Transcript 1 - EMS Online

Seattle/King County EMT-B Class
Topics
1
Environmental Emergencies: Chapter 18
2
Behavioral Emergencies: Chapter 19
3
Ob/Gyn Emergencies: Chapter 20
1
Environmental Emergencies
1
Factors Affecting Exposure
•
•
•
•
Physical condition
Age
Nutrition and hydration
Environmental
conditions
1
Loss of Body Heat
Conduction
• Transfer of heat from
body to colder object
Convection
• Transfer of heat
through circulating air
Evaporation
• Cooling of body
through sweating
Radiation
• Loss of body
heat directly into
a colder
environment
Respirations
• Loss of body
heat during
breathing
1
Loss of Body Heat, continued
Rate and amount of heat gain or loss can
be modified in three ways:
• Increase or decrease heat
production.
• Move to sheltered area where heat
loss is increased or decreased.
• Wear insulated clothing.
1
Hypothermia
• Lowering of the body temperature
below 95°F (35°C)
• Weather does not have to be below
freezing for hypothermia to occur.
• Older persons and infants are at higher
risk.
• People with other illnesses and injuries
are susceptible to hypothermia.
1
Mild Hypothermia
Signs and symptoms include:
• Shivering
• Rapid pulse and respirations
• Red, pale, cyanotic skin
1
Severe Hypothermia
Signs and symptoms include:
• Shivering stops.
• Muscular activity decreases.
• Fine muscle activity ceases.
• Eventually, all muscle activity stops.
1
Core Temperature Less Than 80F
• Patient may appear dead (or in a coma).
• Never assume that a cold, pulseless
patient is dead.
1
Scene Size-up
1. Scene Size-up
• Note weather conditions.
• Identify safety hazards
such as icy roads, mud, or
wet grass.
1
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Decide SICK/NOT SICK
• Check temperature on
patient’s abdomen.
• Ensure adequate airway.
• Palpate for carotid pulse;
wait 30–45 seconds.
• ANY kind of pulse=NO CPR.
• Transport immediately or
move to warmer location.
1
Focused History/Physical Exam
1. Scene Size-up
• If unconscious, do a rapid
physical exam.
2. Initial
• If conscious, obtain
Assessment
SAMPLE history.
3. Focused History/ • Determine how long the
patient was exposed.
Physical Exam
• Medications can affect the
patient’s metabolism.
• Concentrate on areas of
body directly affected by
exposure.
1
Detailed Physical Exam
1. Scene Size-up
• Aimed at determining
degree and extent of cold
2. Initial
injury
Assessment
• Evaluate skin
temperature, texture, and
3. Focused History/
turgor.
Physical Exam
4. Detailed Physical
Exam
1
Ongoing Assessment
1. Scene Size-up
• Rewarming can be harmful;
monitor carefully.
2. Initial
• Communicate conditions at
Assessment
scene, clothing, changes in
mental status.
3. Focused History/
Physical Exam
4. Detailed Physical
Exam
5. Ongoing
Assessment
1
Baseline Vital Signs
• Can be altered by hypothermia
• Monitor for changes in mental status.
• Check body temperature:
(oral, tympanic or axillary)
1
Interventions
• Move from cold environment.
• Do not allow patient to walk, eat, use any
stimulants, or smoke or chew tobacco.
• Remove wet clothing.
• Place dry blankets under and over
patient.
• Handle gently.
• Do not massage extremities.
1
Local Cold Injuries
Frostnip
• Freezing of the skin but not the deeper
surface
Immersion (trench) foot
• Prolonged exposure to cold water
Frostbite
• Freezing of a body part, usually an
extremity
1
Emergency Care for Local Cold Injury
• Remove the patient
from further exposure
to the cold.
• Handle the injured part
gently.
• Administer oxygen.
• Remove any wet or
restrictive clothing.
• Never rub the area.
• Do not break blisters.
• Transport.
1
Warm-Water Bath
• Water temperature should be between
100-112oF.
• Recheck water temperature and stir to
circulate.
• Keep body part in water until warm and
sensation returns.
• Dress with dry, sterile dressings.
1
Cold Exposure and You
• EMT-Bs are at risk for hypothermia
when working in a cold environment.
• Stay aware of local weather conditions.
• Dress appropriately and be prepared.
• Vehicle must be properly equipped and
maintained.
• Never allow yourself to become a
casualty!
