Mod 5 exam study guide

preeclampsia

condition that occurs in the second half of pregnancy (after 20 weeks’ gestation), involves new-onset hypertension along with other systemic effects, such as protein in the urine. HTN for Preeclampsia is >140 systolic, >90 diastolic

Eclampsia definition and Tx

related condition to preeclampsia characterized by seizures, lay pt on their left side, maintain her airway, administer supplemental oxygen. if vomiting occurs, suction the airway. provide rapid transport and call for ALS intercept.

PID and pregnancy risks

PID (Pelvic Inflammatory Disease) is an infection of the upper female reproductive organs—specifically, the uterus, ovaries and fallopian tubes.

An ectopic pregnancy is when an embryo develops outside of the uterus, most often the fallopian tube.

sudden onset abdominal pain and vaginal bleeding in the first trimester of pregnancy should be considered an ectopic on until proven otherwise.

Other indications include missed menstrual cycle and reports of sudden, sever, usually unilateral pain in the lower abdomen.

PID, tubal ligation (cutting, tying or removal of fallopian tubes usually via laparoscopy, getting your “tube tied”) or previous ectopic pregnancies should heighten suspicion of a possible ectopic pregnancy.

what is a nuchal cord and when do we check for it

A nuchal cord is an umbilical cord around the neck. as soon as the head is delivered, use one finger to feel whether the umbilical cord is wrapped around the neck. Usually you can slip the cord gently over the delivered head (or over the shoulders if necessary). If that is not possible, you must cut the cord by placing two clamps about 2 inches apart on the cord and cutting between them. once cut, you must attempt to speed the delivery by encouraging the woman to push harder and possibly more often because the fetus will now have no oxygen supply until it is delivered and breathing spontaneously.

when does a healthy newborn start breathing

the normal respiratory and cardiovascular physiologic response expected are that the newborn will begin spontaneously breathing within 30 seconds afterbirth.

Precipitous

fast labor and birth that may tear the perineal area.

changes in pregnant woman prior to labor

hormone levels increase to support fetal development and prepare the body for childbirth. Uterus grows, stretching to accommodate a full-term fetus, fluid within the uterus increases. Uterus displaces out of the well-protected position in the pelvic area and may expose it to injury.

Uterine displacement causes diaphragmatic displacement leading to reduced tidal volume with each breath, RR increases to compensate. Metabolic demand for oxygen increases, reduction in respiratory reserve and decreased ability tp compensate during times of respiratory distress

blood volume gradually increases throughout pregnancy to adequately perfuse the fetus and prepare for blood loss. blood volume may increase as much as 50% by the end of pregnancy.

RBC quantity increases which increases the woman’s need for iron. woman may take prenatal vitamins of iron to avoid anemia resulting in decreased ability to transport oxygen throughout the body.

speed of clotting increases

HR increases by up to 20% in third trimester to accommodate increased blood volume

change in body’s center of gravity make pregnant woman prone to slipping or falling

cpr on pregnant woman

manual uterine displacement to the pt’s left side while CPR is being performed relieves aortocaval compression

define each stage of labor

stage one, dilation of the cervix, begins with the onset of contractions and ends when the cervix is fully dilated.

The second stage begins with the fetus entering the birth canal and ends with delivery of the newborn.

Third stage of labor begins with the birth of the newborn and ends with the delivery of the placenta.

what should an EMT do if bleeding continues beyond the third stage of labor

significant bleeding after the delivery of the placenta is an emergency, transport the woman and the newborn, place sterile pads over the vagina, administer oxygen, keep them warm and monitor vitals closely.

what is the Apgar score and how do you assess it

The Apgar score is the standard scoring system used to assess the status of a newborn, assigns numeric values 0-2 on 5 categories, appearance, pulse, grimace or irritability, activity or muscle tone and respirations.

assess 1 minute and again 5 minutes after birth, deferred if resuscitation is required.

appearance: entirely pink 2, pink body, blue hands and feet 1, entirely blue 0

Pulse: >100 2, <100 1, absent 0

Grimace or irritability: cries and retracts from plantar stimuli 2, weak cry to stimuli 1, no reaction 0

Activity or muscle tone: resists attempt at knee extension 2, weak attempts to resist 1, limp w/o muscle tone 0

Respiration: rapid respiration 2, slow respiration 1, absent respiration 0

regarding the newborn resuscitation triangle: when do most newborns start to breath

newborns will begin breathing spontaneously within 30 seconds

define placenta previa

in placenta previa, the placenta develops over and covers the cervix. heavy vaginal bleeding without pain occurs prompt transport is necessary

define abruptio placenta

The placenta separates prematurely from the wall of the uterus, commonly cause by HTN and trauma. pt may report severe pain without heavy bleeding.

define spina bifida and Tx

developmental defect in which a portion of the spinal cord or meninges protrudes outside the body, typically seen in the lumbar area.

