Wiki Summary¶
Last updated: 2026-04-05 This file contains 1-2 sentence summaries of every wiki article. Purpose: Claude Code reads this first to understand what exists before deciding which full articles to read for a given query.
Format¶
Foundations¶
wiki/foundations/ems-system.md | Overview of the EMS system from 911 activation through patient handoff; EMT-B vs. paramedic scope of practice; online (real-time) vs. offline (standing orders) medical direction; why EMT-B practice is an extension of a physician's license; NM EMS Bureau and San Juan College program context; chain of survival.
wiki/foundations/safety-bsi.md | BSI (body substance isolation) as standard precautions for every call; PPE levels (gloves, eye protection, gown, N95/surgical mask) with indications; correct donning/doffing order; six scene safety categories (traffic, violence, hazmat, structural, electrical, fire); when to stage vs. enter; NM desert and oil field hazards.
wiki/foundations/legal-ethical.md | Three types of consent (expressed, implied, involuntary); minors and pediatric consent; valid adult refusal requirements; duty to act; abandonment; negligence (duty + breach + causation + damages); scope of practice enforcement; PCR documentation requirements; HIPAA basics; DNR overview with link to full article.
Assessments¶
wiki/assessments/scene-size-up.md | The first step of every patient contact — BSI/PPE, scene safety, MOI vs NOI identification, patient count, resource request, and c-spine consideration. Determines the assessment path and transport urgency for everything that follows.
wiki/assessments/primary-assessment.md | The life-threat identification and treatment step: general impression, AVPU LOC scale, airway management, breathing assessment, circulation and major bleeding control, and the priority vs non-priority transport decision. Must be completed before history or secondary assessment.
wiki/assessments/history-taking.md | Subjective information gathering using SAMPLE (Signs/Allergies/Medications/PMH/Last intake/Events) and OPQRST (Onset/Provocation/Quality/Radiation/Severity/Time). Findings directly drive medication administration decisions (aspirin, oral glucose, epinephrine).
wiki/assessments/secondary-assessment.md | Systematic physical examination — rapid head-to-toe DCAP-BTLS for significant MOI trauma, or focused exam for medical patients — plus a full vital signs set (BP, pulse, respirations, skin, pupils, SpO2, glucose). Identifies non-life-threatening injuries and establishes vital sign baseline.
wiki/assessments/reassessment.md | Continuous monitoring loop from end of secondary assessment through patient handoff: repeat primary assessment, vital signs every 5 min (critical) or 15 min (stable), verify all interventions are working, re-evaluate transport priority. Detects deterioration and confirms treatment effectiveness.
Pharmacology¶
wiki/pharmacology/oxygen.md | Pharmacology reference for oxygen — indications, delivery devices and flow rates (NC 1–6 LPM, NRB 10–15 LPM, BVM), device selection criteria, and 6 Rights application. No contraindications in emergency setting; treat hypoxia aggressively.
wiki/pharmacology/oral-glucose.md | Oral glucose gel (Glutose, Insta-Glucose) for hypoglycemia — requires all three criteria: altered mental status, known diabetic history, and ability to swallow. Dose 15–25g buccal; reassess at 15 minutes; do not give to unconscious or unable-to-swallow patients.
wiki/pharmacology/aspirin.md | Aspirin 162–324 mg chewed (not swallowed whole) for suspected ACS/cardiac chest pain. Contraindicated in aspirin allergy, active bleeding, and patients who already took their daily dose. Requires standing order or medical direction.
wiki/pharmacology/epinephrine-auto-injector.md | Epinephrine auto-injector (EpiPen) for anaphylaxis — requires systemic involvement (airway, breathing, or cardiovascular), not just localized hives. Adult 0.3 mg IM, pediatric 0.15 mg IM, lateral thigh. Reassess in 5 minutes; may repeat per protocol.
wiki/pharmacology/activated-charcoal.md | Activated charcoal for certain ingested poisons within 1 hour of ingestion, in conscious patients who can swallow. Contraindicated in altered mental status, caustic ingestions, and petroleum products. Use is declining in many NM systems — verify current protocol before administering.