1
Heat Exposure
• Normal body temperature is 98.6°F.
• Body attempts to maintain normal
temperature despite ambient
temperature.
• Body cools itself by sweating
(evaporation) and dilation of blood
vessels.
• High temperature and humidity decrease
effectiveness of cooling mechanisms.
1
Heat Cramps
• Painful muscle spasms
• Remove the patient
from hot environment.
• Rest the cramping
muscle.
• Replace fluids by mouth.
• If cramps persist,
transport the patient to
hospital.
1
Heat Exhaustion
Signs and symptoms include:
• Dizziness, weakness, or fainting
• Onset while working hard or
exercising in hot environment
• In older people and young, onset may
occur while at rest in hot, humid, and
poorly ventilated areas.
• Cold, clammy skin
1
Heat Exhaustion, continued
• Dry tongue and thirst
• Patients usually have normal vital signs,
but pulse can increase and blood
pressure can decrease.
• Normal or slightly elevated body
temperature
1
Emergency Medical Care
• Remove extra clothing and remove from
hot environment.
• Give patient oxygen.
• Have patient lie down and elevate legs.
• If patient is alert, give water slowly.
• Be prepared to transport.
1
Heatstroke
Signs and symptoms include:
• Hot, dry, flushed skin
• Change in behavior leading to
unresponsiveness
• Pulse rate is rapid, then slows.
• Blood pressure drops.
• Death can occur if the patient is not
treated.
1
Care for Heat Stroke
• Move patient out of the
hot environment.
• Provide air conditioning
at a high setting.
• Remove the patient’s
clothing.
• Give the patient oxygen.
• Apply cold packs to the
patient’s neck, armpits,
and groin.
1
Care for Heat Stroke, continued
• Cover the patient with wet towels or
sheets.
• Aggressively fan the patient.
• Immediately transport patient.
• Notify the hospital of patient’s condition.
1
Scene Size-up
1. Scene Size-up
• Do environmental
assessment.
• Protect yourself from heat
and biological hazards.
• ALS may need to give IV
fluids.
1
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Decide SICK/NOT SICK
• The more altered the
mental status, the more
severe the exposure.
• Keep airway patent.
• Oxygen may decrease
nausea.
• Treat for shock
aggressively.
1
Focused History/Physical Exam
1. Scene Size-up
• Note activities/medications
that may make patient
2. Initial
susceptible to heat-related
Assessment
problems.
3. Focused History/ • Determine exposure and
activities prior to
Physical Exam
symptoms.
• Assess for muscle cramps,
confusion.
• Examine for mental status,
skin temperature, wetness.
1
Detailed Physical Exam
1. Scene Size-up
• Pay attention to skin
temperature, turgor,
2. Initial
wetness.
Assessment
• Turgor = skin’s ability to
resist deformity
3. Focused History/
• In dehydration, skin will
Physical Exam
tent when pinched on
4. Detailed Physical
back of hand.
Exam
• Perform careful
neurologic exam.
1
Ongoing Assessment
1. Scene Size-up
• Watch for deterioration.
• Reassess vital signs every 5
2. Initial
minutes.
Assessment
• Do not cause shivering.
3. Focused History/ • Document weather
Physical Exam
conditions and activities
prior to emergency.
4. Detailed Physical
Exam
5. Ongoing
Assessment
1
Baseline Vital Signs
• May be tachycardic or tachypneic
• In heat exhaustion, patient may have
normal skin temp; may also be cool
and clammy.
• In heat stroke, patient will have hot
skin.
1
Interventions
• Remove from hot environment.
• Give cool fluids by mouth.
• Cover with sheet and soak with cool
water.
• Set A/C on high.
• Place ice packs on groin and axillae.
• Fan aggressively.
1
Drowning and Near Drowning
Drowning
• Death as a result of suffocation after
submersion in water
Near drowning
• Survival, at least temporarily, after
suffocation in water
1
Drowning Process
1
Spinal Injuries
Suspect spinal injury if:
• Submersion has resulted from a
diving mishap or long fall.
• Patient is unconscious.
• Patient complains of weakness,
paralysis, or numbness.
1
Spinal Stabilization in Water
• Turn the patient supine.
• Restore the airway and begin ventilation.
• Secure a backboard under the patient.
• Remove the patient from the water.
• Cover the patient with a blanket.
1
Resuscitation Efforts
• Hypothermia can protect vital organs
from hypoxia.
