SBVAC Week 7 OB/GYN

What does Geriatrics refer to? How does it affect care?

Population over 65 years old, these are patients who need special precautions due to their age

Physiologic Changes of Aging
What is physiological reserve and how does it change?

Aging affects physiologic function of all body tissue, leading to decreased function in the body.

There is a decreased physiological reserve (body can’t respond to stressors as well) and immune system decline

What are the cellular changes of aging

Decreased cell replication and increased DNA damage and oxidative stress

Decreased cell replication causes decreased blood cell replication and regeneration, and bone thinning and skin thickening

What are respiratory changes with aging?

DECREASED size and strength of respiratory muscles, leading to higher risk of respiratory infection

Enlargement of alveoli in lung tissue leads to decreased chest expansion, reduced coughing/gag reflex, and lowered chemoreceptors to determine CO2 or O2 levels.

Cardiovascular changes with aging

Hypertrophy (thickening) of the heart with age, thicker wall takes up more space, and the ventricle holds less blood

There is decreased collagen and elastin, leading to less elastic vessel walls → higher/wider BP and poor circulation, aortic valve stenosis occurs that impairs blood flow

Increased risk of clots due to lack of movement, and electrical conduction system deteriorates as number of pacemaker cells decreases

What are some nervous system changes with aging?

DECREASED brain weight and volume, loss of 5-10% of neurons.

Changes in 5 physical senses, thinking speed, memory, and posture stability changes

How does vision change with aging, and what is the outcome? What is the inability to see up close called?

Depth perception, vision acuity, and adjustment to light are changed with age.

Outcome:

• Decreased tear production

• Can’t differentiate colors

• Diminished night vision

• Presbyopia (inability to see up close)

How does hearing change with aging, and what is the outcome? What is the gradual hearing loss called?

Hearing sounds become more difficult due to inner ear changes

Outcomes:

• Problems with balance →likely to fall

• Presbycusis → gradual hearing loss

How does taste change with aging? What is the outcome?

Lessened number of taste buds

Outcome:

• Weight loss

• Malnutrition

• Fatigue

How does touch change with aging? What are the outcomes?

Loss of end nerve fibers causes decreased sense of touch and pain perception

Outcome:

• Decreased sensation of hot and cold

• Geriatric patient may not feel injury

What are some musculoskeletal changes with aging? What is reduced bone, muscle mass called? What is the inflammation of joints called?

Osteoporosis(reduced bone mass) and Sarcopenia(reduced muscle mass), reduces strength

Arthritis (painful inflammation of joints destroying cartilage) and wearing down of intervertebral discs lead to decreased height and posture issues.

All of these lead to difficulty with tasks requiring fine motor skills

What are some gastrointestinal changes with aging?

(Less liquid, less digestion, less excretion)

Gastric secretions are reduced, and there’s less saliva production.

Gastric motility is decreased, and there is a higher chance of bowel-related diseases.

Peristalsis(wave movement) leads to constipation, and decreased size and strength of rectal sphincter leads to incontinence.

What are some endocrine system changes with aging?

A decrease in thyroid hormones leads to:

• Decreased heart rate

• Fatigue

• Dry skin and hair

• Cold Intolerance

• Weight gain

A fluid imbalance due to increased secretion of antidiuretic hormones, resulting in hyperglycemia

What are renal system changes associated with aging?

Kidneys shrink in size and weight, leading to less nephrons(filtering units). The decrease in kidney mass leads to electrolyte imbalance/dehydration

Causes a reduction in renal function and renal blood flow and lower bladder capacity.

What is Pneumonia? How does it change in geriatric patients and what are some S/Sx

An infection of the lungs from bacteria/viral causes, leading to fluid/pus accumulation in the alveoli

The risk of respiratory infection increases with age, partly due to increased exposure due to frequent hospitalization

S/Sx: Rhonchi lung sounds, Shortness of breath, productive cough, or asymptomatic due to weakened immune system

What is Pulmonary Embolism? How does it change in geriatric populations and what are some S/Sx?

The sudden blockage of an artery by a venous clot

There are increased risk factors such as living in a nursing home, recent surgery, history of heart failure or clots, and sedentary behavior

S/Sx: Sudden onset of Dyspnea, shoulder/back/chest pain, cough, hemoptysis (coughing of blood), syncope (temp. loss of consciousness)

What is Atherosclerosis? How does it change in geriatric populations and what are some S/Sx?

