Transcript Bumps and Babes

By Christopher I’Anson
SJA Advanced Student Doctor
Leeds LINKS training Officer 2012-13
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Something that is not really covered much...
 Obstetrics:
▪
▪
▪
▪
Bleeding
Less movement
Birth/delivery
Unconscious or fitting
 Babies:
▪ CPR
 Children:
▪
▪
▪
▪
Communication
Reference ranges
Medications
CPR
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Obstetrics= babies inside the womb
(pregnancy)
 From conception-birth
 The womb (uterus) increases in size as the baby
grows
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If you can remember, ask:
 How many weeks pregnant they are
 When they are due
 Any problems in the past with this or other
pregnancies
 Everything okay with this pregnancy so far
 Number of babies
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Movements:
 Babies first start to move inside the womb
between 16-25 weeks
 This is normal
 Mums usually know what is normal amount for
their baby
 Can become decreased normally (sleep) or
abnormally
▪ If in doubt send to hospital
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There are several things that can occur:
 Bleeding
 Trauma
 Less movements
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These should be dealt
with as serious and
needing hospital
referral
Vulnerable adult?
 Yes pregnant women are; they are more likely to
experience domestic violence
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Delivery:
 Not necessarily an emergency although the
mother should get to hospital sooner rather that
later
 Signs:
▪ Contractions/ pain (1st in 90%)
▪ Waters breaking
▪ Bleeding (be cautious)
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What to do?
 Do NOT try to deliver the baby! (unless you are
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trained at have the correct equipment)
Call for an 999 if delivery is imminent or you are
concerned
Treat any other problems like shock
Make them comfortable
No medications!
Can have small sips of water
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This is a serious condition!
It is where a pregnant patient fits due to high
blood pressure (after pre-eclampsia)
Actions:
 ABCDE
 Call 999 and extra help if needed
 Try and place patient in the recovery position*
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Slightly different!
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Try to put the patient on to their left side
 Does it matter?
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Put support under their back
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Babies:
▪ Spotting the sick child
▪ CPR
▪ Choking
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Children:
▪
▪
▪
▪
Communication
Reference ranges
Medications
CPR
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Not going into much detail about them
 Do not see often
 Should be seen by an experienced HCP
▪ Hospital and or duty HCP
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Signs:
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Crying
Grunt (in infants)
Cyanosis (blue)
Intercostal recession
Subcostal recession
Tracheal tug
Increased respiratory rate
Nasal flaring
http://www.youtube.com/watch?v=
U-RfbrnMJZE&feature=related
http://www.youtube.com/watch?v=s
JLHiTaXrtc
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CPR:
 Most likely needed due to respiratory arrest
 5 starter breaths
 Compressions
▪ Two fingers (same place)
▪ 1/3 of the chest
 30/2
 DEMO
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Chocking
•Position the child as shown
GROSE!
•5 back blows (lighter than adults)
Not worked
•Chest compressions
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The main difficulty with children is
communication
 Varies from age to age
 Varies from child to child
 Varies from situation
 Children can be inadvertently misleading
 Will respond to closed question (will go with what
you say)
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Children can not localise or describe
symptoms well
 Do not understand
 Not experienced enough to localise/ describe
 E.g. Tummy pain may mean head pain
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Ask mum/ parent
Get child to be engaged
 Play
 Be silly (having a few magic tricks will help)
 Talk to them
▪ At their level (height and age)
▪ Even if to young to reply
Age
Resps
Pulse
BP (systolic)
<1
30-40
110-160
70-90
2-5
20-30
95-140
80-100
5-12
15-20
80-120
90-110
>12
12-20
60-100
100-120
Age
Dose of
Paracetamol
Minimum interval
Max in 24hrs
3months-1 year
125mg
4 hours
500mg
1-5 years
250mg
4 hours
1g
6-12 years
500mg
4 hours
2g
>12years
500-1000mg
4 hours
4g
DRABC(s)
5 starter
breaths
30:2
(one handed)