Obstetrical Emergencies - PowerPoint PPT Presentation


PPT – Obstetrical Emergencies PowerPoint presentation | free to download - id: 3be278-ZGNhO


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Obstetrical Emergencies


Obstetrical Emergencies Silver Cross EMS CME June 2011 2nd Trimester Instructor/Author: Lonnie Polhemus RN, NREMT-P Detailed Delivery Instructions Re-suction the baby ... – PowerPoint PPT presentation

Number of Views:621
Avg rating:3.0/5.0
Slides: 95
Provided by: willgrund


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Obstetrical Emergencies

Obstetrical Emergencies
  • Silver Cross EMS CME
  • June 2011 2nd Trimester
  • Instructor/Author Lonnie Polhemus RN, NREMT-P

OB/GYN Emergencies
  • Many types of emergencies can occur with female
    reproductive system
  • Gravid and non-gravid
  • Following information will help you refresh
    assessment treatment skills for emergency
    childbirth gynecological emergencies

Because we have to have objectives
  • Identify anatomic structures and functions of
    female reproductive system.
  • Demonstrate basic understanding of pregnancy
    physiology and menstrual cycle, ovulation, and
    fetal development.
  • Identify signs/symptoms and proper care for
    gynecological emergencies.
  • Identify key aspects of evaluating pregnant
    patient to determine if birth is imminent.
  • Identify purpose and use of tools in an OB kit.

More objectives
  • Identify steps for normal delivery of infant.
  • Identify how and when to cut umbilical cord.
  • Identify steps for post-delivery care of
    newborn/mother including placenta delivery.
  • Identify critical treatment interventions for
    pregnancy complications
  • breech (buttocks) or limb presentation
  • shoulder dystocia
  • prolapsed cord
  • postpartum bleeding.
  • Identify steps for assessing infant APGAR score.
  • Identify steps for neonatal resuscitation

Terms to become familiar with
  • abruptio placenta When placenta prematurely
    separates from uterine wall, causing heavy
    internal bleeding and pain
  • Can occur as a result of trauma.
  • bloody show Mucous and blood that comes from
    vagina as first stage of labor begins.
  • Cervix sealed by a plug of mucus during pregnancy
    to prevent contamination.
  • When cervix dilates, plug expelled as pink-tinged
  • crowning Bulging out of the vaginal opening
    caused by the babys head pressing against it.

And these too
  • dilation To get larger or enlarge.
  • Degree of dilation of cervix often key indicator
    used by midwives and physicians to determine if
    birth is imminent.
  • EMTs/paramedics do not perform this test.
  • Process occurs over a period of several hours in
    some women, but can take much longer.
  • eclampsia (toxemia) Serious condition that can
    develop in the third trimester.
  • Characterized by high blood pressure and
    excessive swelling in the extremities and face.
  • Life-threatening seizures differentiate eclampsia
    from preeclampsia.

A few more terms
  • ectopic pregnancy Condition where fertilized
    egg implants outside uterus, often in fallopian
  • Symptoms can include abdominal pain, bleeding
    (intraperitoneal or vaginal).
  • effacement Term relating to thinning of cervix.
  • meconium Dark-green fecal material found in
    intestines of full-term babies.
  • Ordinarily meconium is passed after a baby is
  • In some cases, meconium expelled into the
    amniotic fluid prior to birth.
  • Gives fluid greenish-brown color known as
    meconium staining.

Almost done
  • placenta previa A condition where placenta sits
    low in uterus, blocking cervix.
  • Can present with painless, bright red bleeding.
  • postpartum A term used to describe the period
    shortly after childbirth.

Only three more terms
  • preeclampsia Condition in pregnant women
    characterized by high blood pressure, abnormal
    weight gain, edema, headache, protein in the
    urine, and epigastric pain.
  • If untreated, preeclampsia can progress to
  • supine hypotensive syndrome Weight of unborn
    fetus and uterus puts pressure on inferior vena
  • Result is inadequate venous blood return to the
    heart, reduced cardiac output, and lowered blood

Last one for now
  • Braxton-Hicks Defined by Taber's Medical
    dictionary as intermittent, painless contractions
    that may occur every 10 to 20 minutes after the
    first trimester of pregnancy.
  • First described in 1872 by British gynecologist
    John Braxton Hicks.
  • Sometimes called pre-labor contractions or Hicks
  • Not everyone will notice or experience these
    contractions, and some will have them frequently.
  • Some mothers notice them more in subsequent
    pregnancies than in first pregnancy.

