Lecture 10: Obstetrics and Neonatal Care and Pediatric Emergencies

The ovaries contain _____ that produce _____. If fertilized, these implant in the _____, the lining of the uterus.

Follicles; eggs; endometrium

One _____ for each ovary extends laterally from the uterus.

Fallopian tube

The uterus is a muscular organ responsible for _____. It contracts during labor to push the fetus through the _____.

Enclosing and protecting a developing fetus; birth canal

The perineum is the _____.

Tissue between the vagina and the anus

The umbilical cord contains 2 _____ and 1 _____, the latter of which carries _____.

Arteries; vein; oxygen

The amniotic sac contains _____.

500 to 1000 mL of amniotic fluid

The placenta is an organ responsible for allowing exchange of _____, _____, _____, _____, _____, and _____, connecting to the baby via the _____. The placental barrier consists of 2 layers of cells that allow for the passing of _____ but not _____.

Nutrients; waste; oxygen; carbon dioxide; medications; toxins; umbilical cord; nutrients; blood

During pregnancy, _____ increases up to 50% to increase perfusion to the uterus and prepare for loss during birth.

Blood volume

During pregnancy, blood clots _____.

Faster

During pregnancy, _____ increases up to 20%.

Resting heart rate

During pregnancy, the uterus pushes up on the _____, reducing the ability to _____.

Diaphragm; breathe deeply

During pregnancy, weight gain creates increased workload on the _____ and _____ system.

Heart; musculoskeletal

During pregnancy, the _____ become more loose and less stable.

Joints

During pregnancy, changes in the center of gravity create an increased risk for _____.

Falls

Potential effects of substance abuse on a developing fetus include _____/_____, severe _____, and _____.

Prematurity/low birth weight; respiratory distress; death

Fetal alcohol syndrome refers to _____.

Infants born to women who have abused alcohol

Pregnant women have an increased chance of being victims of domestic abuse and violence. Abuse increases the chance of _____, _____/_____, and _____, _____, and/or _____. If you suspect domestic abuse when working with a pregnant patient, then _____.

Spontaneous abortion; prematurity/low birth weight; bleeding, infection, and uterine rupture'; talk to the patient in a private area away from the abuser

Multiple gestation occurs about 1 in every _____ births. These fetuses are _____ than single fetuses, easing _____. Approximately _____ after the first birth, contractions begin again and the process will repeat itself.

30; smaller; delivery; 10 minutes

Whenever working with a patient who is in their third trimester, place the patient on their _____ side.

Left

Pre-eclampsia refers to pregnancy-induced _____ that typically develops after the 20th week of pregnancy. Signs and symptoms include _____ (type of swelling), excessive _____, _____ (type of feeling), _____ (type of pain), and changes in _____.

Hypertension; edema; weight gain; anxiety; headache; vision

Eclampsia refers to _____ resulting from pregnancy-induced hypertension. Treat these patients as if they were _____ patients.

Convulsions; seizure

Supine hypotensive syndrome refers to _____ due to _____. Manage this condition by _____.

Low blood pressure when placed in the supine position; compression of the inferior vena cava; transporting the patient in the left lateral recumbent position

Gestational diabetes may complicate delivery due to the _____.

Size of the fetus

Ectopic pregnancy refers to when a _____, typically in a _____. Rupture can lead to _____, the leading cause of maternal death in the first trimester. Signs typically present within the first _____ of pregnancy.

Fertilized egg implants outside of the uterus; fallopian tube; internal hemorrhage; 6 to 8 weeks

Placenta abruptio refers to _____. Risk factors include _____ (related to patient history), chronic _____ and/or _____ (another pregnancy-related condition), _____ (type of injury), and _____ or _____ (lifestyle behaviors). Signs and symptoms include _____, but little _____ and uterine _____, _____, or _____.

Premature separation of the cervix; previous abruptions; hypertension and/or pre-eclampsia; falls or other trauma; smoking; cocaine use; pain; bleeding; rigidity; tenderness; contractions

Placenta previa refers to when the _____. Signs and symptoms include _____, but little _____.