The buildup of fat and cholesterol (plaque) in and on artery walls

In geriatric populations, there is an increased risk of developing the condition due to stiffening of arteries

S/Sx: Chest pain, leg pain, shortness of breath, fatigue on exertion, or asymptomatic

What is Congestive Heart Failure? How does it change in geriatric populations and what are some S/Sx?

When the heart muscle can’t pump blood as effectively as it should

In geriatrics, there is an increased risk due to comorbidities such as hypertension, coronary artery disease,

S/Sx: Peripheral Edema, Pulmonary Edema, Shortness of breath, or asymptomatic

What is a heart attack? How does it change in geriatric populations and what are some S/Sx?

Occurs when blood flow to part of the heart muscle is blocked

Geriatric patients present atypically during a heart attack compared to younger patients (fatigure, shortness of breath, acute confusion)

S/Sx: “Silent” heart attacks (prevalent in women and diabetics), dyspnea, nausea/vomiting

What is delirium? How does it change in geriatric populations and what are some S/Sx?

What are the increased risk factors for this**

Temporarily disturbed state of mind, usually has rapid onset

Geriatric patients have an increased risk (DELIRIUM):

• Diabetes (increased risk)

• Emotional

• Low O2

• Infection

• Recent Surgery

• Ictal (Seizures)

• Undernutrition/dehydration

• Meds/alcohol effects

S/Sx: Hallucinations, restlessness, incoherent thought/speech

What is Dementia? How does it change in geriatric populations and what are some S/Sx?

Progressive loss of cognitive function due to neuronal death

Geriatric patients have an increased risk for dementia and associated conditions?

S/Sx: Baseline AMS, rarely any hallucinations, irreversible, progress loss of cognitive, psychomotor, and social skills

What is Alzheimer’s and what is it caused by? How does it change in geriatric populations and what are some S/Sx?

Most common form of dementia, thought to be caused by abnormal buildup of proteins in and around brain cells

Geriatric patients have an increased risk for Alzheimer’s, with the risk doubling every 5 years after turning 65

S/Sx: Misplaced objects and trouble recalling names (early stage), difficulty with moving, eating, swallowing, and speech (late stage)

What is Parkinson’s Disease? How does it change in geriatric populations and what are some S/Sx?

Age-related neurological disease thought to be caused by gradual loss of dopamine-producing cells

Geriatrics are at higher risk of developing the disease, as these neurons automatically decline by age. Older patients have more pronounced symptoms

S/Sx: Resting tremors, rigid extremities, mask-like face, depression, bradykinesia (slow movement)

What is a stroke? How does it change in geriatric populations and what are some S/Sx?

When blood flow to the brain is interrupted, causing a lack of oxygen and nutrients to the brain. Can be ischemic or hemorrhagic

Blood clots and brain bleeds are more common in geriatrics, ask for blood thinners and baseline presentation

S/Sx: AMS, numbness, weakness, or paralysis on one side, slurred speech, visual disturbance, headache/dizziness, incontinence, seizure.

What are some musculoskeletal related conditions in geriatrics? What is the loss of joint flexibility

Falls:

• More prevalent in geriatrics due to vision, gait, balance, and orthostatic hypotension

• Ask about blood thinners

• Higher chance of injury due to sarcopenia

Osteoarthritis:

• Joints lose their flexibility

• Affects joints in the hands, knees, hips, and spine

Decreased muscle mass leading to less strength

What is Chronic Kidney Disease? What are the two types of incontinence? How does urinary retention get affected?

Kidney Disease:

• Geriatrics can experience Chronic Kidney Disease (CKD), leading to kidney failure

• Could be on hemodialysis 3x a week (machine filtering blood), missing dialysis causes lethal toxin buildup

Incontinence

• Stress incontinence: Incontinence during activities like coughing, laughing, sneezing, lifting, and exercise

• Urge incontinence: Incontinence triggered by hot or cold fluids, running water, or thinking about going to bathroom

Urinary Retention

• Difficulty urinating

• Enlargement of the prostate in geriatric men makes urination difficult

• Severe cases of urinary retention can cause renal failure

What are some hospital-related conditions for geriatrics?