Female Anatomy of the reproductive organs
  • Cervix opening of the uterus
  • First stage of birth, cervix opens thins
  • Allows fetus to move into vagina
  • Opening process called dilation
  • Endometrium inner lining of uterus
  • Each month built up in anticipation of
    implantation of fertilized egg
  • Fertilization does not occur, lining simply
    sloughs off
  • Referred to as menstrual period
  • Fallopian tubes long slender passageways
    connect uterus to ovary
  • Female egg (ovum) passes through structure on
    its way to uterus for implantation to uterine
  • Ovaries two almond-sized glands located on
    each side of uterus behind below fallopian
  • Produce estrogen progesterone in response to
    follicle stimulation hormone (FSH) luteinizing
    hormone (LH) secreted from pituitary gland

Female Anatomy
  • Perineum area between vaginal opening anus
  • It sometimes is torn during birth which causes
  • Uterus pear-shaped, muscular organ holds fetus
    during pregnancy
  • Contracts to push fetus through cervix into
    vagina during birth
  • Vagina flexible, muscular tube about three
    inches long
  • Called birth canal
  • Fetus moves from uterus through cervix into
    vagina then out of mothers body

Fetal Anatomy
  • Placenta develops early in pregnancy performs
    important functions
  • Exchanges respiratory gases
  • Transports nutrients from mother to fetus
  • Excretes waste
  • Transfers heat
  • Active endocrine gland produces several
    important hormones
  • Attached by umbilical cord
  • Vein - transports oxygenated blood toward fetus
  • Artery return deoxygenated blood to placenta
  • Amniotic sac develops early in pregnancy
  • Consists of membranes surround protect
    developing fetus
  • Fills with amniotic fluid cushions fetus
    provides stable environment
  • Umbilical cord attaches fetus to placenta
  • Contains one vein two arteries
  • Vessels in umbilical cord similar to pulmonary
  • Arteries carry deoxygenated blood
  • Veins carry oxygenated blood
  • Newborn cord is about two feet long

Fetal Anatomy
Assessment of the OB/GYN patient
  • Recognition of pregnancy
  • Breast tenderness
  • Urinary frequency
  • Amenorrhea
  • Nausea/Vomiting

  • Obstetric History
  • Gravidity and Parity
  • Gravidity Number of pregnancies
  • Parity Number of live births

  • Obstetric History
  • Last normal menstrual period
  • Estimated delivery date (-3/7)
  • Previous Ob-Gyn complications
  • Prenatal care (by whom)
  • Previous Cesarean sections

  • Obstetric Physical Exam
  • Evaluation of Uterine Size
  • 12 to 16 weeks above symphysis pubis
  • 20 weeks at umbilicus
  • For each week beyond 20 weeks 1 cm above
  • At term near xiphoid process

  • Obstetric Physical Exam
  • Presence of fetal movements
  • 20th week
  • Presence of fetal heat tones
  • 20th week
  • Normal 120 to 160/minute

  • Presence of Pain
  • Abdominal pain in last trimester suggests
    abruption until proven otherwise
  • Appendicitis may present with RUQ pain

  • Presence of vaginal bleeding
  • Always dangerous in first trimester
  • Dangerous in late pregnancy if greater than
    normal period

  • General health
  • Diabetes may become unstable
  • Hypoglycemic episodes in early pregnancy
  • Hyperglycemia as pregnancy progresses
  • Hypertension complicated by PIH
  • Cardiovascular disease may worsen

  • Warning signs
  • Vaginal bleeding
  • Swelling of face, hands
  • Dimmed, blurred vision
  • Abdominal pain

  • Warning signs
  • Persistent vomiting
  • Chills, fever
  • Dysuria
  • Fluid escape from vagina

Menstrual cycle
  • Womans monthly hormonal cycle in which uterus
    prepares to receive egg
  • Then discharges a bloody fluid
  • Cycle repeats on average every 28 days, but can
    vary widely