Placenta forms over the cervix; bleeding, but little pain

The frequency of contractions refers to the _____. The duration of contractions refers to _____.

Time between the beginning of each contraction; how long each contraction lasts

Labor refers to continuous, progressively strengthening contractions of the uterus that help the cervix to dilate.

The first stage of labor refers to the _____ to _____. _____ during this stage, leading to a _____ and potential _____ due to the _____.

The second stage of labor refers to the _____ to the _____.

The third stage of labor refers to the _____ to the _____. In a normal delivery, there should be no _____ prior to this point.

Onset of regular contractions to full dilation of cervix; water breaks; gush of fluid; bloody show; mucus plug; full dilation of the cervix; delivery of the infant; delivery of the infant; delivery of the placenta; significant bleeding

Labor is generally longer _____ than _____, with an average of _____ for the first case.

Primagravida; multigravida; 12 to 16 hours

During labor, a patient may experience Braxton-Hicks contractions, which refers to _____ characterized by _____.

Preterm or false labor; irregular contractions

During labor, a patient may experience premature _____.

Rupture of the amniotic sac

Your transport decision is part of your primary assessment. When working with a pregnant patient, if delivery is not imminent, then _____. If delivery is imminent, then _____ and _____.

Transport the patient to the hospital in the left lateral recumbent position; prepare a warm, private place for delivery; stop the ambulance

The 4 signs of an imminent delivery are _____, _____, _____, and _____.

Contractions that are 2-3 minutes apart; a bulging perineum; a crowning patient; the patient expresses the need to push

What are the 13 questions you must ask when obtaining the history of a pregnant patient?

When is your expected due date OR when was your last menstrual period? Did you receive any prenatal care? Do you anticipate any complications? How many pregnancies have you had, including this one (gravida)? How many babies have you delivered (para)? Have you had any miscarriages or abortions?Have you had any multiple births (including this one)? Has your water broken, and if so, what color was it, and was there any material floating around in it (meconium)? Have you had any vaginal discharge or bleeding? Do you have any past medical conditions like hypertension, diabetes, etc? What type(s) of deliveries have you had in the past (vaginal vs. C-section)? When was the last time the baby moved? Are you currently taking any medications AND do you have any allergies?

When assessing a pregnant patient, check for _____, which is a sign of _____ and may cause _____.

Meconium staining; fetal distress; meconium aspiration syndrome

When preparing for delivery, start with _____ in the form of _____, _____, and _____. You should also call for _____. Position the patient in _____, and preserve their _____ while exposing the _____. Elevate the _____ about 2” to 4”, then cleanse the perineum to create a _____ by _____.

Additional BSI; eye protection; mask; gown; ALS; Semi-Fowler’s modesty; vagina; hips; sterile; using one sanitary wipe to wipe one side of the labia from top to bottom, then using another sanitary wipe to wipe the other side of the labia from top to bottom

After all preparations for delivery have been completed, don _____. Support the head as it emerges, then check for a _____. If present, gently slip it over the infant’s head. Next, guide the head _____ then _____ as the shoulders deliver. As the rest of the body delivers, handle the infant firmly but gently, remembering the infant will be _____. Never _____. Reduce the risk of perineal tearing by _____ with a sterile gauze pad.

Sterile gloves; nuchal cord; up; down; slippery; pull; applying gentle pressure on the perineum

If the amniotic membrane has not yet ruptured by the time the mother is ready to give birth, then _____.

Pinch and twist the membrane until it ruptures

Breech delivery refers to when _____. This type of delivery is generally _____ than normal delivery. If needed, as the baby delivers, _____ to provide an _____ for the baby.

Both legs or buttocks come out first; slower; make a “V” with your fingers and insert into the vagina; airway

Limb presentation refers to when _____. This type of presentation cannot _____. Managing this condition involves _____, placing the patient in the _____ position, and transporting _____.

A visible arm or leg comes out first; be delivered in the field; covering the area with a sterile towel; left lateral Trendelenburg; C-3

A prolapsed cord refers to when the _____. Managing this condition involves _____ to attempt to _____, _____ to attempt to _____, placing the patient in the _____ position, and transporting _____.