Decubitus Ulcers

• Bedsores/pressure ulcers that form due to immobility

• Usually found on lower legs, sacrum, and glutes

• Occurs most in nursing homes or prolonged hospital stay

• Patients must be turned every 2 hours in nursing homes

UTIs:

• Urinary tract infection, occurs when a foley catheter is left too long in geriatric patients, check the catheter for color and opacity of urine, as well as blood

• Common hospital-associated infection, more prevalent in women (shorter urinary tract)

• S/Sx: Shortness of breath, painful urination, polyuria, can lead to septic shock

What is Polypharmacy? What are some common drug (endings)?

Simultaneous use of multiple drugs at a time by a single patient (geriatrics are on a lot of medication), causing multiple side effects

Ask about ALL medications they’re taking and medical history, some common ones include:

• Metformin (Diabettes)

• Drugs ending in “statin” (high cholesterol)

• Drugs ending in “pril” or “olol” (hypertension)

• Drugs ending in “cillin” or “mycin” (antibiotics)

How is suicide and depression affected by geriatrics?

More prevalent due to loneliness, loss of function, lack of independence, extremely common in older patients

Older men most at risk for suicidal ideation, substance and prescription abuse along with chronic medical conditions lead to depression

What are some increased risk factors for falls in geriatrics?

• Increased age

• Gender (women more prone)

• Drugs (Greatly increases if more than four medications are taken)

• Benzodiazepine use increases falls by 44%, used to treat anxiety by depressing the CNS

• Living alone

• Poor nutrition

• Cognitive disorders

What are the main problems with geriatric falls?

Environmental Factors increase fall risk

• Poor lighting

• Uneven surfaces

• Slippery Floors

• Missed steps/slips/trips

Hip Fractures

• 90% of hip fractures caused by falls in geriatrics

What are EMS considerations or what may you see on geriatric calls?

• Indwelling catheter

• Lung Drains (chest tubes)

• Feeding Tube

• Colostomy Bag

What should you look out for on geriatric calls? (Report)

Elder abuse and neglect, most common in women older than 75 years old

How can you move a geriatric patient?

Sheet transfer, have the patient “hug themselves,” and have all crew members hold the sheet taut as close to the body as possible. (move them to another place)

What are some important questions for geriatrics?

• All medications they’re taking (especially blood thinners)

• Advanced Directives (DNR, MOLST)

• Baseline Presentation (Geriatric patients can suffer from more than one condition normally)

What is palliative care?

Comfort care provided to people with serious illnesses to improve quality of life (treating for comfort, not the disease)

What is hospice care?

Form of palliative care in which the prognosis of the patient is 6 months or less, focusing on symptom management, spiritual, and psychosocial support for end of life care

What defines a child?

Pediatric Protocols are used for children under 15 years old

How does consent work with children?

Consent considered as the ability of the patient to understand and make an informed decision about their health care.

Minors (under 18) are generally not able to provide consent, guardians/parents must provide informed consent

If parents are not present and care is needed, implied consent is applied even if minors refuse care

How are airways different in children?

Their airways are smaller! They have narrow nostrils, looser teeth, and a larger tongue relative to the oropharynx

The epiglottis and trachea are smaller and collapse easier

What is the pediatric airway positioning? Why is it used?

Children have larger heads, which flexes the neck and compresses the soft airway

Use the classic sniffing position, don’t overextend the head/neck, and apply head rests or shoulder rolls if needed

How is blood volume affected in children?

Newborns only have 300 mL of blood!

How do massive heads in children affect their skull structures? What about chance for injury?

Children have a prominent occiput but underdeveloped cervical support. Their big heads can cause injury with little injury or obvious signs!

Infants have fontanelles, a “soft spot” caused by any of the soft membranous gaps between the incompletely formed cranial bones of an infant.

How are organs affected in children?

Organs of children are vulnerable, as bone development starts as cartilage, hardening gradually by ossification.

What is pediatric shock like? What are some early signs and late signs of shock?

Children maintain blood pressure by increasing heart rate and vasoconstriction, while losing up to 1/8 of blood volume.

They decompensate extremely fast! Hypotensive pediatrics approach cardiac arrest!