Menstrual cycle
  • Days 1 to 5
  • Egg not fertilized, hormone levels lower, causes
    thickened lining of uterus to shed
  • Results in a womans period
  • First day of menstrual bleeding is Day 1 in
    menstrual cycle
  • Days 6 to 14
  • Pituitary gland produces hormone, stimulates
    ovaries to develop follicles
  • Each follicle contains an egg
  • Only one egg reaches maturity has potential to
    become fertilized
  • Hormone levels increase, lining of uterus
    thickens prepares to receive mature egg
  • Days 10 to 18
  • Hypothalamus pituitary glands release hormone,
    mature follicle bursts releases egg
  • Ovulation typically occurs midway through
    menstrual cycle on Day 14
  • Egg begins its journey down fallopian tubes to
  • Time period when a woman is most likely to
    become pregnant
  • Days 16 to 28
  • After releasing egg, ruptured follicle secretes
  • Progesterone continues to thicken lining of
    uterus in preparation for fertilized egg
  • If egg is fertilized by sperm, it implants in
    lining of uterus
  • If egg not fertilized or implanted, lining of
    uterus shed again at next menstrual cycle

Pelvic Inflammatory Disease
  • Pelvic inflammatory disease (PID) infection of
    female reproductive tract
  • Organs most commonly involved
  • Uterus
  • Fallopian tubes
  • Ovaries
  • Occasionally, peritoneum intestines

Pelvic Inflammatory Disease
  • Symptoms of PID include
  • Lower abdominal pain
  • Fever
  • Abnormal vaginal discharge
  • Painful intercourse
  • Irregular menstrual bleeding
  • Pain in right-upper quadrant
  • Vaginal bleeding lower abdominal pain can
    indicate serious gynecological problem
  • Maintain high index of suspicion when

Pelvic Inflammatory Disease
  • Causes of PID
  • Gonorrhea Chlamydia infections
  • Can progress undetected before PID symptoms
  • Other bacteria, such as staph or strep.
  • Acute or chronic
  • Allowed to progress untreated, sepsis can develop
  • Most common symptom of PID moderate to severe,
    lower abdominal pain

Vaginal Bleeding
  • Vaginal bleeding not result of direct trauma or
    normal menstrual cycle can indicate serious
  • Difficult to isolate specific cause, treat all
    vaginal bleeding as if there is serious
    underlying condition
  • Especially true if bleeding associated with lower
    abdominal pain

Vaginal Bleeding
  • Treatment depends on patients needs, but may
    include the following
  • Maintain ABCs
  • Control bleeding, if possible
  • Administer oxygen
  • Place in shock position
  • Provide fluid replacement
  • Large bore IV if needed

Dilation and Curettage (DC)
  • Dilation opening of the cervix
  • Curettage scraping the walls of uterus
  • Surgical procedure usually done on outpatient
    basis under local anesthesia
  • Diagnose conditions such as cancer
  • Remove tissue after miscarriage
  • Elective abortion
  • Complications
  • Heavy bleeding uncommon
  • Patients with heavy bleeding
  • Evaluate for signs of shock
  • Expedite transport to hospital

Ectopic Pregnancy
  • Egg released from ovary, cyst often left in its
  • Cyst fluid-filled sac that is often enlarged
  • Can rupture cause abdominal pain
  • Occasionally cysts develop independent of

Sexual Assault
  • Rape any genital, oral or anal penetration by a
    body part or object, through use of force or
    without victim's consent
  • It is a crime of violence with serious physical
    and psychological implications

Sexual Assault
  • Trauma to womans external genitalia can be
    difficult to treat
  • Need to maintain patients modesty
  • Rich network of nerves in external genitalia
    makes such injuries painful
  • Tends to bleed profusely due to rich blood supply
  • Treat open genitalia wounds with sterile
  • Use direct pressure to control bleeding if
  • Do not place dressings in the vagina

  • Pregnancy begins with ovulation in female
  • Fourteen days before beginning of next menstrual
    period, ovary releases egg into the fallopian
  • Egg enters fallopian tube for transportation to
  • Intercourse 24-48 hrs before ovulation
  • Fertilization should occur in fallopian tube

