + beta agonist

Dose: Arrest: 1 mg (1:10,000) IV/IO q3–5 min. Anaphylaxis: 0.3–0.5 mg (1:1,000) IM. Push-dose: 5–20 mcg q1–5 min.

Indications

  • Cardiac arrest (all rhythms)
  • Anaphylaxis
  • Symptomatic bradycardia infusion
  • Post-ROSC hypotension

Cautions

  • Increases myocardial O₂ demand
  • Never 1:1,000 IV push in arrest
  • Extravasation causes tissue necrosis

EPI

  • E — Every 3–5 minutes
  • P — Push 1 mg of the dilute (1:10,000)
  • I — IM 1:1,000 for anaphylaxis

Pearl: First drug in every arrest rhythm, but it never replaces compressions — CPR is the drug.

Magnesium sulfate
Electrolyte / antiarrhythmic

Dose: 1–2 g IV over 5–20 min (arrest: 1–2 g push).

Indications

  • Torsades de pointes
  • Refractory VF with suspected hypomagnesemia
  • Eclampsia, severe asthma

Cautions

  • Hypotension with fast push
  • Respiratory depression, loss of reflexes
  • Renal failure — accumulates

Twisting = Mag

  • Polymorphic + long QT = torsades
  • Mag first, defibrillate if pulseless
  • Stop the QT-prolonging drug

Pearl: Loss of the patellar reflex is the earliest sign you have given too much.

Norepinephrine
Alpha-1 predominant vasopressor

Dose: 0.05–0.5 mcg/kg/min titrated to MAP ≥ 65.

Indications

  • Septic and cardiogenic shock
  • Post-ROSC hypotension

Cautions

  • Central line preferred; watch peripheral site
  • Reflex bradycardia
  • Ischemia in end vessels

Levo = Leave the pressure up

  • First-line for most shock
  • Titrate to MAP, not systolic
  • Fix volume alongside it

Pearl: MAP ≥ 65 is the target because that is the pressure the kidneys and brain actually perfuse at.

Midazolam
Benzodiazepine

Dose: Seizures: 5 mg IM/IN or 2.5–5 mg IV. Sedation: 1–2.5 mg IV titrated.

Indications

  • Status epilepticus
  • Sedation for cardioversion
  • Cocaine/stimulant chest pain and agitation

Cautions

  • Respiratory depression — bag and ETCO₂ ready
  • Synergistic crash with opioids
  • Paradoxical agitation in some patients

VERSED

  • Versed = very effective sedation
  • E — Expect amnesia
  • R — Respirations need watching
  • S — Seizures stop
  • E — ETCO₂ on
  • D — Dose small, repeat

Pearl: First-line benzo for stimulant toxicity — it treats the catecholamine storm, not just the behavior.

Glucagon
Hormone / inotrope-chronotrope (beta-receptor bypass)

Dose: 1–5 mg IV (beta-blocker overdose); may repeat. Hypoglycemia: 1 mg IM/IN.

Indications

  • Beta-blocker overdose with bradycardia/hypotension
  • Hypoglycemia without IV access

Cautions

  • Vomiting — protect the airway in the altered patient
  • Effect fades; drip or calcium follow-up needed
  • Does nothing if glycogen stores are empty

BACK DOOR

  • Beta-blocker blocks the receptor
  • Glucagon works around it via cAMP
  • Key to the blocked heart

Pearl: The antidote that bypasses the blocked beta receptor entirely — the first phone-call drug in a beta-blocker overdose.

Ondansetron
5-HT3 antiemetic

Dose: 4 mg ODT/IV/IM; may repeat once.

Indications

  • Nausea and vomiting
  • Prophylaxis before ketamine or opioids

Cautions

  • QT prolongation — caution with amiodarone and torsades history
  • Headache is common
  • Does not treat the cause of the vomiting

ZOFRAN ZONE

  • 4 mg and reassess
  • QT caution with antiarrhythmics
  • ODT melts for the patient who cannot swallow

Pearl: Small kindness, big effect — but remember a vomiting cardiac patient might be an inferior MI, not a stomach bug.

Field cases
5

The teenager and the pill bottle
Overdose, 17-year-old female, parents found an empty amitriptyline bottle.

Drowsy but rousable, dry mouth, flushed skin, dilated pupils. One brief seizure before you arrived.

Vitals: BP 88/50 · HR 132 · RR 14 · SpO₂ 96%

Monitor: Sinus tach with a QRS of 140 ms and a tall R wave in aVR.

The rollover crash on the interstate
Single-vehicle rollover, one occupant, unrestrained, ejected partially through the window.

Blunt trauma with obvious pelvic instability and a large thigh hematoma. Bleeding controlled with direct pressure.

Vitals: BP 84/50 · HR 132 · RR 28 · SpO₂ 93% RA

Monitor: Sinus tachycardia at 132. Cool, mottled skin, delayed capillary refill.

The child who seized at daycare
Pediatric seizure, 3-year-old child, now stopped.