Early Signs:

• Sustained Tachycardia

• Capillary refill > 2 seconds

• Cold, clammy extremities

Late Signs:

• Weak peripheral pulses

• Decreased consciousness

• Hypotension

How do you recognize if a patient is sick or not? What are some indicators for adult and pediatrics***?

Literally just look at them.

Adult Indicators:

• MOI/NOI, obvious trauma

• Pulse, respirations, skin

• Level of Consciousness

Pediatric Indicators:

• Appearance

• Work of breathing

• Circulation to skin

What is the Pediatric Assessment triangle? What does it do?

Appearance, work of breathing, and circulation to skin.

Informs oxygenation, brain perfusion, and overall CNS function

What is the Appearance section of Pediatrics?

(TICLSC)

Tone: Good muscle tone?

Interactiveness: Responds to people or environmental changes?

Consolability: Able to be comforted by caregiver or responder?

Look/Gaze: Maintains eye contact with objects/people? Fixes gaze on faces?

Speech/Cry: Strong and spontaneous crying?

Color: Skin color? Visible differences between trunk and extremities?

What is the Work of breathing section of Pediatrics?

Does the child require extra effort to move air in and out?

(PAR)

Positioning: Sniffing position, tripoding, head bobbing, nasal flaring?

Adventitious lung sounds: Stridor, wheezing, rales, or rhonchi?

Retractions: Visible sinking-in of soft tissues, especially in the chest or neck?

What is the Circulation to skin section of Pediatrics?

Skin signs reflect overall circulation status

(CCP)

Color, temperature, condition: Examine the child’s calf or forearm

Capillary Refill: Blanch a distal extremity, such as the nail bed or foot

Pulse: Rate and strength of the brachial or radial pulse. Are the vitals normal?

What are the divided age ranges?

Neonates: Birth - 28 days

Infant: 1 - 12 months

Toddler: 1 - 2 years

Preschool: 3 - 5 years

School Age: 6 - 11 years

Adolescence: 12 - 18 years

How do the vital signs of extremely young children compare to that of older children?

Heart Rate: Much higher in younger patients (Small heart)

Respiratory Rate: Much higher in younger patients (Small Lungs)

Systolic/Diastolic BP: Much lower in younger patients

MAP (Mean Arterial Pressure: Much lower in younger patients

What are some developmental conditions for infants?

• May have separation anxiety

• Provide sensory comforts

• Be careful of nasal obstructions

What are some developmental conditions for toddlers?

• May have stranger anxiety

• Approach slowly, limit physical contact, use a quieter

• Use play or distraction objects

• Have parent hold ask history

• Not very good at describing pain

What are some developmental conditions for preschool age?

• Explain procedures simply

• Praise and set limits on behavior

What are some developmental conditions for school age?

• Explain all procedures beforehand

• Speak directly, don’t negotiate

What are some developmental conditions for adolescents?

• Explain procedures and why

• Show and respect independence

• Ask some questions privately

What are common pediatric emergencies?

Fevers, Seizures, Sirs (sepsis), and respiratory infections

How do fevers present in children? How to take history and a physical assessment, and what are some considerations?

38 C or higher

History:

• OPQRSTI, SAMPLE

• Recent or household illness

• Up-to-date immunisation status

• Maximum temperature, method

• Food and consumption, urination, and bowel movements

Physical Assessments:

• Bulging or sunken fontanelles

• Rash, especially if NON blanching

• Palpable abdominal mass

Considerations:

• Fevers most commonly caused by some form of infection

• For patients less than 3 months old, note and be careful of tylenol, aspirin, or other fever reducers

How do seizures present in children? How to take history and a physical assessment, and what are some considerations? What is a common seizure type in children

History:

• OPQRSTI, SAMPLE

• Infection, head trauma, epilepsy, electrolyte imbalance, toxins, hypoglycemia, birth injury

• Diastat is commonly prescribed gel form of valium (diazepam)

Febrile Seizures:

• Accounts for most seizures in patients 6 months - 6 years

• < 15 minutes, generalized tonic-clonic and short postictal period

How do sirs/sepsis present in children? How to take history and a physical assessment, and what are some considerations?