  • Once fertilized, egg begins to divide
  • Fertilized egg continues down fallopian tube to
  • Attaches to endometrium

  • Direct abdominal trauma can cause
  • Premature separation of placenta from uterine
  • Premature labor
  • Abortion
  • Uterine rupture
  • Fetal death
  • Fetal death can result from
  • separation of placenta from uterine wall
  • maternal shock
  • uterine rupture
  • fetal head injury

Gestational Diabetes
  • Some women develop diabetes during pregnancy
  • Pregnant diabetics prescribed insulin if blood
    sugar cannot be controlled by diet alone
  • Cannot be managed with oral drugs
  • They are absorbed into placenta can adversely
    affect fetus

Ectopic Pregnancy
  • Implantation of growing fetus in location other
    than endometrium
  • Most common site is in one of the fallopian
  • Surgical emergency because tube can rupture
    cause massive bleeding

1 month gestation
6 weeks gestation
Ectopic Pregnancy
  • Patients with ectopic pregnancy often have
    one-sided, lower abdominal pain
  • Late or missed menstrual period
  • Occasionally vaginal bleeding
  • Life-threatening emergency
  • Treat for shock, initiate immediate transport

Vaginal Bleeding (Gravid)
  • Vaginal bleeding during pregnancy cause for
  • Bleeding in early pregnancy often associated
  • spontaneous abortion
  • ectopic pregnancy
  • vaginal trauma
  • Vaginal bleeding in third trimester usually
    caused by
  • abruptio placenta
  • placenta previa
  • trauma to vagina or cervix
  • Can be a life-threatening emergency!

Vaginal Bleeding (Gravid)
  • Range light spotting to massive hemorrhage
  • Difficult to find cause of in field
  • Suspect placenta previa, abruptio placenta, or
    vaginal trauma in third trimester bleeding

Abruptio Placenta
  • Premature separation of placenta from wall of
  • Separation either partial or complete
  • Complete separation usually results in death of
  • Several factors may predispose patient to
    abruptio placenta
  • Preeclampsia
  • Maternal hypertension
  • Multiparity
  • Abdominal trauma
  • Short umbilical cord

Placenta Previa
  • Attachment of placenta in lower part of uterus
    covering cervix
  • Unless sonogram done, placenta previa usually is
    not detected until third trimester
  • When fetal pressure on placenta increases or
    uterine contractions begin, cervix thins out
    resulting in bleeding from placenta

Gravid Hypertension
  • Preeclampsia condition characterized by high
    blood pressure, abnormal weight gain, edema,
    headache, protein in urine
  • Eclampsia characterized by high blood pressure
    excessive swelling in extremities face
  • Life-threatening seizures differentiate eclampsia
    from preeclampsia

  • Variety of signs and symptoms including
  • Hypertension
  • Abnormal weight gain
  • Edema
  • Headache
  • Protein in the urine
  • Epigastric pain
  • If untreated, preeclampsia can progress to

  • Eclampsia, also called toxemia, most serious
    manifestation of hypertensive disorders of
  • Characterized by grand mal seizures
  • Often preceded by visual disturbances such as
    flashing lights or spots before the eyes
  • Eclampsia patients often experience swelling of
    hands feet markedly elevated blood pressure
  • If eclampsia develops, death of mother fetus
    frequently results
  • Treat by lying mother on her side, maintaining
    airway, delivering high-flow oxygen

Supine Hypertensive Syndrome
  • Supine hypotensive syndrome occurs when increased
    weight of uterus compresses inferior vena cava
    while a patient is supine
  • Markedly decreases blood return to heart
    reduces cardiac output
  • Some women are predisposed to this condition
    because of an overall decrease in circulating
    blood volume or anemia

Take 5.
  • Take a five minute break.
  • Enjoy this movie interlude. Remember the volume
    for movies comes from the computer, not the
  • See you in five!