Procedures¶
wiki/procedures/bvm-ventilation.md | Bag-valve-mask ventilation for absent or inadequate breathing — OPA/NPA airway adjunct before mask application, two-rescuer E-C clamp technique preferred, O2 at 15 LPM to reservoir, adult rate 10–12/min with visible chest rise. Critical failure: no chest rise.
wiki/procedures/oxygen-administration.md | NREMT skill for nasal cannula (1–6 LPM, mild hypoxia) and non-rebreather mask (10–15 LPM, respiratory distress) oxygen delivery. Key step: pre-inflate NRB reservoir bag before placing on patient. Reassess SpO2 after initiating; upgrade device if inadequate response.
wiki/procedures/cardiac-arrest-aed.md | BLS cardiac arrest management integrating CPR (100–120/min, ≥2 inch depth, 30:2 ratio) with AED use — analyze rhythm, clear patient, shock if advised, immediately resume CPR post-shock. Two-minute CPR cycles; rotate compressor every cycle.
wiki/procedures/spinal-immobilization-supine.md | Supine spinal immobilization — manual c-spine stabilization throughout, baseline PMS before collar, correct C-collar sizing, log roll to long board, body straps before head, reassess PMS after. Manual stabilization cannot be released until head is fully secured to board.
wiki/procedures/spinal-immobilization-seated.md | KED-based seated spinal immobilization for patients found sitting (typically MVC) — C-collar first, torso straps before head straps, pad the void behind occiput, transfer to long board. Rapid extrication without KED when scene is unsafe or patient is in cardiac arrest.
wiki/procedures/bleeding-control-shock.md | External hemorrhage control (direct pressure or tourniquet 2–3 inches proximal) combined with systemic shock management: position supine with legs elevated, high-flow O2, blanket for warmth, priority transport. Tourniquet: note time, do not remove in field.
wiki/procedures/joint-immobilization.md | Splinting of injured joints — immobilize bone above and below the injured joint, pad bony prominences and voids, assess PMS before and after, do not attempt to reduce dislocations in the field. Worsening PMS post-splint requires immediate splint loosening and reassessment.
wiki/procedures/long-bone-immobilization.md | Splinting of long bone fractures — immobilize joint above and below the fracture site, pad thoroughly, assess PMS before and after. Mid-shaft femur fractures may qualify for traction splinting; monitor for significant internal hemorrhage and shock.
Medical Emergencies¶
wiki/medical/acs-chest-pain.md | Acute Coronary Syndrome and STEMI — recognition (classic and atypical presentations), aspirin 324 mg, nitroglycerin criteria, STEMI advance notification, and PCI destination decision. High-frequency NREMT topic.
wiki/medical/anaphylaxis.md | Severe systemic allergic reaction requiring epinephrine — distinguish localized reaction (no epi) from anaphylaxis (systemic involvement: airway, breathing, or cardiovascular). EMT-B scope: epinephrine auto-injector 0.3 mg IM adult, 0.01 mg/kg pediatric; may repeat every 5–15 min. All anaphylaxis patients must be transported.
wiki/medical/seizure.md | Seizure assessment and management — airway protection during and after, lateral positioning, glucometry mandatory, status epilepticus (>10 min) requires ALS. Benzodiazepines (midazolam, diazepam) are ALS scope; EMT-B establishes IV/IO and monitors.
wiki/medical/stroke.md | Stroke and TIA — Cincinnati/FAST screening, establish "last known well" precisely, transport to Stroke Center with advance notification. Do NOT treat hypertension prehospital. Do NOT give aspirin (hemorrhagic stroke contraindication). Always check BGL (hypoglycemia mimics stroke).
wiki/medical/diabetic-emergencies.md | Hypoglycemia (BGL <60 mg/dL + AMS + can swallow = oral glucose 12–25 g) and hyperglycemia (>250 mg/dL). EMT-B gives oral glucose only if patient is conscious and can swallow. IV dextrose is ALS scope. Glucagon 0.5–1 mg IM if no IV access (ALS).
wiki/medical/respiratory-distress.md | Respiratory distress vs. failure — assessment (rate, depth, effort, SpO2), intervention ladder (position → O2 → BVM → advanced airway). Silent chest in asthma = impending arrest. COPD: titrate O2 to SpO2 88–92%; never withhold O2 from hypoxic patient.
wiki/medical/asthma-copd.md | Asthma and COPD exacerbations — bronchospasm, wheezing, respiratory distress. Albuterol 5 mg nebulized (EMT-B scope in NM), ipratropium 250–500 mcg as adjunct. Silent chest is ominous. Do not delay transport for nebulizer effect.
wiki/medical/altered-loc.md | Altered level of consciousness — differential (hypoglycemia, overdose, stroke, cardiac, trauma, infection, metabolic); glucometry first; if narcotic OD suspected follow overdose protocol; spinal precautions if occult trauma possible.
wiki/medical/behavioral-psychiatric.md | Behavioral/psychiatric emergencies — scene safety first, one provider communicates, verbal de-escalation before restraint. Chemical restraint with midazolam is ALS scope. Assume medical cause until ruled out (hypoglycemia, hypoxia, stroke mimic psychiatric illness).