Systemic inflammatory response

Syndrome + known infection → sepsis

Systemic organ damage and failure

Physical Assessment:

• Hypo/hyperthermia

• Heart rate and respirations above normal age range by 2 Standard Deviations

• Additionally: signs of shock

What are the types of respiratory infections in children? How to treat?

Primary Infections:

• Common Cold (viral): cough, runny nose, sore throat, body aches

• Croup (viral): stridor, seal-like barking cough, fever, running cough

Secondary Infections

• Sinusitis (viral, bacterial): sinus pressure, congestion, cough, runny nose

• Bronchitis (viral): wheezing, congestion, fever, runny nose, sore throat

• Pneumonia (viral, bacterial): chest pain, tachy/dyspnea, cough, fever

Many of these are similar and can’t be distinguished prehospitally. Treat with humidified O2, albuterol, rapid transport, and ALS as necessary, using APPROPRIATE PPE as necessary!

How should oxygen therapy be used on children?

Any child with a respiratory emergency or significant trauma should receive oxygen

Blow by oxygen: For children who can’t tolerate an NRB or NC, hold mask 2 inches from the face, making sure NOT to over-ventilate

What are some other interventions for children?

• Consider giving humidified O2 via a nasal cannula to reduce nasal discomfort and irritation to moisten airways

• Provide parental reassurance and guidance!

• BGL can be taken at the heel!

What are concerns of poisoning in children? What are some common sources?

• Oral seeking is a common developmental characteristic (children like putting things in mouth)

• S/Sx depend on poison

Common poison sources:

• Alcohol, pills, vitamins

• Houseplants

• Cleaning Products

What are concerns of trauma in children? What are some pediatric trauma centers?

Trauma kills more children than all other causes combined

Causes:

• Submersion injuries, burns, abuse, neglect and trauma from firearms, MVAs, pedestrian and bicycle injuries

• Consider mechanism in deciding in stable or critical

Centers:

• Stony Brook University (lvl 1), Good Samaritan Hospital (lvl 2)

How to do SMR on children?

Roll towels and place on the sides of the head, or an upside down KED can be used as a full-body splint, just tape the forehead.

What are some sudden events that can occur in children? What must you do if these occur?

Sudden Infant Death Syndrome:

• Unexplained death of a child < 1 year old, often while sleeping

• Typically presents as cardiac or respiratory arrest

• In cases of SIDS, law enforcement MUST be called, an investigation needed to rule out other causes of death

Brief resolved unexplained event:

• Transient, self-resolving <1 minute event involving cyanosis/pallor, respiratory changes, and unresponsiveness

• Must take a BGL!

How to deal with child abuse and neglect as an EMT? What are some signs/symptoms?

Abuse includes physical or emotional injury, negligent treatment, maltreatment, and sexual exploitation: 90% by primary caregiver

Signs/Symptoms:

• Passive, withdrawn behavior

• Injuries at various stages of healing or in unusual locations

• Poor hygiene or nutrition

• Drug or Alcohol Abuse

Required to report within 48 hours!

What is gynecology and obstetrics?

Gynecology: Field with medicinal and surgical aspects involving healthcare of female reproductive health

Obstetrics: Focuses on pre-conception, pregancy, and delivery

What are some external anatomy of female reproductive organs?

Vulva: Term describing all aspects of female external genitalia

Labia Majora & Minora: Tissue folds surrounding/protecting the vaginal opening

Clitoris: Erectile Organ of female genitalia

Vaginal Opening: Opening to the internal reproductive organs

Urethra: Exit for liquid waste (urinary system exit)

Anus: Exit for solid waste (digestive system exit)

Perineum: Skin between vagina and anus

What are some internal anatomy of female reproductive organs?

Vagina: Muscular opening between external genitalia and uterus

Cervix: Opening of the uterus to the vagina which dilates during labor and menstration

Uterus: Muscular organ that sheds endometrium during menstrual cycle, houses a developing fetus

Endometrium: Inner uterus lining

Ovaries: 2 almond-shaped organs that develop and release ova during ovulation

Ova: Egg, mature female reproductive cell that can give rise to an embryo if fertilized

Fallopian tubes: pair of hollow, muscular ducts serving as passageways for ova between the ovaries and the uterus

What is the menstrual cycle? What are the phases? What hormones control it?