• Documented case of a survivor of a
66-minute cold water submersion
• Diving reflex may cause heart rate to
slow.
1
Diving Problems
Descent problems
• Usually due to the sudden increase in
pressure on the body as the person
dives
Bottom problems
• Not commonly seen
Ascent problems
• Air embolism and decompression
sickness
1
Air Embolism
Signs and symptoms include:
• Blotching
• Froth at the mouth and nose
• Severe pain in muscle, joints, or
abdomen
• Dyspnea and/or chest pain
1
Air Embolism, continued
Signs and symptoms include:
• Dizziness, nausea, and vomiting
• Dysphasia
• Difficulty with vision
• Paralysis and/or coma
• Irregular pulse or cardiac arrest
1
Decompression Sickness (Bends)
• Can result from rapid
ascent
• Most common
symptom is abdominal
and/or joint pain.
• Symptoms may
develop after hours.
• Treatment is BLS and
hyperbaric chamber.
1
Scene Size-up
1. Scene Size-up
• Never drive through
moving water; be cautious
driving through still water.
• Never attempt water
rescue without proper
training and equipment.
• Consider trauma and
spinal stabilization.
• Check for additional
patients.
1
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Decide SICK/NOT SICK.
• Pay attention to chest
pain, dyspnea, complaints
of sensory changes.
• Be suspicious of alcohol
use.
• Maintain airway; suction.
• If pulse cannot be
obtained, begin CPR.
• Evaluate for shock and
adequate perfusion.
1
Focused History/Physical Exam
1. Scene Size-up
• If responsive, listen to
breath sounds.
2. Initial
• If unresponsive, look for
Assessment
signs of trauma.
3. Focused History/ • Check divers for
indications of air embolism
Physical Exam
or bends.
• Focus on pain in joints and
abdomen.
• Check for signs of
hypothermia.
1
Detailed Physical Exam
1. Scene Size-up
• Examine respiratory,
circulatory, neurologic
2. Initial
systems.
Assessment
• Distal circulatory, sensory,
and motor function tests
3. Focused History/
determine extent of
Physical Exam
injury.
4. Detailed Physical • Examine for peripheral
Exam
pulses, skin color, and
discoloration, itching,
pain, numbness/tingling.
1
Ongoing Assessment
1. Scene Size-up
2. Initial
Assessment
3. Focused History/
Physical Exam
4. Detailed Physical
Exam
5. Ongoing
Assessment
• Assess mental status
frequently.
• Document:
— Circumstances of drowning
and extrication
— Time submerged
— Temperature of water
— Clarity of water
— Possible spinal injury
— Bring dive log, dive computer,
and dive equipment to
hospital.
1
Transport Decision
• Always transport near-drowning
patients to hospital.
• Decompression sickness and air
embolism must be treated in
recompression chamber.
• Perform interventions en route.
1
Baseline Vital Signs/ SAMPLE History
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•
•
•
Check pulse rate, quality, rhythm.
Check peripheral, central pulses.
Check for pupil size, reactivity.
Determine length of time patient was
underwater or time of onset of
symptoms.
• Note physical activity, alcohol/drug use,
other medical conditions.
• Determine dive parameters in history
depth, time, previous dive activity.
1
Drowning Interventions
• Begin artificial ventilations as soon as
possible.
• Stabilize and protect spine.
• Maintain patent airway. If there is no
spinal injury, turn patient on side to
allow draining from upper airway.
• Make sure patient is warm, especially
after cold-water immersion.
1
Diving Interventions
• Remove patient from water.
• Begin BLS; administer oxygen.
• Place patient in left lateral recumbent
position with head down.
• Provide prompt transport to nearest
recompression facility.
• Administer oxygen and provide rapid
transport.
1
Other Water Hazards
• Hypothermia from water immersion
• Breath-holding syncope
• Injuries from recreational equipment
or marine animals
1
Prevention
• Pools should be surrounded with
appropriate enclosures.
• Alcohol involved in adult and teenage
drownings.
1
Lightning
• Strikes boaters, swimmers, golfers,
anyone in large, open area
• Cardiac arrest and tissue damage are
common.
• Three categories of lightning injuries
—Mild: Loss of consciousness,
amnesia, tingling, superficial burns
—Moderate: Seizures, respiratory
arrest, asystole (spontaneously
resolves), superficial burns
—Severe: Cardiopulmonary arrest
1
Emergency Medical Care
• Protect yourself.