Emergency Childbirth
  • Usually not a big deal unless something hits the

Signs of Imminent Delivery
  • Main task in evaluating expectant mother is to
    determine if delivery is imminent
  • Expose abdomen genital area, taking care to be
  • Visually inspect the abdominal vaginal areas
    for bleeding or crowning
  • Prepare for immediate delivery if observe any of
    the following
  • Crowning
  • Contractions less than 2 minutes apart
  • Rectal fullness
  • Feeling of imminent delivery

  • Crowning appearance of any part of fetus in
    mothers vagina
  • Remove enough of mothers clothing to view
    genital region
  • Look for bulging at vaginal opening or a
    presenting part of infant

  • Occur at regular intervals ranging from 30
    minutes to 2 minutes or less
  • Labor pain from contractions lasts from 30
    seconds to 1 minute
  • As birth approaches, interval between
    contractions gets shorter
  • Contractions that occur within 2 minutes of each
    other, from end of one to beginning of next,
    signify impending delivery
  • Consider transporting mother if baby does not
    deliver after 20 minutes of contractions 2 to 3
    minutes apart
  • Labor is generally prolonged for mothers first
  • Average is 12 to 17 hours which allows plenty of
    time for transport

Rectal Fullness
  • Rectal fullness or sensation of having to move
    ones bowels can indicate infants head is in
    vagina pressing against the rectum
  • Delivery is imminent
  • Do not let the mother sit on the toilet

Feeling of Imminent Delivery
  • Mothers who have previously given birth often
    know when ready to deliver
  • Labor tends to be shorter after first child
  • Use your judgment given circumstances
  • When evaluating mother, keep in mind four signs
    of imminent delivery
  • Consider transport time

Preparing for Delivery
  • Don sterile gloves, gown, and eye protection
  • Position mother on her back, legs drawn up
  • Provide supplemental oxygen
  • Prepare OB kit
  • Prepare infant BVM
  • IV is optional at this point

Take a look
  • Presentations you cant deliver safely
  • Single limb
  • Prolapsed cord
  • Presentations you can deliver
  • Head first
  • Umbilical cord wrapped
  • Shoulder dystocia
  • Breech (Buttocks first)
  • Double footling

Assisting With Delivery
  • Support head with gentle pressure
  • Check if cord is wrapped around babys neck
    attempt to loosen
  • Apply gentle downward pressure on shoulder head
  • After anterior shoulder has delivered, apply
    gentle upward pressure
  • Suction mouth nostrils when head appears
  • Once delivered, stimulate infant if it does not
  • Put two clamps on umbilical cord cut 6 inches
    from navel

Amniotic sac
  • During first stage of labor amniotic sac usually
    breaks, expelling amniotic fluid
  • If sac is still covering infants head when head
    appears, use a finger to pierce sac
  • Very tough membrane
  • Note color character of amniotic fluid
  • Fluid can be clear or straw-colored (which is
  • Tainted, discolored, thick or pea soup-like
    (which indicates meconium staining or a bad
    intra-uterine infection)

Detailed Delivery Instructions
  • Encourage the mother to breath deeply between
    contractions and push with contractions.
  • As the baby crowns, support with gentle pressure
    over perineum to avoid an explosive birth.
  • If the amniotic sac is still intact, rupture it
    with a finger to allow amniotic fluid to leak

Detailed Delivery Instructions
  • If the umbilical cord is wrapped around the
    babys neck, gently slip it over the head.
  • Do not force it.
  • If the cord is too tight to slip over the head,
    apply umbilical cord clamps and cut the cord.
  • Clamp and cut the umbilical cord only if he
    babys head has emerged and is in a position that
    lows you to manage the airway.

Detailed Delivery Instructions
  • Re-suction the babys mouth nostrils
  • Dry wrap baby in a warm blanket cover its
  • Place baby on its side to facilitate drainage
  • Perform an APGAR assessment at 1 minute 5
    minutes after delivery

Infant care
  • Baby not breathing stimulate it
  • If newborn does not start breathing effectively
    within 10 15 seconds of stimulation
  • Blow-by oxygen
  • If no response
  • use infant BVM to deliver gentle puffs of air
    enough to cause the chest to rise
  • If after 30 seconds of assisted ventilation there
    is no response
  • heart rate lt60 beats/min
  • begin CPR

CPR - Two-Thumb Encircling Hands Technique
  • CPR technique for infant with pulse rate below 60
  • Place infant on a firm, flat surface
  • Remove clothing from chest
  • Find compression site which is just below nipple
    line on middle or lower third of sternum
  • Wrap your hands around upper abdomen with your
    thumbs on compression site
  • Use your thumbs to deliver gentle pressure
    against sternum, pressing ½ to ¾ inch into chest