• A female hormone cycle that begins on the first day of the period and ends on the day before the next period

• Can last between 23-35 days

• Consists of four phases:

  • Menstruation

  • Follicular phase

  • Ovulation

  • Luteal phase

• Controlled by estrogen and progesterone hormones

What is menstruation? What are some terms for when women start/stop having periods? What are some S/Sx?

A period that typically lasts 2-7 days (varies per person and cycle).

Occurs when an egg from the previous cycle isn’t fertilized, and the endometrium that had been thickening to prepare for a potential pregnancy is no longer needed

Menarche: When one begins having periods (~12 years)

Menopause: When one stops having periods (~51 years)

S/Sx: Abdominal cramps (from shedding), backaches, headaches, bloating

What are some period products?

Pads: Strips of absorbent material to soak up blood

Liners: Slimmer, neater, and discreet pads, better for lighter flow days or discharge

Tampons: Small, cotton-wool tubes inserted in the vagina to soak up blood, with a string at the bottom to remove them

Menstrual Cups: Insert menstrual cup into the vagina for collection instead of absorption

Menstrual disc: Disc-shaped menstrual cups

Period pants/underwear: Act like pads but are worn and washed like normal pants

What is Toxic-Shock Syndrome? What are some S/Sx?

A rare but life-threatening condition caused by infection, can be caused if a tampon or menstrual cup is left in for too long.

• Tampons should only be left in for 4-8 hours

S/sx: Sudden high fever, low bp (vasodilation), vomiting or diarrhea, confusion, muscle aches, seizures

What are the common types of birth control?

Birth Control Pill: Daily pill taken

IUD (Intrauterine device): A copper, T-shaped object placed inside uterus (lethal to sperm)

Contraceptive injection: Injection every three months, suppressing ovulation and thickens cervical mucus

Implant: A tiny, thin rod around size of matchstick, inserted under skin of upper arm, releasing progestin

Reasons for birth control?

• Preventing preganncy

• Regulating menstrual cycle

• Lightening periods and reducing menstrual cramps

What are some female reproductive disorders? (part 1)

Amenorrhea: Absence of period (not by pregnancy)

Menorrhagia: Heavy/prolonged bleeding during period

Urinary Tract Infection: Infection of urinary tract from bacteria entering urethra, common in women

• S/Sx: painful urination, cloudy urine with foul smell, lower back pain

STIs/STDs: Sexually transmitted disease (chlamydia, gonorrhea, herpes)

• S/Sx: Itching, burning, Painful urination, painful intercourse, foul-smelling discharge

Yeast Infection: Fungal infection of vulva and vagina caused by environmental changes

• Sx: itching, burning, thick white “cottage cheese” discharge

Endometriosis: Disease in which tissue similar to the lining of uterus grows outside uterus, causing severe pelvic pain and difficulty getting pregnant

What are some female reproductive disorders? (part 2)

Polycystic ovary syndrome: Hormone imbalance causing one to have many eggs that don’t or rarely mature

• S/Sx: irregular period, hirsutism, weight gain

Pelvic Inflammatory Disease: When untreated sexually transmitted bacteria spread from vagina to womb, fallopian tubes, or ovaries

• S/Sx: lower abdominal pain, foul-smelling discharge, painful intercourse, shuffling gait

Ovarian Cyst: Fluid-filled sac in ovary, caused by unregulated hormones or as a symptom of something more serious. Often asymptomatic or pain on one side, can go away, but bursting can cause sepsis

Assault: Can happen to anyone, have a female crew member take lead if possible, preserve evidence and crime scene, request SAFE/SANE nurse

General Vaginal Bleeding: Multiple causes, assess circulation and treat for shock, active bleeding can be treated with a pad, let the patient do it themselves if they can

Vocabulary for pregnancy

Placenta: Source of nutrients for growing baby

Umbilical cord: Connects mom to baby through placenta

Amniotic sac: Insulates and protects baby

Full Term: 38-40 weeks gestation

Premature: <38 weeks gestation

Postmature: >42 weeks gestation

Trimester: Classifying pregnancy stages

Neonate: Infant <28 days old

Gravida: Number of times patient has been pregnant (ASK)

Para: Number of patient’s live births (ASK)

Abortus: Number of miscarriages, abortions, and stillbirths (ASK)

What are some body changes during pregnancy?