Umbilical cord comes out first; placing a gloved hand into the vagina; relieve pressure on the cord; elevating the fetal head; restore the pulse; left lateral Trendelenburg; C-3

After delivery, _____ the newborn by _____ or _____, then place them on _____.

Stimulate; rubbing the back; flicking the soles of the feet; the mother’s abdomen

APGAR scoring is performed at _____ and _____ after delivery.

The components of APGAR are _____, _____, _____, _____, and _____.

1 minute; 5 minutes; appearance; pulse; grimace; activity (muscle tone) respirations

When performing an APGAR score for an infant, if _____, they receive an appearance score of 2. If _____, they receive an appearance score of 1. If _____, they receive an appearance score of 0.

The entire newborn is pink; the body is pink, but the hands and feet are blue; the entire newborn is blue or pale

When performing an APGAR score for an infant, if _____, they receive a pulse score of 2. If _____, they receive a pulse score of 1. If _____, they receive a pulse score of 0.

The pulse is over 100 BPM; the pulse is less than 100 BPM; there is no pulse

When performing an APGAR score for an infant, if _____, they receive a grimace score of 2. If _____, they receive a grimace score of 1. If _____, they receive a grimace score of 0.

Cry and move away from stimuli; have a weak cry in response to stimuli; the newborn does not react to stimuli

When performing an APGAR score for an infant, if _____, they receive an activity score of 2. If _____, they receive an activity score of 1. If _____, they receive an activity score of 0.

The newborn resists attempts to straighten their hips and knees; the newborn makes weak attempts to resist straightening; the newborn is completely limp

When performing an APGAR score for an infant, if _____, they receive a respirations score of 2. If _____, they receive a respirations score of 1. If _____, they receive a respirations score of 0.

The newborn is breathing rapidly; the newborn is breathing slowly; the newborn is not breathing

Clamping and cutting the umbilical cord is typically done _____ after delivery. According to DOT, the first clamp should be placed _____. According to LA County, the first clamp should be placed _____. In either case, the second clamp should be placed _____.

1” to 2” away from the baby; 4” away from the baby; 2” away from the first

Suction a newborn only if the _____. Begin with the _____, then the _____ to prevent aspiration, and insert the _____ 1 1/2” into the baby’s mouth to prevent _____.

Airway is obstructed; mouth; nose; bulb syringe; vagal stimulation

The placenta is ready to be delivered when the _____. This typically happens about _____ after the baby is delivered, with anything over _____ considered concerning. After the placenta is delivered, make sure to _____ and watch for _____, which involves _____.

Umbilical cord gets longer; 5 to 20 minutes; 30 minutes; wrap the placenta and take it to the hospital; postpartum hemorrhage; bleeding over 500 mL

To control post-delivery bleeding, provide a _____. If that is not sufficient, perform a _____.

Vaginal pad; fundal massage

If a baby is delivered prematurely, keep the infant _____, _____ PRN, provide _____, do not _____, and notify the hospital.

Warm; suction; oxygen; breathe in their face

Spina bifida refers to when a _____. Managing this condition involves _____ and maintaining _____ by _____.

Portion of the spinal cord or meninges protrudes outside the vertebrae or body; covering the area with a moist, sterile compress; body temperature; holding the child against an adult for warmth

Abortion or miscarriage refers to _____, either _____ or _____. Potential complications include _____ and _____, so management involves treating for _____, transporting _____, and bringing _____ to the hospital.

Delivery before 20 weeks; spontaneous; induced; bleeding; infection; shock; C-3; fetal remains

T/F: Even if the onset of labor is premature, labor will still progress normally.

True

A normal neonate has _____ breathing within _____ after birth and a heart rate of _____.

Spontaneous; 15 to 30 seconds, 120 to 160 BPM

If a neonate presents with a heart rate of 100 to 120 BPM, make sure the infant is _____ and _____, _____ the infant appropriately, _____ the infant, and _____ PRN.

Dry and warm; position; stimulate; suction

If a neonate presents with a heart rate of 100 to 120 BPM and adequate respirations but central cyanosis, then _____.

Administer blow-by oxygen at 10-15 L/min

If a neonate presents with gasping or inadequate respirations, then _____.