Warm, flushed toddler on the mat, sleepy but arousable. Two days of ear pain and fever. Seizure lasted about 90 seconds per staff.

Vitals: Temp 39.4 C · HR 158 · RR 30 · SpO₂ 97% · glucose 96

Monitor: Sinus tachycardia, appropriate for fever and age.

The stroke at the breakfast table
Altered speech, 71-year-old female, family on scene.

Right facial droop, right arm drift, slurred speech. Husband says she was normal 70 minutes ago when she poured coffee.

Vitals: BP 188/102 · HR 92 irregular · RR 18 · SpO₂ 96% · glucose 112

Monitor: Atrial fibrillation with a controlled ventricular response.

The diabetic teenager breathing too fast
Sick person, 16-year-old with vomiting and confusion.

Deep rapid respirations, fruity breath, dry mucous membranes. Insulin pump site looks inflamed and has been failing for two days.

Vitals: BP 96/58 · HR 128 · RR 32 deep · SpO₂ 99% · glucose reads HIGH

Monitor: Sinus tachycardia with flattened T waves.

Skills to drill
4

Assessment & vitals

Mastery: Full head-to-toe with lung sounds, pupils, and skin in under 3 minutes, trending not snapshotting.

Drill: Practice a 90-second rapid trauma and a 3-minute medical assessment until narrated smooth.

History taking (OPQRST/SAMPLE)

Mastery: Pulls a complete history from a scared patient in plain language, and hears what is not said.

Drill: Role-play with a partner who answers evasively — get the whole SAMPLE anyway.

Scene safety & size-up

Mastery: Reads the scene before the patient: hazards, mechanism, number of patients, resources needed.

Drill: On every arrival, say your size-up out loud before touching anyone. Every time.

Lifting & moving

Mastery: Power lifts, stair chair, and draw-sheet moves with zero back strain — for a 30-year career.

Drill: Practice the stair chair with a partner monthly; legs lift, back stays locked.

Board-style exam questions
42

1. Suspected opioid overdose with a respiratory rate of 4. First priority?

2. Hypoglycemia with a blood sugar of 38 in a conscious adult who can swallow. Best action?

3. Seizure lasting more than 5 minutes. Treatment?

4. Sepsis alert criteria most commonly include:

5. Prolapsed umbilical cord during delivery. Action?

6. Newborn is limp with a heart rate of 50 after 30 seconds of effective ventilation. Next?

7. Preeclamptic patient begins seizing. Definitive prehospital drug?

8. Postpartum hemorrhage in the field. First maneuver?

9. Anaphylaxis with wheezing and hypotension. First drug and route?

10. Stroke symptoms with last known well 90 minutes ago. Most important prehospital action?

11. DKA patient with Kussmaul respirations who requires intubation. Ventilation principle?

12. Tricyclic antidepressant overdose with a QRS of 140 ms. Treatment?

13. Beta blocker overdose with refractory bradycardia and hypotension. Best adjunct?

14. Organophosphate exposure with SLUDGE symptoms. Priority?

15. Suspected excited delirium with extreme agitation and hyperthermia. Key risks?

16. Dialysis patient with weakness, missed treatment and a wide QRS. First drug?

17. Heat stroke versus heat exhaustion is distinguished chiefly by:

18. Pediatric patient with a fever, petechial rash and hypotension. Suspect:

19. Imminent delivery: crowning with contractions two minutes apart. Best action?

20. Adult with GI bleeding, a heart rate of 128 and a systolic of 84. Prehospital priority?

21. Stroke patient last known well 90 minutes ago. Field priority?

22. Hypoglycemic unresponsive adult with no IV access. Give:

23. Status epilepticus first-line drug class?

24. Opioid overdose with respiratory depression. Priority before naloxone?

25. DKA presentation typically includes:

26. Sepsis field management centers on:

27. Third-trimester patient supine and hypotensive. Fix by:

28. Prolapsed umbilical cord. Action?

29. Eclamptic seizure treatment of choice?

30. Newborn APGAR components include:

31. Tricyclic antidepressant overdose with a wide QRS. Give:

32. Organophosphate poisoning presents with:

33. Excited delirium with extreme agitation and hyperthermia. Priorities?

34. Adrenal crisis or severe dehydration with hypotension. First field therapy?

35. A 3-year-old child has a brief generalized seizure with a temperature of 39.4 C and is now sleepy but arousable. Best management?

36. Pediatric fluid bolus for compensated shock?

37. A child with known peanut allergy has hives, vomiting and stridor. First drug?

38. Beta blocker overdose with refractory bradycardia and hypotension. Antidote?

39. Calcium channel blocker overdose is treated with:

40. An infant is limp with a glucose of 32. Correct dextrose therapy?

41. A dialysis patient missed two sessions and has peaked T waves with weakness. Priority treatment?

42. Shoulder dystocia during a field delivery. First maneuver?

Prove it under a clock
80 questions, 150 minutes, 70% pass line, domain scoring and a printable certificate.
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