• Move patient to
sheltered area or stay
close to ground.
• Treat as for other
electrical injuries.
• Transport to nearest
facility.
1
Spider Bites
• Spiders are numerous and widespread
in the US.
• Many species of spiders bite.
• Only the female black widow spider and
the brown recluse spider deliver
serious, even life-threatening bites.
• Your safety is of paramount
importance.
1
Black Widow Spider
• Found in all states except Alaska
• Black with bright red-orange marking in
hourglass shape on abdomen
• Venom poisonous to nerve tissue
• Requires patient transport as soon as
possible
1
Brown Recluse Spider (Hobo) cousin
• Mostly in southern and central US
• Short-haired body has violinshaped mark, brown to yellow in
color, on its back.
• Venom causes local tissue
damage.
• Area becomes swollen and
tender, with pale, mottled,
cyanotic center.
• Requires patient transport as
soon as possible.
1
Snake Bites
• 40,000 to 50,000 reported snake bites
in the US annually.
• 7,000 bites in the US come from
poisonous snakes.
—Death from snake bites is rare.
—About 15 deaths occur each year in
the US.
1
Poisonous Snakes in the US
Rattlesnake
Copperhead
Cottonmouth
Coral snake
1
Pit Vipers
• Rattlesnakes,
copperheads, and
cotton mouths
• Store poison in
pits behind
nostrils
• Inject poison to
victim through
fangs
1
Pit Viper Bite
Signs and symptoms include:
• Severe burning at the bite site
• Swelling and bluish discoloration
• Bleeding at various distant sites
Other signs may include:
—Weakness
—Fainting
—Sweating
—Shock
1
Care for Pit Viper Bites
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•
•
•
•
Calm the patient.
Locate bite and cleanse the area.
Do not apply ice.
Splint area to minimize movement.
Watch out for vomiting caused by
anxiety.
• Do not give anything by mouth.
1
Care for Pit Viper Bites, cont'd
• If the patient is bitten on the trunk, lay
the patient supine and transport quickly.
• Monitor patient’s vital signs.
• Mark the swollen area with a pen.
• Care for shock if signs and symptoms
develop.
• Bring the snake to hospital if it has been
killed.
1
Coral Snakes
• Small snake with red, yellow, and black
bands
• “Red on yellow will kill a fellow, red on
black, venom will lack.”
• Injects venom with teeth, using a
chewing motion that leaves puncture
wounds
• Causes paralysis of the nervous system
1
Care for Coral Snake Bites
• Quiet and reassure the patient.
• Flush the area with 1 to 2 quarts of
warm, soapy water.
• Do not apply ice.
• Splint the extremity.
• Check and monitor baseline vital
signs.
1
Care for Coral Snake Bites, cont'd
• Keep the patient warm and elevate the
lower extremities to help prevent shock.
• Give supplemental oxygen if needed.
• Transport promptly. Give advance notice
to hospital of coral snake bite.
• Give the patient nothing by mouth.
1
Scorpion Stings
• Venom gland and
stinger found in the tail
end.
• Mostly found in
southwestern US
• With one exception, the
Centruroides
sculpturatus, most
stings are only painful.
• Provide BLS care and
transport.
1
Tick Bites
• Ticks attach
themselves to the
skin.
• Bite is not painful, but
potential exposure to
infecting organisms is
dangerous.
• Ticks commonly carry
Rocky Mountain
spotted fever or Lyme
Disease.
1
Tick Bites, continued
• Rocky Mountain spotted fever develops
7 to 10 days after bite.
• Symptoms include:
—Nausea, vomiting
—Headache
—Weakness
—Paralysis
—Possible cardiorespiratory collapse
1
Tick Bites, continued
• Lyme Disease has now been reported
in over 35 states.
• Lyme Disease symptoms may begin 3
days after the bite.
• Symptoms include:
—Target bull’s-eye pattern
—Rash
—Painful swelling of the joints
1
Caring for a Tick Bite
• Do not attempt to suffocate or burn tick.
• Use fine tweezers to grasp tick by the
body and pull it straight out.
• Cover the area with disinfectant and
save the tick for identification.
• Provide any necessary supportive
emergency care and transport.
1
Injuries from Marine Animals
• Coelenterates are responsible for more
envenomations than any other marine life
animal
• Have stinging cells called nematocysts
• Results in very painful, reddish lesions
• Symptoms include headache, dizziness,
muscle cramps, and fainting.