wiki/medical/overdose-poisoning.md | Poisoning and overdose — scene safety, BSI, remove from hazardous environment. Naloxone for narcotic OD: adult 0.4–2.0 mg IM/SQ or 2 mg IN. Activated charcoal use declining in NM — verify protocol. Carbon monoxide: 100% O2. Poison Control: 800-222-1222.
wiki/medical/abdominal-pain.md | Acute abdominal pain — wide differential (appendicitis, AAA, ectopic, bowel obstruction, kidney stone). EMT-B: NPO, position of comfort, IV/IO en route, priority transport. AAA + hypotension = priority. Pain management is ALS scope.
wiki/medical/shock.md | Shock — recognize by AMS, tachycardia, hypotension, poor skin perfusion, diaphoresis. Classify by etiology (hypovolemic, distributive, cardiogenic, obstructive). EMT-B: O2, position (supine + legs elevated for most types), IV/IO, warmth, priority transport.
wiki/medical/syncope.md | Syncope — sudden transient loss of consciousness with loss of postural tone; evaluate for cardiac, neurological, hemorrhage, and metabolic causes; all syncope patients require hospital evaluation; obtain BGL and vital signs; spinal precautions if trauma involved.
wiki/medical/environmental-emergencies.md | Hyperthermia (heat stroke = AMS + elevated temp; mist + fan to cool), hypothermia (LOC best severity indicator; 60-sec pulse check; handle gently; "not dead until warm and dead"), and drowning (ABC approach; c-spine consideration; never stop CPR in cold water). NM-specific: high desert climate context.
wiki/medical/nausea-vomiting.md | Nausea and vomiting as symptoms — identify the underlying cause (ACS, stroke, bowel obstruction, GI hemorrhage, ectopic pregnancy). Airway priority; lateral position; keep NPO; anti-emetics are ALS scope. Acupressure (P6) is EMT-B option.
Trauma¶
wiki/trauma/burns.md | Thermal and chemical burns — depth classification (partial/full thickness), TBSA estimation (Rule of Nines; palm = 1%), critical burns criteria, airway burn recognition (singed nasal hair, soot, stridor). Parkland formula for large burns (>20% TBSA). Transport to burn center.
wiki/trauma/chest-trauma.md | Chest injuries — flail chest, tension pneumothorax, open chest wound (3-sided occlusive dressing), hemothorax, pulmonary contusion. Tension pneumo: tracheal deviation, absent breath sounds, JVD, hypotension — ALS needle decompression. All chest trauma: 100% O2, NRB, SpO2 ≥94%.
wiki/trauma/head-injury-tbi.md | Traumatic brain injury — prevent secondary injury (hypoxia, hypotension). O2 target SpO2 ≥94%; SBP ≥110 mmHg for adults. Glasgow Coma Scale. Do NOT hyperventilate except for herniation signs (GCS ≤8 + herniation: EtCO2 target 30–35 mmHg). Elevate head 30°.
wiki/trauma/spinal-injury.md | Spinal injury and spinal motion restriction — cervical collar criteria (midline pain/tenderness, AMS, neurological deficit, intoxication, distracting injury). NM protocol: patients should not routinely be transported on long boards; selective immobilization based on clinical criteria.
wiki/trauma/electrical-injury.md | Electrical injury — scene safety first (never approach live source); cardiac arrest from VF; entry/exit wounds underestimate internal damage; rhabdomyolysis risk; cardiac monitoring required; burn center destination. Fractures from tetanic contractions common.
wiki/trauma/venomous-bites.md | Venomous bites/stings in NM — crotalid (rattlesnake) most common. No tourniquet, no cut-and-suck, no cryotherapy. Immobilize extremity at heart level. Irrigate wound. Rapid transport; antivenom is hospital-only. If anaphylaxis: epinephrine per anaphylaxis protocol.
wiki/trauma/sexual-assault.md | Sexual assault — evidence preservation (no bathing/changing), minimize personnel, one provider communicates, no pelvic exam prehospital. Strangulation victims require transport even if asymptomatic — risk of delayed carotid dissection, laryngeal fracture, neurological injury.
Special Populations¶
wiki/special-populations/obstetric-childbirth.md | Imminent delivery, childbirth complications (nuchal cord, breech, prolapsed cord, pre-eclampsia/eclampsia, shoulder dystocia, vaginal bleeding, maternal cardiac arrest). APGAR scoring. Support head, clear airway, clamp cord. Transport mother and infant together.
wiki/special-populations/neonatal-resuscitation.md | Neonatal resuscitation — initial steps (warm, dry, stimulate, position), assessment (HR, respiratory effort, tone, color), BVM at 40–60/min for HR <100, CPR (3:1 ratio) + BVM for HR <60. Target SpO2 at 10 min: 85–95%. Two-thumb encircling hands technique preferred for compressions.