cover the open spinal cord with moist sterile dressing and then occlusive dressing to seal the area immediately after birth to help prevent fatal infection. maintain body temperature.

supine hypotension syndrome and Tx

condition cause by compression of the inferior vena cava by the pregnant uterus when the pt lies supine, reducing the amount of blood that is returned to the heart.

lay the pt on her left side

What to do if you see the umbilical cord exiting before the baby

Prolapse of the umbilical cord, a situation in which the umbilical cord comes out the vagina before the fetus, is a rare presentation that must be treated in the hospital.

place the woman supine with her hips raised 6-12 inches or knees to chest kneeling and bent forward face down. place sterile gloved fingers into the vagina and keep the weight of the fetus off the cord. wrap a sterile towel moistened with saline over the cord, administer oxygen and transport.

Breech presentations buttock and limb first Tx

If the buttocks have already passed through the vagina, delivery has begun. Provide prompt transport if delivery has not occurred within 10 minutes. support the baby, make a V with your fingers and insert into the vagina to protect the neonates airway.

For limb presenting deliveries, lay pt supine hips elevated, cover the limb with a sterile towel, administer oxygen and transport.

detail the two situations when pre-hospital providers should place gloved fingers in the vagina during delivery

the only two situations when pre-hospital providers should place gloved fingers in the vagina are to keep the baby from compressing the umbilical cord when it is prolapsed and to protect an infants airway during breech presentations

what is meconium? why is it concerning, What should the EMT be prepared to do about it?

Meconium is fetal stool, it can indicate newborn distress. EMTs might need to quickly suction the newborn’s mouth then nose after delivery before providing rescue ventilations.

define primigravida and multi gravida

Primigravida (first pregnancy) woman’s first stage of labor lasts an average of 12-18 hours, compared to an average duration of 6.5-13 hours for multigravida (had previous pregnancies).

what vasculature does the umbilical cord include?

The umbilical cord contains two arteries and one vein. The flow of oxygen is altered while in the womb and transitions to normal physiology within minutes after birth. The umbilical vein carries oxygenated blood from the placenta to the heart of the fetus, and the umbilical arteries carry deoxygenated blood from the heart of the fetus to the placenta.

what is an embolism and why might post-delivery woman be more prone to this?

An embolism is a blood clot that plugs a blood vessel.

Postpartum woman clot easier due to regular effects of pregnancy as well as extended bed rests

what do you check first following delivery of the head

Support the head while avoiding the eyes and fontanelles, after the head is delivered check for a nuchal cord.

what is a nuchal cord and what do you do about it

a nuchal cord is an umbilical cord wrapped around a newborns neck, slip it gently over the newborn’s head. if unable to slip, place two clamps 2 inches apart and cut in between

what should you do if the baby’s amniotic sac is unbroken

will look like a water balloon coming out the vagina. only when the newborn is crowning, you must puncture the unruptured sac with a clamp or by twisting away from the fetus’s face. push the ruptured sac away from the fetus’s face and wipe the mouth and nose with gauze. notify hospital of any meconium findings

how do you time the frequency and the duration of contractions

time the frequency from start of one to the start of the next contraction. time the duration by feeling the pt’s abdomen from the moment the contraction begins until it ends.

when do you suction a newborn? which order

if meconium is present and the newborn is not breathing suction the mouth then nose.

what is the APGAR score? when do you asses it and how?

APGAR score is the standard scoring system for newborn status. assess at 1 minute and again at 5 minutes by ranking from 0 to 2 on the newborn’s appearance, pulse, grimace or irritability, activity or muscle tone and respirations

define febrile seizures. Why do they happen, and how are they the same or different than regular seizures, what the Tx

Febrile seizures are caused by high fevers, typically the first day of febrile illness and occurs in children 6 months to 6 years most commonly. They are more well tolerated, the child may be fully awake and oriented by the time you make contact. Their high temp could lead to more seizures. Might be a sign of a more serious underlying illness such as meningitis.

assess ABCs cool with tepid water and transport.

Shock in infants and children vs adults, S&S and Tx

Children develop shock when they lose >25% BV while can loose up to 30-40%

Children exhibit tachycardia, poor cap refill and ALOC. Adults have tachycardia, low BP and ALOC

Assess ABCs and treat for shock

head injury in children vs adults, S&S and Tx

The size of the head, in relation to the body, is larger in children than adults. the skull is softer and thinner as-well, the scalp vessels can bleed easily and may cause significant blood loss. suspect a serious head injury in children experiencing N&V as it is more common for children. treat in a similar manner to adults.

Normal cap refill and what age do we check it

normal cap refill is within 2 seconds, it is most reliable in children younger than 6 years.