• Increased blood volume (up to 50%) in mother by end of term, increases anemic risk and higher HR

• Uterus grows with fetus, exposing fetus to injury and displaces the organs and balance disruption

• Displaced organs place diaphragm pressure, increased respiratory rate and shallow respirations

• Higher chance of vomiting due to trauma and aspiration

• Increased hormone levels

• Looser ligaments to prepare for birth

What are some pregnancy complications? (Pt 1)

Ectopic Pregnancy: Pregnancy that develops outside the uterus, will eventually rupture, causing internal bleeding

• Must be treated by termination of pregnancy

• S/Sx: Sudden, sharp, one-sided abdominal pain, vaginal bleeding, signs of shock, proteinuria

Preeclampsia: High BP during pregnancy

• S/Sx: headache, hypertension, peripheral edema

Eclampsia: Preeclampsia + seizure activity

• Treatment: Lay patient on left side, provide O2, maintain ABCs, rapid transport, ALS

Miscarriage: Spontaneous abortion occurring within the first 20 weeks

Stillbirth: Fetal death after 20 weeks of pregnancy, very rare

Abruptio placenta: Placenta separates from uterus prematurely

• S/Sx: Port win vaginal bleeding, shock, abdominal pain, contractions

What are some pregnancy complications? (Pt 2)

Placenta previa: Placenta develops over cervix

• S/Sx: Bright red vaginal bleeding, shock, painless

Gestational Diabetes: New diabetes developing pregannt person

• Raises risk of Type II developing in mother and child

• Extra glucose from mom passes in placenta, causing fetus to make extra insulin → fat baby, need C section

• Treatment: Treat patients the same as non-pregnant

Supine Hypotension Syndrome: If patient is lying supine, their descending aorta and inferior vena cava become compressed

• S/Sx: Hypotension and dizziness

PROM: Premature rupture of membrane:

• Occurs before 37 weeks of gestation

• Increased infection risk

Trauma: Have high index of shock suspicion in all cases of trauma involving pregnant woman, treat for shock

What are the stages of labor?

1. Onset to dilation

   1. rupturing of amniotic sac and onset of contractions until full dilation achieved

2. Dilation to baby delivery

   1. From the time of full dilation to delivery of baby

3. Baby to placenta delivery

   1. From time baby was delivered until placenta was delivered

What is the APGAR Scoring System? What is the range of a heathy baby and when should it be taken?

Activity (muscle Tone):

• Absent: 0 points

• Flexed Limbs: 1 point

• Active: 2 points

Pulse:

• Absent: 0 points

• <100 BPM: 1 point

• >100 BPM: 2 points

Grimace (reflex irritability)

• Floppy: 0 points

• Minimal stimulation response: 1 point

• Prompt response to stimulation: 2 points

Appearance:

• Pale/blue: 0 points

• Pink body, blue extremities: 1 point

• Pink: 2 points

Respiration:

• Absent: 0 points

• Slow and irregular: 1 point

• Vigorous cry: 2 points

Should be taken after birth and 5 minutes after

Healthy range: 7-10

What are some neonatal reflexes?

Rooting: Stroke baby cheek, should turn to finger

Moro: If baby feels like it’s falling, it will spread out its arms

Walking: Baby will try to “walk” when feet touch flat surface

Sucking: Baby begins to suck when roof of mouth is touched

Palmar: Baby will grab anything touching the palm.

Delivery Complications

Breech: Baby hips come out before head

Footling Breech: Feet come out first

Prolapsed Umbilical Cord: UC coming out first

Shoulder Dystocia: Shoulders get stuck behind pelvis

Nuchal Cord: Umbilical cord wrapped around the baby’s neck

What is a tracheostomy? What is it also known as?

A surgical opening in the neck to secure ventilation and airway, also known as a stoma

What is a colostomy bag?

Medical device used to collect stool from a hole made in an abdomen

What is a gastrostomy tube?

Tube inserted directly in abdomen to directly deliver food, nutrients, medications, or fluids.

What is an indwelling catheter? What is it also known as?

A flexible tube inserted in the urethra to drain urine. Also known as a foley catheter.