EMT-B OBGYN Emergencies Chapter 24 Brady 10th Edition
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| cephalic presentation | presenting part is head
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| breach presentation | buttocks or both feet deliver first
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| second stage of labor | full dilation of cervix, baby enters birth canal until born, EMT-B decides to transport or prepare to assist with delivery
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| third stage of labor | after baby is born until the afterbirth is delivered
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| meconium staining | amniotic fluid is greenish or brownish-yellow, may indicate maternal or fetal distress
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| supine hypotensive syndrome | also vena cava compression syndrome; mass compressing vena cava, major blood vessel, reducing return of blood to heart, reducing cardiac output - resulting in dizziness and drop of bp
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| vena cava compression syndrome | supine hypotensive syndrome
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| fontanelles | soft spots on baby's skull
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| normal pulse for newborn | greater than 100
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| Apgar scale | evaluation protocol for newborns
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| APGAR | Appearance, Pulse, Grimace, Activity, Respiratory effort - 0, 1, 2
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| APGAR Appearance | 0 - blue or pale all over, 1 - extremeties blue, trunk pink, 2 - pink all over
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| APGAR Pulse | 0 - no pulse, 1 - pulse between 1 and 100, 2 - pulse greater than 100
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| APGAR Grimace (reaction to suctioning or flicking on the feet) | 0 - no reaction, 1 - facial grimace, 2 - sneeze, cough, cry
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| APGAR Activity | 0 - no movement, 1 - only slight activity (flex extremities), 2 - move around normal
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| APGAR Respiratory effort | 0 - none, 1 - slow, irregular breathing, weak cry, 2 - good breathing, strong cry
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| artificial ventilation rate during neonatal resuscitation | 40 to 60 per minute - rapid, small puffs - reassess in 30 seconds
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| What if heart rate is less than 60 minute | initiate chest compressions at rate of 120 per minute - 90 compressions and 30 ventilations each minute
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| What if baby exhibits cyanosis of face or torso | supplemental oxygen at 10-15 liters per minute with tubing placed close to infant's mouth
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| Clamping and cutting cord | keep infant warm, use sterile clamps from OB kit, slowly tie square knot, one clamp 10 inches from baby, other about 7 inches out, cut between clamps
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| How much blood loss is normal after delivering the baby and placenta? | 500 cc
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| How can you control vaginal bleeding after delivery of the baby and placenta? | sanitary napkin, lower legs and raise feet, massage the uterus to help it contract (circular motion), mother nurse baby which leads to contraction of uterus (not recommended by all docs)
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| prolapsed unbilical cord | cord is pinched, most common in breech births, caused by being squeezed between vaginal wall and baby's head
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| How do you care for prolapsed umbilical cord? | elevate hips, oxygen, keep mother warm, keep baby's head away from cord, don't push cord back in, wrap cord in moist towel. Transport, continue pressure on baby's head.
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| How do you care for the baby if you see meconium staining? | suction the oropharynx before stimulating, suction mouth, then nose. Maintain airway, provide ventilations or compressions if needed, transport
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| What is placenta previa? | placenta is formed in an abnormal location like low in uterus and close to or over the cervical opening, not allowing normal delivery, causes excessive prebirth bleeding - cervix dilates, the placenta tears
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| What is abruptio placentae? | placenta separates from the uterine wall, causing prebirth bleeding, occurs in 3rd trimester
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| What is an ectopic pregnancy? | implantation of the fertilized egg is in the ovidcut, cervix, or abdominopelvic cavity
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| What are signs of a ectopic pregnancy? | acute abdominal pain, often beginning on one side, vaginal bleeding, rapid or week pulse, low BP
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| How do you care for a patient with ectopic pregnancy? | immediate transport, position and care for shock, high concentration oxygen, nothing by mouth
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| What is eclampsia? | eclampia is complication late in pregnancy that produces seizures and coma.
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| What is preeclampsia? | complication during pregnancy where woman retains large amounts of fluid and has hypertension. She may also experience seizures or coma. very dangerous to baby.
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| What are signs of seizure from preeclampsia? | elevated BP (increased with risk of abruptio placentae), excessive weight gain, extreme swelling of face, hands, ankles, feet; headache
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| How do you care for patient with seizures during pregnancy? | airway, high concentration oxygen, transport with patient on left side, gentle, keep her warm, not overheated though; have suction and OB kit ready
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