Infant Care
  • If signs of meconium are present, do not
    stimulate infant
  • suction mouth nose
  • This avoids aspiration of fecal material that can
    cause pneumonia
  • Good antibiotics to treat bacteria but we would
    rather not need to

  • APGAR scale numerical measure of babys overall
    condition immediately after birth
  • Healthy baby will have total score of 10
  • Many babies score 7 to 8 during first minute
  • By 5 minutes, most babies score 8 to 10
  • APGAR stands for
  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respirations


Managing a Poor APGAR Score
  • Three things to remember when managing infant
    with low APGAR score position, suction and
    stimulate (PSS)
  • Position body so head is down airway is open
  • Suction mucous fluid from mouth nostrils
  • Stimulate infant by taping bottoms of feet
  • PSS memory aid to help recall these steps
    position, suction and stimulate

Care for mom after birth
  • Once baby delivered umbilical cord cut
    clamped you should
  • Monitor and control bleeding from mother
  • Begin fundal massage
  • Monitor vital signs
  • Keep the mother and baby warm
  • Transport once infant is delivered
  • Do not wait for placentamay take up to 30
    minutes to deliver
  • Do not pull on umbilical cord
  • If placenta does deliver at scene, transport
    with mother baby to hospital

Care for mom after birth
  • After placenta delivered, place sanitary napkin
    between mothers legs
  • Ask her to hold legs together
  • Normal for mother to bleed up to one cup (about
    250 cc) or 5 sanitary napkins of blood after
  • Record number of pads
  • Now it is time for an IV for fluid replacement

Fundal Massage
  • Makes uterus contract diminishes vaginal
  • Can feel for fundus of uterus
  • located in abdomen between pubic bone
  • Should feel like a softball
  • Perform massage like you would a muscle massage
  • Area may be tender massaging it can cause
  • Be gentle but use some muscle

  • Field care

Nuccal Cord
  • Once head delivered ask mother to stop pushing so
    you can check if cord is wrapped around infants
  • If cord looks like it is wrapped tightly, so as
    to constrict airway, need to loosen it
  • Gently slip cord over babys head by placing two
    fingers under cord at back of neck

Nuccal Cord
  • Bring cord over shoulders head
  • Cord durable, it can tear if handled roughly so
    dont use excessive force
  • Too tight to loosen, clamp cord in two places two
    inches apart
  • Cut cord between clamps
  • Unwrap cord from around neck take care not to
    injure baby

Shoulder Dystocia
  • Labor progresses normally head delivered
  • However, immediately after head delivers,
    shoulders become trapped between symphysis pubis
    sacrum, preventing further delivery
  • First step in treating shoulder dystocia is
    recognizing when it occurs
  • Two main signs of shoulder dystocia are
  • Babys body does not emerge with standard
    moderate traction maternal pushing after
    delivery of babys head
  • Turtle Sign head suddenly retracts back
    against mothers perineum after it emerges from

Buttocks Double Footling Presentation
  • If buttocks or two feet present first, you can
    attempt delivery in field
  • These are generally slow deliveries you likely
    have time to transport
  • Position mother with buttocks at edge of bed
  • Hold mothers legs in flexed position
  • Support infants legs do not pull
  • As head passes pubis, apply gentle upward
    traction until mouth appears
  • If head is stuck, create airway by pushing away
    vaginal wall transport immediately

When the head does not deliver
  • Create airway for infant
  • First, place gloved hand into vagina with your
    palm towards infants face
  • Form a V with index middle finger on either
    side of infants nose
  • Push vaginal wall away from infants face to
    allow unrestricted breathing
  • Maintain airway transport immediately

Single limb presentation
  • Support baby with your hands
  • Provide airway for baby using your fingers if
  • Transport immediately do not attempt delivery
    in field
  • Supportive care for mother