Provide BMV with room air for 30 seconds at a rate of 40 to 60 breaths/min

If a neonate presents with a heart rate between 60 and 100 BPM or central cyanosis, then _____. If there is no improvement, then _____. If there is still not improvement, then _____.

Provide BMV with room air for 60 to 90 seconds at a rate of 40 to 60 breaths/min; provide BMV with oxygen for 30 seconds at a rate of 40 to 60 breaths/min; continue with oxygen

If a neonate presents with a heart rate < 60 BPM after 30 seconds of BVM with oxygen, then _____.

Start CPR at a 3:1 ratio

When performing infant CPR, use a ratio of _____ compressions to every _____ breaths. This requires _____.

3; 1; 2 rescuers

Because pregnant women have an increased amount of blood and increased heart rate, they may experience significant blood loss before showing signs of _____.

Shock

If a pregnant patient needs spinal immobilization, then _____ to _____ and prevent _____.

Place towels under the right side of the board; roll the patient to the left; supine hypotension syndrome

If a pregnant patient is suddenly short of breath following delivery, they may have a _____.

Pulmonary embolism

Infancy refers to the first year of life.

At 1-2 months, infants are mostly _____ and _____. They use _____ as an expression, and enjoy being cuddled and rocked.

At 2-6 months, infants are more active and can _____, _____, _____, and _____.

At 6-12 months, infants begin _____, can _____ without support, can begin to _____ and _____, start _____, and may develop _____.

Sleeping; eating; crying; smile; make eye contact; recognize caregivers; roll over; babbling; sit; crawl; walk; putting things in their mouth; separation anxiety

Although crying is normal in infants, persistent crying and irritability can be an indicator of _____ and _____.

Serious illness; ALOC

When working with an infant patient, begin at a _____, get down to _____, let the caregiver _____, and provide _____ comfort by _____, saving _____ procedures for the end, and _____ before any procedure.

Distance; their level; hold the infant; sensory; warming your hands and stethoscope; painful; notifying the parent

Toddlers are between 1-3 years old.

At 12-18 months, they begin _____ and may start to open _____, _____, etc. They also become more _____, causing _____ to increase.

At 18-24 months, they begin to develop their _____, _____ and _____ skills, tend to _____, and like _____.

Walking; doors; bottles; vocabulary; running; climbing; cling to their caregivers; comforting objects

When working with a toddler patient, you should _____.

Perform your assessment from toe to head

Preschool-age children are children between 3-6 years old.

At this age, they experience a rapid increase in _____, can _____, _____, _____, and _____, and begin to develop _____.

Vocabulary; walk; run; throw; catch; fear about pain

When working with a preschool-age patient, you should _____.

Perform your assessment from toe to head

School-age children are children between 6 to 12 years old.

At this age, they act more like _____, can _____, and begin grasping the concept of _____.

Adults; respond to questions; death

Adolescents are children between 12-18 years old.

At this age, they can participate in _____, know _____, may have concerns about _____, and may feel _____, leading to _____ like _____, _____, and _____.

Decision-making; right from wrong; body image; indestructible; risky behaviors; substance use; sex; pregnancy

Children have a larger and rounder _____, a proportionally larger _____, and long, floppy, and U-shaped _____.

Occiput; tongue; epiglottis

Children have airways that are more easily _____ by blood, secretions, and swelling. Children also have twice the _____ demand of adults, creating an increased risk for _____.

Children are _____ breathers. _____ may interfere with this movement, leading to decreased _____. They also have less-developed _____, leading to a smaller diameter for air.

Infants are _____ breathers, meaning they might need _____ to keep the airway patent.

Obstructed; oxygen; hypoxia; diaphragm; gastric distention; tidal volume; tracheas; nose; suction

In children, _____ is the primary means of compensating for poor perfusion, meaning that _____ can indicate an impending cardiac arrest.

Additional ways children compensate for poor perfusion is _____, which may present as _____, _____, _____, and _____.

Heart rate; bradycardia; vasoconstriction; pallor; weak distal pulses; delayed capillary refill; cold hands and feet

The nervous system in children is immature and not _____. They are more prone to _____ injuries from falls and MVAs. The subarachnoid space is also smaller, creating less _____.