Define PAT and its general purpose

The pediatric assessment triangle is a structured assessment tool that allows you to rapidly form a general impression of a child’s condition without touching the child. in 30 seconds you can determine the category of the pt’s physical problem and determine transport urgency. PAT assesses appearance, work of breathing and circulation to the skin.

cause of respiratory distress in children: early and late S&S and Tx

causes of respiratory arrest in children include traumas or illnesses. early signs include tachypnea, grunting or wheezing, supraclavicular contractions, intercostal or substernal retractions, head bobbing, nasal flaring and tripod position. late signs include cyanosis, skin pallor and bradypnea.

Treat with oxygen, albuterol and transport for asthma

oxygen and bronchodilator if wheezing is heard for pneumonia than transport

humidified oxygen and transport for croup (laryngotracheobronchitis), bronchodilators are contraindicated and could provoke

signs of impending cardiovascular arrest in children

Bradycardia (HR <80 for children and <100 for newborns) is a sign of impending cardiac arrest.

Low BP, ALOC< cold grey or blue skin, slow cap refill, slow HR or RR.

S&S of meningitis

Fever, ALOC, seizures, pain accompanying movement, stiff neck, bulging fontanelles without crying in infants.

children infected with Neisseria meningitidis typically have small, pinpoint, cherry-red spots or a larger or black rash.

infant and children car seat protocols

children weighing less then 40 pounds (18kilo) who do not require spinal motions restriction should be transported in a car seat if the situation allows.

greenstick fracture

an incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation; occurs in children

dementia vs delirium

dementia is a gradual onset of progressive disorientation, shortened attention span, and loss of cognitive function. delirium is a sudden change in mental status, usually memory is intact. Dementia pts may be poor historians and have impaired judgement

purpose of GEMS diamond

used to help remember the differences in older pts.

Geriatrics (physical differences between geriatrics)

Environmental assessment (what is the environment they are in like)

Medical assessment (what medications do they take)

Social assessment (do they have social support for their ADLs)

down syndrome differences in anatomy and treatment

people with down syndrome have a rounded head with a flat occiput, protruding tongue, slanted, wide-set eyes, folded skin on either side of their nose, wide hand with small face and features. they can have congenital heart defects, thyroid problems and hearing and vision problems. Treat pts normally and build report by having just on person talk and introduce the team.

Down syndrome pts may also have atlantoaxial instability putting them at higher risk for cervical and spinal cord injuries

procedure when a DNR cannot be located for a patient in cardiac arrest

when you are in doubt or when there are no written orders, you should try to resuscitate the patient

DOPE mneumonic

help you remember possible causes of an airway obstruction and correct the problem

Displaced, dislodged or damaged tube

Obstructed tube

Pneumothorax

Equipment failure

EMTALA

Emergency Medical Treatment and Active Labor Law, all hospital emergency departments must provide a medical assessment and required treatment, regardless of a patient’s ability to pay.

Geriatric patients and blood clot cause/S&Ss

Geriatric pts lose function or have reduced function of veins in the legs that carry blood to the heart. this along with decreased activity can increase clotting and cause MIs, PEs and ischemic cerebrovascular accidents (stroke).

People with venous stasis (motionless state) may exhibit edema, or swelling, of the legs or ankles and feelings of fullness, aches and tiredness in their legs.

Geriatric S&S of sepsis

Geriatric pts are less able to fight infections, anorexia, fatigue, weight loss and ALOC are common.

pneumonia and UTIs are common in patients who are bed ridden

VP shunt

Ventriculoperitoneal shunt, which may be indicated by a fluid reservoir place beneath the skin on the side of the head behind the ear, drains excess fluid from the ventricles of the brain to the peritoneum of the abdomen

ileostomy

surgical procedure that creates and opening from the small intestine to the surface of the body to allow for the elimination of waste.

LVAD

Left Ventricular Assist Device is the most common VAD. It takes over the function of the ventricle and is typically used as a bridge to heart transplantation while a donor heart is being located or as a permanent solution for those who do not qualify for the heart transplant.

Should make a “hum” sound

cerebral palsy

term for a group of disorders characterized by poorly controlled body movement. results from damage to developing brain, condition is associated with visual and hearing impairment, difficulty communicating, epilepsy, intellectual difficulties, and ataxia.

types of ambulance bodies

type 1, conventional, truck cab-chassis with a modular ambulance body that can be transferred to a newer chassis as needed.

type 2, standard van, forward-control integral cab-body ambulance

type 3, specialty van cab with a modular ambulance body that is mounted on a cutaway van chassis

parking the ambulance at the scene

if first to arrive, park 100 feet before the on the same side of the scene in the fend off position which means to park at a diagonal angle with the front of the wheels turned away from the scene. if not arriving first than park 100 feet beyond the scene. if the street has not been completely closed and there is a driveway or parking lot adjacent to the scene, consider parking there.