1
Care for Marine Stings
• Limit further discharge by minimizing
patient movement.
• Inactivate nematocysts by applying
alcohol.
• Remove the remaining tentacles by
scraping them off.
• Provide transport to hospital.
2
Behavioral Emergencies
2
Myth and Reality
• Everyone has symptoms of mental
illness problems at some point.
• Only a small percentage of mental
health patients are violent.
• Perfectly healthy people may have
symptoms occasionally.
2
Defining Behavioral Emergencies
Behavior
• What you can see of a person’s
response to the environment and his or
her actions
Behavioral crisis
• Any reaction to events that interferes
with activities of daily living or that
becomes unacceptable to the patient,
family, or others
• A pattern, not an isolated incident
2
Causes of Behavioral Emergencies
Organic Brain Syndrome
• Caused by disturbance in brain tissue
function
Functional Disorder
• Cannot be traced to change in
structure or physiology of the brain
2
Organic Brain Syndrome
Causes include:
•
•
•
•
•
•
•
•
Sudden illness
Recent trauma
Drug or alcohol intoxication
Diseases of the brain
Low blood glucose
Lack of oxygen
Inadequate blood flow to the brain
Excessive heat or cold
2
Safety Guidelines
• Be prepared to
spend extra time.
• Have a plan of
action.
• Identify yourself.
• Be calm.
• Be direct.
• Assess the scene.
• Stay with patient.
• Encourage purposeful
movement.
• Express interest.
• Do not get too close.
• Avoid fighting.
• Be honest and
reassuring.
• Do not judge.
2
Scene Size-up
1. Scene Size-up
• Scene safety is most
important. Consider calling
appropriate resources if
needed.
• Take BSI precautions at all
times.
• Avoid tunnel vision.
2
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
•
•
•
•
•
Start from the doorway.
State why you are there.
Decide SICK/NOT SICK.
Be calm and relaxed.
Provide appropriate
interventions.
• Transport to appropriate
facility based on condition.
2
Focused History/Physical Exam
1. Scene Size-up
• If unconscious, do rapid
exam for life threats.
2. Initial
• Assess three major areas
Assessment
as contributors:
3. Focused History/ • Is patient’s CNS
functioning properly?
Physical Exam
• Are hallucinogens or other
drugs or alcohol a factor?
• Are psychogenic
circumstances, symptoms,
or illness involved?
2
Focused History/Physical Exam
1. Scene Size-up
• Use reflective listening:
repeating what the patient
2. Initial
has said in question form
Assessment
to help patient expand
thoughts.
3. Focused History/
• Tears, sweating, blushing
Physical Exam
may be indicators.
• Look at patient’s eyes.
• Coping mechanisms are
stressed; perception of
reality may be distorted.
2
Detailed Physical Exam
1. Scene Size-up
2. Initial
Assessment
3. Focused History/
Physical Exam
4. Detailed Physical
Exam
• Rarely called for.
2
Ongoing Assessment
1. Scene Size-up
• Never let your guard down.
• Use law enforcement
2. Initial
personnel with transport if
Assessment
available.
3. Focused History/ • Give advance warning to
hospital.
Physical Exam
• Can involve legal matters;
4. Detailed Physical
document clearly and well.
Exam
• Be clear and specific on
restraint use.
5. Ongoing
Assessment
2
Interventions
• Be caring and careful.
• Intervene only to safely transport.
2
Suicide
• Depression is the single most significant
factor that contributes to suicide.
• An attempted suicide is a cry for help.
• Immediate intervention is necessary.
• Suicidal patients will usually exhibit
warning signs.
2
Critical Warning Signs of Suicide
• Does the patient have an air of
tearfulness, sadness, deep despair, or
hopelessness?
• Does the patient avoid eye contact,
speak slowly, or project a sense of
vacancy?
• Does the patient seem unable to talk
about the future?
• Is there any suggestion of suicide?
• Does the patient have any specific plans
relating to death?
2
Risk Factors for Suicide
• Are there any unsafe objects in the
patient’s hands or nearby?
• Is the environment unsafe?
• Is there evidence of self-destructive
behavior?
• Keep in mind the suicidal patient may be
homicidal as well.
2
Medicolegal Considerations
• Mental incapacity may take many forms.
• Once a patient has been determined to
have an impaired mental capacity, you
must decide if care is needed.
• Do not leave the patient alone.
