Module 5 - Pediatrics, obstetrics, geriatrics, special populations, vehicle extractions, triage

Amniotic sac with amniotic fluid

fluid is clear, baby floats in this, protection, nourishment

brown color in amniotic fluid

meconium staining, suction

Supine hypotensive syndrome

very low blood pressure, gravid uterus compresses vena cava Place blanket under left hip and/or roll onto her left side

Ectopic pregnancy

the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tubes., bright red blood, possible low blood pressure

Placenta previa

placental implantation in the lower uterine segment encroaching on/covering cevix

Placenta previa delivery

cesarean

Placenta abruptio

partial/complete premature detachment of a normally implanted placenta at more than 20 weeks, see bright red blood

Pre-Eclampsia (toxemia)

hypertensive disorder in the last trimester, headache, protein in urine

Eclampsia

hypertension with seizures/coma

Gestational Diabetes

diabetes that develops during pregnancy and may go away after the baby is born

Trauma during pregnancy

mom can have excessive bleeding called hemorrhagic shock and could die or the baby could die. Mom could lose up to 35% of her blood before the signs of shock could show up in her

Breech delivery

a baby is born bottom first instead of head first. Around 3-5% of pregnant women at term (37–40 weeks pregnant) will have a breech baby. Most babies in the breech position are born by a caesarean section because it is seen as safer than being born vaginally

Prolapsed umbilical cord

umbilical cord slips down into the vagina or presents externally, which can cause fetal asphyxiation. cover with moist dressing

Braxton Hicks

is not a complication but rather mimics labor but then stops, ask if their water has broke, urge to push

First stage of labor

dilation and thinning of the cervix, dilates from 0 to 10 centimeters. onset of contractions through full dilation of the cervix

Second stage

delivery of the infant

Third stage

delivery of the placenta

Mom is in early labor

strong desire to go to bathroom may mean delivery occurring soon, don’t have her go to the bathroom (baby could fall out in toilet)

Baby is crowning

stop ambulance to deliver

Protruding cord

keep the cord moist, move the cord from around the baby

Amniotic sac still intact

tear open the sac with your fingers only

How to suction baby

mouth and then the nose as the head is protruding (crowning)

APGAR score

done 1 minute and 5 minutes after the baby is born

Cutting the cord

baby must be breathing on its own, cord has stopped pulsating, cord clamped at 7 inches from baby and 10 inches from baby

Signs of adequate breathing with the newborn

Heart rate over 100, their extremities are moving, crying, cyanosis of just the hands and feet but not the head and chest

Steps if the baby is not breathing

Rub back and feet, waft oxygen from bvm over the nose, baby bvm, check pulse, cpr

Deliver the placenta

place in plastic bag, examine to see if entire placenta is intact

Premature baby

born before 37 weeks and/or 5.5 pound birth rate

Blood loss during delivery

Mom will usually lose less than 500 cc (ml) of blood

Mom is still bleeding after delivery

massage the uterus (fundus), give the baby to mom for breast feeding, sanitary napkins on the vagina

Evaluate children with the pediatric triangle

appearance, breathing, circulation

Grunting and nasal flaring is a large sign for

distressed breathing

Bulging fontanelles in child

from excessive crying or intracranial pressure increase

Epiglottitis

severe inflammation in the throat around epiglottis. Can cause breathing problems

Hypothermia

always be concerned with this when a child is in water or in cold weather

A very early sign that an infant may be going into respiratory distress is

extreme drowsiness

A child with a high fever could lead to

seizures

A child with a high fever and grunting after exhaling are dangerous signs of

respiratory problems

Children can go into shock because of

infections, blood loss, dehydration

Children hit by a vehicle can have these top three injury types

abdominal injuries, head injuries, chest injuries

There are many challenges in communicating with the elderly including

deafness

Congenital deafness

caused by genetics

Acquired deafness

results from injury

Chest pain in the elderly is commonly caused by these top three causes

angina, pneumonia, and aneurysms

A huge fear for the elderly after an injury is that they

may lose their independence and have to move from their home, can not do all the normal daily bodily functions and ability to drive

Bariatrics is the

branch of medicine for treating overweight patients

Vagina

the birth canal

Cervix

the neck of the uterus at the entrance of the birth canal

Uterus

the muscular abdominal organ where the fetus develops; the womb

Fallopian tubes

the narrow tube that connects the ovary to the uterus

Ovaries

the female reproductive organ that produces ova (egg)

Placenta

the organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and fetus

Umbilical cord

the fetal structure containing the blood vessels that carry blood to and from the placenta

First trimester

First day of LMS-12 weeks embryonic stage

Second trimester

13-26 weeks head is bigger at the beginning, rest of body will catch up by end of the trimester, 20th week will feel the kicks; know the sex of baby; baby can hear, eyes formed but can't see; fingerprints formed

Third trimester

27-end of pregnancy lungs will fully develop the longer they are closer to the due date, fat built, will move more, start to listen to music

Name the 8 things that should be assessed first for a woman in labor.

Ask her name, age, and expected due date, Ask if this is the first pregnancy, Ask her if she has seen a doctor regarding her pregnancy, Ask her when the labor pains started and how often she has them. Ask when the water broke & if there has been any bleeding., Ask her if she feels the urge to push or if she feels as though she needs to move her bowels, Examine the mother for crowning, Feel for uterine contractions, Take vital signs

List the things the EMT should do to prepare the mother for delivery

Control the scene so the mother will have privacy, BSI, Place mother on bed, floor, or ambulance stretcher. Elevate her buttocks with blankets or a pillow. Knees drawn up and spread apart, Remove any clothing obstructing vaginal view, Place someone at mother’s head for support, Position the obstetrics kit near the patient

Describe the nine things that should be done by the EMT to help to deliver the baby

Keep someone at the mother's head for support & to check health, BSI & place hands at vaginal opening when head starts to show, Place one head below the baby’s head as it delivers (don't pull on the baby), Puncture amniotic sac with fingers & observe it; if not already broken by the time the baby’s head is delivered, Make sure the umbilical cord isn't around baby’s neck; try to not have the mother push at this time, Help deliver the shoulders, Support baby through the whole process; after the baby is delivered you need to dry them and put them in a warm blanket, Assess the airway, Note the exact time of birth

Low birth rate is considered below

5 pounds, 8 ounces

What are four things that decrease in the elderly?

vision, hearing, maximum heart rate, muscle mass, memory

What is an irregularly irregular heartbeat?