Additionally, the brain requires more blood, oxygen, and glucose than adults, making them more prone to damage from _____ or _____.

Well protected; head; cushioning; hypoxia; hypotension

In children, the _____ muscles are less developed, creating less protection from trauma. The liver, spleen, and kidneys are also proportionally large, making them more prone to _____.

Abdominal; bleeding

In children, the bones are more _____, making them more prone to _____.

In infants, the bones in the head are not _____, making them more _____ and _____. Fontanelles can also help identify potential problems. A bulging fontanelle may indicate _____, _____, and/or _____, while a sunken fontanelle typically indicates _____.

Flexible; stress fractures; fused; flexible; soft; rising ICP; meningitis; encephalitis; dehydration

In children, the skin is _____ with less _____. They also tend to burn easier and deeper than adults, and their higher _____ ratio increases fluid and heat loss.

Thinner; subcutaneous fat; surface area to mass

Forming a general impression for a pediatric patient involves using the _____, which consists of _____, _____, and _____.

Pediatric assessment triangle; appearance; work of breathing; circulation

When forming a general impression for a pediatric patient, you can assess their appearance by observing their _____, _____, _____, _____, and _____.

LOC; position; muscle tone; interactiveness; eye contact

When forming a general impression for a pediatric patient, you can assess work of breathing by observing any _____, _____, _____, and _____, _____, or _____.

Abnormal noises; head bobbing; flared nostrils; accessory muscle use; retractions; tripod position

When forming a general impression for a pediatric patient, you can assess circulation by observing any _____, _____, or _____ skin.

Pale; mottling; cyanosis

If a pediatric patient is under 40 pounds, then you should transport them using a _____.

Safety seat secured to the gurney or captain’s chair

The rule of thumb for blood pressure in children under 10 is _____.

70 + 2x child’s age in years = Systolic

Signs of increased work of breathing in pediatric patients include _____, _____, _____, and _____.

Abnormal breath sounds; flared nostrils; accessory muscle use; tripod position

Signs of respiratory distress in pediatric patients include _____, _____, and _____; _____; _____ respirations; and _____, _____, or _____.

Restlessness, combativeness, and anxiety; flared nostrils; grunting; accessory muscle use; tripod position; retractions

Late signs of respiratory distress include decreased _____ due to _____, decreased _____, _____ and _____.

Breathing effort; fatigue; tidal volume; ALOC; bradycardia

To relieve an airway obstruction in a conscious infant, perform _____ followed by _____, then _____, _____ if possible, and _____, repeating if necessary.

5 back blows; 5 chest thrusts; visualize the airway; finger sweep the object out; ventilate

To relieve an airway obstruction in an unconscious infant, perform _____.

Modified CPR

To relieve an airway obstruction in a conscious child, perform _____.

Abdominal thrusts

To relieve an airway obstruction in an unconscious child, perform _____.

Modified CPR

If you need to open the airway in a pediatric patient, _____ to help open the airway.

When using an OPA, use the _____ method to insert the OPA.

NPAs are contraindicated for _____.

Place towels under the torso; straight-in; infants under 12 months old

Proper oxygen delivery devices for a pediatric patient with adequate rate and tidal volume include _____, _____, and _____.

Nasal cannula; simple face mask; non-rebreather

The proper oxygen delivery device for a pediatric patient with adequate rate and tidal volume that cannot tolerate a nasal cannula, simple face mask, or non-rebreather is _____.

Blow-by oxygen

A BMV should be used to provide oxygen to a pediatric patient who is _____ and/or _____, has _____, an inadequate _____, or respirations below _____ or above _____.

Pulseless and/or apneic; ALOC; tidal volume; 12 breaths/min; 60 breaths/min

Common sources of shock for pediatric patients include _____ with _____, especially to the _____; _____ from _____ or _____; severe _____; _____ trauma that causes _____ injury; _____; and _____ disease.

Trauma; blood loss; abdomen; dehydration; vomiting; diarrhea; infection; head; neurological; anaphylaxis; heart