Cord Presentation
  • If you see umbilical cord presenting before the
    baby, initiate the following steps
  • Place mother in knee-chest position
  • Check umbilical cord for pulsations
  • No pulsations - press presenting part of fetus
    away from umbilical cord, towards mothers head
  • Re-check cord for pulsations
  • Administer high flow oxygen to mother
  • Transport immediately fetus will die without
    rapid intervention
  • Continue holding presenting part of baby away
    from umbilical cord
  • Apply moistened dressing on exposed umbilical
  • Do not push umbilical cord back into vagina

  • Key structures of female reproductive system
  • Cervix
  • Endometrium
  • Fallopian tubes
  • Ovaries
  • Perineum
  • Uterus
  • Vagina
  • The key structures of fetal anatomy include
  • Placenta
  • Amniotic sac
  • Umbilical cord

  • Fetus has excellent chance of survival after the
    seventh month of pregnancy
  • Pregnant women more susceptible to traumatic
    injury because of the increased vascularity of
  • Patients with ectopic pregnancy often have
    one-sided abdominal pain, late or missed period,
    occasionally vaginal bleeding
  • Vaginal bleeding in third trimester usually
    caused by abruptio placenta, placenta previa, or
  • To relieve supine hypotensive syndrome tilt the
    pregnant patient to one side

  • Key points for assisting with normal delivery
  • Support head with gentle pressure
  • Check if cord wrapped around babys neckif so,
    attempt to loosen
  • Apply gentle downward pressure on anterior
    shoulder and head
  • After anterior shoulder has delivered, apply
    gentle upward pressure on posterior shoulder
  • Suction mouth and nostrils when head appears
  • Once delivered, stimulate newborn if it does not
  • Put two clamps on umbilical cord cut 6 inches
    from navel

  • Care for newborn infant includes
  • Stimulate infant if not breathing sufficiently
  • Start CPR if no response after 30 seconds
  • Keep infant warm
  • Repeat suctioning of mouth nose
  • Check APGAR score at 1 5 minutes

  • APGAR stands for appearance, pulse, grimace,
    activity, respirations
  • Care of mother includes
  • Monitor control bleeding from mother
  • Begin fundal massage
  • Monitor vital signs
  • Keep mother baby warm
  • If head remains stuck during buttocks or double
    footling presentation, create airway by pushing
    away vaginal wall then transport immediately
  • Important steps in caring for postpartum bleeding
    include fundal massage and treatment of shock

Silver Cross EMS skill o the month!
  • Dexi!

No, not Dixie
Dexi as in blood sugar
  • Should be checked on every ALS patient.
  • After all, we are starting IVs anyway, so we
    have plenty of blood.
  • Should also be checked on every altered mental
    status, dizziness, weakness and fall.
  • Falling is a symptom, not a complaint.
  • Also, any patient who is a diabetic should have a
    sugar tested.
  • Low blood sugar is scary to have and easy to fix,
    thats why we should always check for it.

Testing Tips
  • Of course you should always be wearing gloves.
  • Choose a finger.
  • Diabetic patients will often tell you which
    finger they prefer.
  • Wipe finger with alcohol wipe, let dry
  • Insert a test strip into your meter.
  • Some models like you to put the blood on the
    strip before testing. Know your model.
  • Use lancing device on SIDE of fingertip to get
    drop of blood.
  • Closer to the nail the better people need the
    pads of their fingers to do stuff!
  • Or use whatever method you prefer to get the
    blood from an IV catheter.
  • You may have to squeeze or massage the finger to
    get enough blood out.
  • But too much squeezing/massaging can change the
    character of the blood.
  • Hold hand downward to allow gravity to help.

Dexi tips continued
  • Touch and hold the edge of the test strip to the
    drop of blood, and wait for the result.
  • Blood glucose level will appear on the meter's
  • Many models read hi or low when sugar is
    below 20 or above 600. Know your meter.
  • Some newer meters out there let you use forearm,
    thigh or fleshy part of hand.
  • Its OK to use the patients meter in a pinch, or
    let him/her do it, but always check with yours as
  • Patients glucometer may not have been calibrated
  • Plus a lot of patients are not too good at finger
    hygiene eww!

References King County EMS American Heart
Association Tabers Medical Dictionary American
Diabetes Association
  • Ask Dr Dave
  • Send extra questions to AFinkel_at_Silvercross.org
About PowerShow.com