OB Emergencies Flashcards
1
Q
Obstetrical pts are defined as gestation
A
> 20 weeks
2
Q
Physiological changes during pregnancy
A
- Mother’s HR increases
- HR can be 15-20 bpm above normal range by the third trimester
- Systolic and Diastolic BP decreases by 5-15 mm Hg during the second trimester
- Mother’s cardiac output and blood volume increases
- therefore, mom can lose 30-35% of her blood volume before the signs of shock become apparent
- Supine hypotension can occur
3
Q
Pts in third trimester and not in active labor transport
A
Left side
4
Q
If water has broken
A
Document time and color of fluid
5
Q
If blood is present
A
Document time and volume
6
Q
If crowning
A
- Prepare for delivery
- Transport to the closest appropriate hospital
7
Q
Focus History
A
- Gravida
- Para
- Multiple birth
- Gestational diabetes
- Due date
- Frequency of contractions
- Feeling of having to push or bowel movement
8
Q
First trimester
A
1- 12 weeks (1-3 Month)
9
Q
Second trimester
A
13-27 weeks (4-6 Month)
10
Q
Ectopic Pregnancy
A
- Usually first trimester
- sudden onset of severe abdominal pain
- Vagina Bleeding
- Amenorrhea (Absent period)
- Cullen’s Sign (periumbilical ecchymosis)
- Grey’s Tuner (Bruise flanks)
- Abdominal Distention and tenderness
10
Q
Spontaneous Abortion Signs and symptoms
A
- Abdominal cramping
- Vaginal bleeding
- Passage of tissue or fetus
11
Q
For active bleeding
A
- Loosely place trauma pads over the vagina in an effort to stop the flow of blood
- DO NOT pack the vagina
If hypotensive: NS 1L
x1
12
Q
Placenta Eruption
A
- Sudden onset of severe abdominal pain and tenderness
- Painful uterine contractions
- Vaginal bleeding with dark red blood
- Patient may present in shock
13
Q
Placenta Previa
A
Painless vaginal bleeding (bright red blood)
14
Q
Uterine Rupture
A
- Sudden, intense abdominal pain
- Vaginal bleeding
15
Q
For pregnant pts transport
A
Place 4-6 inches of padding under the patient’s right side while maintaining normal anatomical alignment
If hypotensive: NS 1L
x1
16
Q
Severe pre-Eclampsia/Eclampsia
A
- Begins after 20 weeks of pregnancy
- HTN (SBP > 160 mm Hg OR a DBP of > 110 mm Hg) with any of the following:
- AMS
- Visual disturbances
- Headache
- Pulmonary edema
17
Q
Severe Eclampsia not in active labor
A
Either condition can occur for up to 60 days postpartum. Transport ALL PATIENTS to OB Hospital.
* Mag Sulfate: 2g in 50mL, 10gtt, 1gtt/sec
over 10 mins MUST repeat x1
18
Q
Eclampsia
A
- Versed 5mg IV/IO in 5 mins
May repeat x1 - Mag Sulfate 4mg in 50mL, 60gtt, run wide open
19
Q
If unable to stablish an IV for eclampsia
A
- Mag sulfate 4mg (8mL total) IM
4mL per injection site
20
Q
Normal delivery positioning
A
- Place patient on her back with knees flexed and feet flat on the floor
- Control delivery of the head, with gentle perineal pressure
21
Q
Once the baby’s head delivers
A
- Suction the mouth and then the nose
- Support the neonate’s head as it rotates to align with the shoulders, and gently guide the
neonate’s head downward to deliver the anterior shoulder - Once the anterior shoulder delivers, gently guide the neonate’s head upward to deliver the
posterior shoulder and the rest of the body
22
Q
Upon delivery of the Neonate
A
- Dry, warm, and stimulate the neonate
- Keep the neonate at the same level of the placenta
23
Q
When to perform APGAR Score
A
1 and 5 minutes after birth
24
Once the umbilical cord stops pulsating (usually 3-5 minutes)
* Clamp the cord in the following fashion:
* Place the first clamp 4” away from the neonate’s body
* Milk the cord away from the neonate and towards the mother (this will minimize
splatter)
* Place the second clamp 2” away from the first, towards the mother
* Cut the cord between the 2 clamps
* Place the neonate on the mother’s chest, skin-to-skin, and cover with a dry blanket
* Record and encode an APGAR score at 1 and 5 minutes and document the delivery time
* Apply firm continuous pressure, manually massaging the uterine fundus after the placenta delivers
* Preserve the placenta in the bag provided with the OB Kit or a “Red Bio-Hazard bag” for inspection by the receiving hospital
25
APGAR Score Criteria
Activity
* No Movement 0
* Some Movement 1
* Active Movement 2
Pulse
* No Pulse 0
* Less than 100 bpm 1
* Greater than 100 bpm 2
Grimace
* No response 0
* Grimace or feeble cry 1
* Active Motion 2
Appearance
* Blue all over 0
* Body pink, extremities blue 1
* Completely pink 2
Respiration
* Not breathing 0
* Slow, irregular 1
* Strong cry 2
26
Breech presentation
If the head does not deliver within 3 minutes of the body:
* Elevate the mother’s hips (knee to chest position)
* Insert a gloved hand into the vagina
* Push the vaginal wall away from the neonate’s nose and mouth
* Expedite transport while maintaining the knee to chest position and the neonate’s airway
* Administer blow-by OXYGEN to the neonate
27
Shoulder Dystocia
MCROBERT’S PROCEDURE:
* Hyperflex the mother’s legs tightly to her abdomen
* It may be necessary to apply suprapubic pressure (mother’s lower abdomen)
* Gently pull on the neonate’s head
28
Nuchal Cord
* Check for the presence of a nuchal cord after delivery of the head
* If the cord is around the neck:
* Gently hook your finger under the loop
* Pull it over the neonates head
* You may have to repeat this if there is more than 1
loop present
* If you are unable to free the cord:
* Clamp the cord in 2 places
* Cut the cord between the clamps
29
Prolapsed Umbilical Cord
* Place mother in the knee to chest position
* Manually displace the uterus to the left
* Insert a gloved hand into the vagina
* Push the neonate up and away from the umbilical cord regardless if there is a pulse present or
not
* Maintain this position during transport
* Frequently reassess the umbilical cord for the presence of a pulse, as contractions are likely to
compress the umbilical cord
* Wrap the exposed cord in a moist sterile dressing
* Expedite transport to closest OB facility
