Emergency Medicine - Babies and Children Flashcards
What are signs of imminent birth?
Contractions 2-3 minutes apart or less
- Duration of contraction - count from beginning to end of contraction
- Frequency of contraction - count from beginning of 1 contraction to beginning of next
- Mother feels urge to push with each contraction
- Crowning
Preparation for emergency delivery?
- Proper mother with pillows
- Drape abdomen, drape each leg, drape catch area and under her
- Wash hands
- Get ready for catch
What position is appropriate for baby to emerge? Head? Shoulders?
Head down, nose down
Next, head rotates naturally and shoulders rotate to come out, one shoulder at a time
Stabilize the head, ask for more contractions to push baby downwards
When to clear baby’s airway?
When head is all the way out and rotated and before shoulders are delivered - because there is compression on lungs, no air going in, and risk of meconium aspiration if body is delivery before airway clear
When do lungs expand?
After the torso and legs out, lungs expand and baby takes first breath
First steps after baby fully delivered?
Remember umbilical cord is still attached
Lay baby next to or on mother and:
- Clear airway
- Towel dry and wrap in dry blanket (must warm baby!)
- If not breathing (crying) yet, clear airway again and flick soles of feet
- If still not breathing, give 2 breaths, check pulse, CPR if needed
- EMS
What are two most important concerns for newborn?
Clear airway, get breathing
Prevent heat loss
Does the umbilical cord have to be cut?
Not necessary to cut (although it is cut)
Is it worse to cut it too soon or late?
Cutting it too soon is worse
Let 2 to 3 minutes pass
Longer cord = more blood to baby
How to clamp and cut cord?
After baby is dry and breathing
- Make two ties, 4 inches from baby and 6 inches from baby and cut between
- With infant wrapped, breathing, cord cut, place on mother’s abdomen
How is placenta delivered?
Passively - don’t try to help or pull! May do some fundal massage to help w/ contractions
Placenta should naturally abrupt from uterus - all lobes should be intact with no retained placental product (risk of hemorrhage)
What is done after placental delivery?
Continue fundal massage to help natural release of oxytocin to help w/ sealing off of arteries / stopping bleeding
What is Apgar scoring?
A - Appearance (skin color) P - Pulse G - Grimace (reflex irritability) A - Activity (mm tone) R - Respiration
A: 0 = blue or pale, 1 = blue extremities, body pale, 2 = no cyanosis
P: 0 = absent, 1 = < 100, 2 = > 100
G: 0 = no response, 1 = grimace/feeble cry when stimulated, 2 = Cry or pull away when stimulated
A: 0 = no mm tone, 1 = some flexion, 2 = flexed arms and legs that resist extension
R: 0 = Absent resp, 1 = weak irregular gasping, 2 = Strong cry
If EMS shows up after emergency delivery, what 3 things need to go to hospital?
Mother
Baby
Placenta (to see if placenta completely delivered)
Possible complications of emergency birth?
Twins Prematurity Breech presentation - Bum and feet appear first Footling breech - Arm or leg appears first (EMERGENCY) - Baby must be turned
What is shoulder dystocia? How to deal with it?
After delivery of head, anterior shoulder obstructed from passing below the pubic symphysis
If mother in lithotomy position on back - flex mother’s knees up side of head and move baby down
