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Normal vital signs by age
| Age | HR | RR | SBP |
|---|---|---|---|
| Newborn (0–1 mo) | 100–180 | 30–60 | 60–90 |
| Infant (1–12 mo) | 100–160 | 25–50 | 70–95 |
| Toddler (1–3 y) | 90–150 | 20–30 | 80–100 |
| Preschool (4–5 y) | 80–140 | 20–25 | 80–110 |
| School age (6–12 y) | 70–120 | 15–20 | 80–120 |
| Adolescent (13–18 y) | 60–100 | 12–20 | 90–120 |
| Adult | 60–100 | 12–20 | 90–140 |
Pediatric SBP rule of thumb: 70 + (2 × age in years).
EMS drug quick reference
| Drug | Indication | Adult dose | Route |
|---|---|---|---|
| Aspirin | Suspected ACS | 324 mg (4 × 81 mg) chewed | PO |
| Nitroglycerin | Chest pain, CHF | 0.4 mg q5 min × 3 | SL |
| Epinephrine 1:10,000 | Cardiac arrest | 1 mg q3–5 min | IV/IO |
| Epinephrine 1:1,000 | Anaphylaxis | 0.3 mg | IM thigh |
| Albuterol | Bronchospasm | 2.5 mg / 3 mL | Neb |
| Ipratropium | Bronchospasm | 0.5 mg | Neb |
| Naloxone | Opioid overdose | 0.4–2 mg | IN/IM/IV |
| Dextrose 10% | Hypoglycemia | 12.5–25 g | IV |
| Glucagon | Hypoglycemia, no IV | 1 mg | IM |
| Amiodarone | V-fib/pulseless VT | 300 mg (then 150) | IV/IO |
| Adenosine | SVT | 6 mg → 12 mg → 12 mg | IV rapid push |
| Atropine | Symptomatic bradycardia | 1 mg q3–5 min; max 3 mg | IV |
| Fentanyl | Analgesia | 1 mcg/kg | IV/IN/IM |
| Ketamine | Analgesia / sedation | 0.3 mg/kg (pain), 1–2 mg/kg (RSI) | IV |
| Midazolam | Seizure / sedation | 0.1 mg/kg (max 5 mg IV / 10 mg IM) | IV/IM/IN |
| Ondansetron | Nausea | 4 mg | IV/IM/ODT |
| Diphenhydramine | Allergic reaction | 25–50 mg | IV/IM |
| Methylprednisolone | Asthma / anaphylaxis | 125 mg | IV/IM |
| Calcium chloride | Hyperkalemia, CCB OD | 1 g | IV slow |
| Sodium bicarbonate | TCA OD, hyperkalemia | 1 mEq/kg | IV |
Always follow local protocol. Doses shown are adult defaults.
ACLS algorithms (compact)
Cardiac arrest
- CPR 30:2, attach monitor.
- Shockable (VF/pVT): defibrillate → CPR 2 min → epi 1 mg q3–5 min → amiodarone 300 mg → 150 mg.
- Non-shockable (PEA/asystole): CPR → epi 1 mg q3–5 min → find & treat H's & T's.
- Advanced airway: ventilate 1 breath q6 s (10/min), continuous compressions.
Bradycardia
- Assess for signs of poor perfusion.
- Atropine 1 mg IV (may repeat q3–5 min; max 3 mg).
- If ineffective: transcutaneous pacing OR epi drip 2–10 mcg/min OR dopamine 5–20 mcg/kg/min.
Tachycardia
- Unstable → sync cardioversion (narrow reg 50–100 J, narrow irreg 120–200 J, wide reg 100 J).
- Stable narrow: vagal → adenosine 6 → 12 → 12 mg.
- Stable wide regular: amiodarone 150 mg over 10 min.
H's & T's: Hypovolemia, Hypoxia, H⁺, Hypo/Hyperkalemia, Hypothermia — Toxins, Tamponade, Tension pneumo, Thrombosis (coronary/pulmonary), Trauma.
Glasgow Coma Scale
Eye (E) / 4
- 4 Spontaneous
- 3 To voice
- 2 To pain
- 1 None
Verbal (V) / 5
- 5 Oriented
- 4 Confused
- 3 Inappropriate
- 2 Incomprehensible
- 1 None
Motor (M) / 6
- 6 Obeys
- 5 Localizes
- 4 Withdraws
- 3 Flexion (decorticate)
- 2 Extension (decerebrate)
- 1 None
Severity: 13–15 mild · 9–12 moderate · ≤8 severe (consider intubation).
APGAR score (1 and 5 min)
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance | Blue/pale | Body pink, extremities blue | All pink |
| Pulse | Absent | < 100 | ≥ 100 |
| Grimace | No response | Grimace | Cry / cough |
| Activity | Limp | Some flexion | Active motion |
| Respiration | Absent | Slow, irregular | Strong cry |
Interpretation: 7–10 normal · 4–6 moderately depressed · 0–3 severely depressed.
Rule of Nines & Parkland formula
Adult Rule of Nines
- Head: 9%
- Each arm: 9%
- Chest / abdomen: 18%
- Back: 18%
- Each leg: 18%
- Groin: 1%
Pediatric (infant)
- Head: 18%
- Each arm: 9%
- Chest / abdomen: 18%
- Back: 18%
- Each leg: 13.5%
Parkland formula
4 mL × kg × %TBSA of LR over 24 hours. Give half in the first 8 hours (from time of burn), remainder over next 16.
EMS acronyms
SAMPLE (history)
Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events leading up.
OPQRST (pain)
Onset, Provocation, Quality, Radiation, Severity, Time.
DCAP-BTLS (trauma exam)
Deformities, Contusions, Abrasions, Punctures — Burns, Tenderness, Lacerations, Swelling.
AVPU (mental status)
Alert, Verbal, Painful, Unresponsive.
START triage
RPM: Respirations (>30 red), Perfusion (cap refill >2s or no radial red), Mental status (can't follow commands red).
CINCINNATI stroke
Facial droop, Arm drift, Slurred speech. Any positive = time-critical stroke alert.
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