The person’s heart rate does not have the same repeatable rate every time the heart contracts, usually does not cause a problem for the patient

Name four things that cause shortness of breath in the elderly.

decreased elasticity of the lungs, decreased lung volume, decreased activity of cilia, diminished cough and gag reflexes

pulmonary embolism, emphysema, cardiac problems, pneumonia

What are the top four causes of chest pain in the elderly?

angina, myocardial infarction, pneumonia, and aortic aneurysm, GERD

How do you do CPR/AED with a person with an implanted pacemaker under their skin

position AED pads in clinically acceptable position as far away from pacemaker as possible

Name five things that can cause altered mental status in the elderly.

medications, hypoglycemia, stroke, sepsis, hypothermia

Describe what an abdominal aortic aneurysm is?

an enlargement of the aorta at the level of the abdomen and if bursts can cause intense pain and severe shock if the artery has been ruptured and death

damaged aortic wall

Name four causes of abdominal pain.

abdominal aortic aneurysm, bowel obstruction/blockage, diverticulosis, internal bleeding, cancers of the gastrointestinal tract, ulcers

Your patient has an inserted catheter with urine bag. Where do you place the urine bag when transporting this patient?

below level of patients bladder (but not on the ground)

What is herpes zoster?

shingles, extreme pain, narrow rash in a band shape

Name three reasons for depression in the elderly.

medical conditions that limit mobility, loneliness, loss of independence, loss of friends/spouse

Name three considerations you should think about with the elderly and medications.

elderly take much more medications than most people, they can easily mix up pills, medications are expensive, so they may not follow schedule, forget to take their pills/take too many, may need to take medication with/without food

Name five trauma/fall considerations with the elderly and accidents.

hip and proximal femur fractures, weakening of bone, edema and swelling, abnormal curvature can make immobilization challenging, do best to keep vertebrae in alignment

May indicate a more serious problem: abnormal heart rhythm, stroke, internal bleeding

A frequent action that many elderly have is kidney dialysis. What does that mean?

treatment that does some of the things done by healthy kidneys, removes body’s wastes, controls blood pressure, and removes extra salt and water when kidneys cannot

Hemodialysis

blood is pumped out of your body to an artificial kidney machine, toxins filtered out and blood returned to body by tubes

Peritoneal Dialysis

placed inside lining of your own abdomen acts as a natural filter(catheter put in belly and fluid goes through catheter which cleans blood), done at home

Define Pediatric

Of or pertaining to a patient who has yet to reach puberty

How are the following areas different between infants/children and adults?

Airway size is smaller and shorter, Size of tongue is proportionately larger, Size of head compared to body size is larger in proportion, Respiratory rate is faster, Neck length is shorter

Newborn pulse

120-160

Adolescent pulse

60-105

Newborn respirations

30-50

Adolescent respirations

12-20

How much blood is in the infant?

12 oz (335 ml) (75 mL/kg)

The amount of blood is in an average child?

2 liters (65-70 mL/kg)

The amount of blood in an average adult?

4 liters (1.2-1.5 gal)

Newborns and infants to 1 year

Minimal stranger anxiety and can be separated from parents (newborn), like to feel warm physically and emotionally, do not want to be “suffocated with oxygen mask”

Toddlers 1-3 years

Don’t like to be touched by strangers or separated from parents, Do not like having clothing removed, Frighten easily, overreact, and have a fear of needles and pain

Preschool 3-5 years

May believe illness is punishment for being bad, Have fear of blood, pain, and permanent injury (don’t like O2 mask), Curious, communicative, and can be cooperative

School age 6-12

Cooperates but likes opinions heard, Fear blood, pain, disfigurement, and permanent injury, Modest and do not like bodies exposed

Adolescent age 13-18

Want to be treated as adults

Explain four ways to interact with the pediatric patient.

Identify yourself, Kneel or sit at eye level, Smile, Touch child and hold hand or foot

Explain four ways to interact with an adolescent.

Be discreet when asking about things like drug/alcohol abuse and pregnancy, Preliminary of description of examinations, May regress emotionally and need as much support as younger children, Tact required to get info and may be needed to take patient into a private area

Pediatric Assessment Triangle (PAT)-Appearance

AVPU, Mental status

PAT- Breathing

(including airway), Abnormal sounds, positions, etc, Quality of breathing

PAT- Circulation

Pallor, mottling, cyanosis, Pulse and capillary refill

Fever

high body temp with shivering, headache, and delirium, seizures are possible, May not indicate how serious illness is, Fever w rash is need for transport

Diarrhea and vomiting

feces discharged from bowels in liquid form/eject matter through the mouth, Cramping, Cause dehydration and worsens whatever condition they are in., can lead to hypovolemic shock

Seizures

abnormal electricity in the brain, Can be sign of injury or underlying illness/disorder, Rarely life threatening but treated as id they are

Describe what a tension pneumothorax is.

collapsed lung that leaks oxygen into chest

Describe what an occlusive dressing is that is used with a tension pneumothorax.

dressing that is clear in the center and is taped down on three sides