• Obtain help from law enforcement as
necessary.
2
Consent
• When a patient is not mentally
competent, the law assumes that there
is implied consent.
• The matter is not always clear-cut with
psychiatric emergencies.
• If you are not sure about the situation,
request law enforcement assistance.
2
Limited Legal Authority
• As an EMT-B, you have limited legal
authority to require or force a patient
to undergo care.
• Police may put a patient in protective
custody to allow you to provide care.
• Know your local laws and protocols.
2
Restraints
• You cannot restrain a
patient unless it is an
emergency.
• Transport a disturbed
patient without
restraints if possible.
• If you must restrain
the patient, use only
reasonable force.
—Law enforcement
personnel should
be involved.
2
Potentially Violent Patients
Use a list of risk factors to assess the
level of danger:
• Past history
• Posture
• Scene
• Vocal activity
• Physical activity
2
Other Factors to Consider
•
•
•
•
•
•
Poor impulse control
History of uncontrollable temper
Low socioeconomic status
Substance abuse
Depression
Functional disorders
3
Ob/Gyn Emergencies
3
Female Reproductive System
3
Three Stages of Labor
First stage: Dilation of the cervix
Second stage: Expulsion of the infant
Third stage: Delivery of the placenta
3
Predelivery Emergencies
Preeclampsia
• Headache, vision disturbance, edema,
anxiety, high blood pressure
Eclampsia
• Convulsions resulting from hypertension
Supine hypotensive syndrome
• Low blood pressure from lying supine
3
Hemorrhage
• Vaginal bleeding that occurs before
labor begins
• If present in early pregnancy, it may be
a spontaneous abortion or ectopic
pregnancy.
3
Ectopic Pregnancy
• Pregnancy outside of the uterus
• Should be considered for any woman of
childbearing age with unilateral lower
abdominal pain and missed menstrual
period
• History of PID, tubal ligation, or previous
ectopic pregnancy
3
Placenta Problems
Placenta abruptio
• Premature
separation of the
placenta
Placenta previa
• Development of
placenta over the
cervix
3
Gestational Diabetes
• Develops only during pregnancy.
• Treat as regular patient with diabetes.
3
Scene Size-up
1. Scene Size-up
• Woman’s balance is
altered. Be aware for falls
and the need for spinal
stabilization.
• Use BSI.
• Usual threats to your
safety still exist.
• Be calm.
• Protect the mother and the
child.
3
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Is the mother in active
labor?
• Evaluate trauma or
medical problems first.
• Treat ABCs in line with
local protocols.
3
Focused History/Physical Exam
1. Scene Size-up
• Obtain full SAMPLE history,
and also:
2. Initial
• Prenatal history
Assessment
• Complications during
pregnancy
3. Focused History/
Physical Exam
• Due date
• Number of babies (twins)
• Drugs or alcohol
• Water broken
• Green fluid (meconium)
3
Focused History/Physical Exam
1. Scene Size-up
• Mainly abdomen and
delivery of fetus
2. Initial
• Based on her chief
Assessment
complaints and history
3. Focused History/ • Pay close attention to
tachycardia, hypotension,
Physical Exam
or hypertension.
3
Detailed Physical Exam
1. Scene Size-up
2. Initial
Assessment
3. Focused History/
Physical Exam
4. Detailed Physical
Exam
• Only if other treatments
are not required.
3
Ongoing Assessment
1. Scene Size-up
• Continue to reassess the
patient for changes in vital
2. Initial
signs. Watch for
Assessment
hypoperfusion.
3. Focused History/ • Notify hospital of your
preparations for delivery.
Physical Exam
• Document carefully,
4. Detailed Physical
especially baby’s status.
Exam
• Obstetrics is one of the
most litigated specialties in
5. Ongoing
medicine.
Assessment
3
Transport Decision
• If delivery is imminent, prepare for
delivery in warm, private location.
• If delivery is not imminent, transport on
left side if in last two trimesters of
pregnancy.
• If the patient was subject to spinal
injury, stabilize and prop backboard
with towel roll on right side.
3
Interventions
• Childbirth is natural, does not require
intervention in most cases.
• Treating the mother will benefit the
baby.
3
When to Consider Field Delivery
• Delivery can be expected within a few
minutes
• A natural disaster or other catastrophe
makes it impossible to reach a hospital
• No transportation is available
3
Preparing for Delivery
• Use proper BSI precautions.