Concepts¶
wiki/concepts/glasgow-coma-scale.md | Standardized neurological scoring across eye, verbal, and motor components (3–15 total); GCS ≤8 = severe TBI; document as breakdown (E/V/M) not just total; compare to AVPU for field LOC assessment.
wiki/concepts/avpu.md | Four-level LOC scale used in the primary assessment: Alert, Voice, Pain, Unresponsive. Faster than GCS for initial triage; determines airway adjunct selection; V/P/U = priority transport.
wiki/concepts/dcap-btls.md | Eight-component mnemonic (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling) applied at each body region in rapid trauma assessment; explains clinical significance of each finding and what injuries to suspect.
wiki/concepts/sample-opqrst.md | SAMPLE (background history) and OPQRST (complaint characterization) together; detailed table showing how each letter drives medication decisions; includes worked examples for ACS, stroke, anaphylaxis, and hypoglycemia.
wiki/concepts/six-rights.md | The 6 Rights of medication administration (Right Patient, Drug, Dose, Route, Time, Documentation) applied to all EMT-B scope drugs; includes a 7th Right (Reason); worked examples for aspirin, oral glucose, epinephrine, and activated charcoal.
wiki/concepts/start-triage.md | Simple Triage And Rapid Treatment for MCIs: four tags (Black/Red/Yellow/Green), the five-step decision algorithm, JumpSTART for pediatric, expectant tagging rationale, and NM MCI protocol context including drill-05 application.
wiki/concepts/shock-physiology.md | Pathophysiology of shock at cellular and organ level: anaerobic metabolism, lactic acidosis, organ failure cascade. Four types (hypovolemic, distributive, cardiogenic, obstructive), three stages (compensated/decompensated/irreversible), and why tachycardia precedes hypotension.
wiki/concepts/rule-of-nines.md | TBSA estimation for burns: adult Rule of Nines (all percentages), pediatric modifications, palm method (patient's palm = 1%), critical burn thresholds, and Parkland formula (4 mL/kg/%TBSA) for fluid resuscitation.
wiki/concepts/cincinnati-stroke-scale.md | Three-component prehospital stroke screen (facial droop, arm drift, speech); how to test each; any 1 abnormal = positive; comparison to FAST; last known well vs. symptom onset; transport and tPA implications.
wiki/concepts/apgar-score.md | Neonatal assessment at 1 and 5 minutes post-delivery: five components (Appearance, Pulse, Grimace, Activity, Respirations), scored 0–2 each; 7–10 normal, 4–6 needs stimulation, 0–3 needs resuscitation; APGAR documents but does not guide immediate resuscitation.
wiki/concepts/vital-signs.md | The six EMT-B vital signs (BP, pulse, respirations, skin signs, pupils, SpO2); normal ranges by age group (adult through infant); correct measurement technique for each; abnormal findings with clinical meaning; trending: one set = snapshot, two = trend, three = direction; critical vitals requiring immediate action.
wiki/concepts/pulse-oximetry.md | SpO2 measurement of hemoglobin oxygen saturation; how it works (red/infrared light); normal ≥94% adults, 88–92% for COPD; critical limitations: CO poisoning reads falsely high, poor perfusion/shock unreliable, anemia normal reading with poor delivery, nail polish/motion artifact, jaundice. Core rule: treat the patient, not the number.
wiki/concepts/kinematics-of-trauma.md | Physics of trauma: KE = ½mv² (velocity squared); three collisions in every MVC (vehicle/object, occupant/interior, organs/body wall); seatbelt and airbag injury patterns; falls (>3× height adult); low vs. high velocity penetrating (temporary cavity); significant MOI criteria list; predictable injury patterns by mechanism.
Procedures (Airway)¶
wiki/procedures/airway-adjuncts.md | OPA (unconscious, absent gag reflex — contraindicated with any gag) and NPA (semi-conscious or intact gag — contraindicated with suspected basilar skull fracture); correct sizing for each; adult rotation insertion technique vs. pediatric tongue-depressor technique; suctioning technique (Yankauer vs. soft catheter); 15-sec max suction time adults; 80–120 mmHg suction pressure.
Operations¶
wiki/operations/dnr-death-determination.md | DNR orders, advance directives (MOST, DNR, DPOA), and criteria for withholding resuscitation (decapitation, decomposition, torso transection, incineration, dependent lividity + rigor). Lightning/drowning/hypothermia are exceptions. Valid DNR: intact, patient name, physician name, state-compliant format.
wiki/operations/refusal-of-care.md | Adult refusal (competent adult, must be informed of risks, signed refusal + witness, document thoroughly), pediatric refusal (parent/guardian; not valid if life threat), and involuntary transport (NM statute 24-10B-9.1: lacks capacity + life threat). Refusal is highest EMS liability exposure.