• Be calm and reassuring while
protecting the mother’s modesty.
• Contact medical control for a decision
to deliver on scene or transport.
• Prepare OB kit.
3
Positioning for Delivery
3
Delivering the Baby
• Support the head as it emerges.
• Once the head emerges, the shoulders
will be visible.
3
Delivering the Baby, cont'd
• Support the head and upper body as
the shoulders deliver.
3
Delivering the Baby, cont'd
• Handle the infant firmly but gently as
the body delivers.
3
Complications
Unruptured amniotic sac
• Puncture the sac and push it away
from the baby.
Umbilical cord around the neck
• Gently slip the cord over the infant’s
head.
• It may have to be cut.
3
Postdelivery Care
• Immediately wrap the infant in a towel
with the head lower than the body.
• Suction the mouth and nose again.
• Clamp and cut the cord.
• Ensure the infant is pink and breathing
well.
3
Delivery of Placenta
• Placenta is attached to the end of the
umbilical cord.
• It should deliver within 30 minutes.
• Once the placenta delivers, wrap it and
take to the hospital so it can be
examined.
• If the mother continues to bleed,
transport promptly to the hospital.
3
APGAR Scoring
A
Appearance
P
Pulse
G
Grimace
A
Activity
R
Respirations
3
Neonatal Resuscitation
3
Chest Compressions to an Infant
1. Find the proper position
• Just below the nipple line
• Middle third of the sternum
2. Wrap your hands around the body, with
your thumbs resting at that position.
3. Press your thumbs gently against the
sternum, compressing 1/3 to 1/2 the
depth of the patient’s chest.
3
Chest Compressions to an Infant
• Ventilate with a BVM device after every
third compression.
• 100 compressions to 20 ventilations per
minute
• Continue CPR during transport.
3
Breech Delivery
• Presenting part is the
buttocks or legs.
• Breech delivery is usually
slow, giving you time to get
to the hospital.
• Support the infant as it
comes out.
• Make a “V” with your gloved
fingers then place them in
the vagina to prevent it from
compressing infant’s airway.
3
Rare Presentations
Limb presentation
• This is a very rare
occurrence.
• This is a true
emergency that
requires immediate
transport.
3
Rare Presentations, cont'd
Prolapsed cord
• Transport
immediately.
• Place fingers into
the mother’s vagina
and push the cord
away from the
infant’s face.
3
Excessive Bleeding
• Bleeding always occurs with delivery but
should not exceed 500 mL.
• Massage the mother’s uterus to slow
bleeding.
• Treat for shock.
• Place pad over vaginal opening.
• Transport to hospital.
3
Spina Bifida
• Defect in which the portion of the
spinal cord or meninges may protrude
outside the vertebrae or body.
• Cover area with moist, sterile
compresses to prevent infection.
• Maintain body temperature by holding
baby against an adult for warmth.
3
Abortion (Miscarriage)
• Delivery of the fetus or placenta before
the 20th week
• Infection and bleeding are the most
important complications.
• Treat the mother for shock.
• Transport to the hospital.
• Bring tissue that has passed through the
vagina to the hospital.
3
Twins
• Twins are usually smaller than single
infants.
• Delivery procedures are the same as that
for single infants.
• There may be one or two placentas to
deliver.
3
Delivering for Addicted Mothers
• Ensure proper BSI precautions
• Deliver as normal.
• Watch out for severe respiratory
depression and low birth weight.
• Infant may require immediate care.
3
Premature Infants and Procedures
• Delivery before 8
months or weight less
than 5 lbs at birth.
• Keep the infant warm.
• Keep the mouth and
nose clear of mucus.
• Give oxygen.
• Do not infect the infant.
• Notify the hospital.
3
Fetal Demise
• An infant that has died in the uterus
before labor
• This is a very emotional situation for
family and providers.
• The infant may be born with skin
blisters, skin sloughing, and dark
discoloration.
• Do not attempt to resuscitate an
obviously dead infant.
3
Delivery Without Sterile Supplies
• You should always have goggles and
sterile gloves with you.
• Use clean sheets and towels.
• Do not cut or clamp umbilical cord.
• Keep placenta and infant at same level.
3
Gynecologic Emergencies
• Do not examine genitalia unless there is
obvious bleeding.
• Leave any foreign bodies in place, after
packing with bandages
• Treat as any other patient with blood
loss.
Questions
• What questions do you have?
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