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Suctioning Nonvigorous Infants Through

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Suctioning Nonvigorous Infants Through 1 OB Emergencies Module 1 2016 CE- ECRN Condell Medical Center EMS System IDPH Site Code: 107200E-1216 PREPARED BY: DEBORAH SEMENEK RN, EMT-P MARK DZWONKIEWICZ FP-C, LI REVISED 7/11/16 OBJECTIVES 2 Upon successful completion of this module, the ECRN will be able to: 1. Differentiate the changes in assessment due to the patient’s pregnancy status as it relates to changes to the cardiovascular and respiratory systems. 2. Correlate findings in the assessment of the obstetrical patient with stages of labor. 3. Predict delivery complications based on the patient assessment. 4. Discuss presentation, assessment, and EMS intervention for antepartum bleeding, hypertensive emergencies, and maternal resuscitation. 5. Demonstrate appropriate actions to take for obstetrical delivery complications including breech birth, prolapsed cord, nuchal cord, presence of thick meconium, post partum hemorrhage. 6. Review selected Region X SOP’s as related to the topics presented. 3 7.Review case scenarios presented. 8. Review contents available in OB kit. 9. Review indications, complications, and the process of use of the meconium aspirator.. 10. Successfully complete the post quiz with a score of 80% or better. Terminology of pregnancy 4 Prenatal period – time from conception until delivery of fetus Antepartum – time period prior to delivery Post partum – time interval after delivery Gravidity – number of times pregnant Parity – number of pregnancies to full term Fetus – a developing human in the womb Neonate – the first 30 days of life for the infant Estimated date of confinement (EDC) – estimated birth date Terminology cont’d 5 Placenta – temporary blood-rich structure; lifeline for the fetus Transfers heat Exchanges O2 and carbon dioxide Delivers nutrients Carries away wastes Bag of waters – amniotic sac; surrounds and protects fetus; volume varies from 500 – 1000ml Perineum – the skin between the vaginal opening and the anus Nuchal cord – cord wrapped around the fetal neck Physiological Changes During 6 Pregnancy Pregnancy is a normal and natural process A woman’s body will undergo many changes in preparation for carrying another life Complications are uncommon but you must be prepared for them Pre-existing medical situations could be aggravated during pregnancy and develop into acute problems Physiological changes during 7 pregnancy: Nausea and vomiting due to hormonal changes Delayed gastric emptying renal blood flow Kidneys may not be able to keep up with filtration and reabsorption Bladder displaced anteriorly and superiorly More likely to be ruptured in trauma Urinary frequency Loosened pelvic joints due to hormonal changes Physiological changes cont’d 8 oxygen demand and consumption Diaphragm pushed up by enlarging uterus = lung capacity cardiac output to 6-7 L/min by end of 2nd trimester Average in resting non-pregnant female is 4.9L/minute maternal blood volume by 45% Can sustain 30-35% total blood loss before change in vital signs are evident venous return to right atrium with gravid uterus compressing inferior vena cava Fetal blood supply 9 No direct link between mother’s blood and infant Mother’s blood flows to the placenta Placenta supplies blood to the fetus Placenta acts as a barrier protecting the fetus Some items cross the placental barrier and can affect the fetus: Alcohol Some medications – Valium Versed, oral diabetic meds, narcotics, some antibiotics, steroids Umbilical cord 10 A flexible, rope-like structure approx. 2 feet long Contains 2 arteries, 1 vein Transports oxygenated blood to fetus Returns relatively deoxygenated blood to placenta Fetus can twist and turn in the uterus and get wrapped up in cord Fetus can “tie umbilical cord into a knot” Normal pregnancy – 20 weeks & term 11 Antepartum Complications 12 Vaginal bleeding Ectopic pregnancy Placenta previa Placenta abruptio Hypertensive disorders Preeclampsia, eclampsia Supine Hypotensive Syndrome Vaginal Bleeding 13 May occur at anytime during the pregnancy If early, patient may not even realize they are pregnant In the field, exact etiology cannot be determined Keep heightened suspicion that vaginal bleeding may be related to patient being pregnant This could prove to be an emotional time for the patient and family Being supportive is important in this patient population Ectopic Pregnancy 14 Fertilized egg has implanted outside the normal uterus Patient often presents with abdominal pain that starts diffuse and then localizes to lower quadrant on affected side Patient may not even be aware that they are pregnant If in fallopian tube and tube ruptures, maternal death due to internal hemorrhage is a real possibility Abdomen becomes rigid with pain Often referred shoulder pain on affected side Placenta previa 15 Abnormal implantation of placenta on lower half of uterine wall Cervical opening partially or completely covered Placenta can start pulling away from attachment starting at 7th month Painless bright red vaginal bleeding Uterus usually soft Potential for profuse hemorrhage Definitive treatment is cesarean section delivery Abruptio placenta 16 Premature separation of normally implanted placenta from uterine wall Life threat for mother and fetus 20-30% mortality for fetus Signs & symptoms depend on extent of abruption Can have sudden sharp, tearing pain and stiff, board like abdomen Vaginal bleeding could range from none to some Blood could be trapped between placenta and uterine wall Maintain maternal oxygenation and perfusion Pre-hospital Care of antepartum 17 bleeding Maintain high index of suspicion Treat for blood loss Positioning – lay or tilt left Monitor for adequate oxygenation Providing supplemental oxygen is also for benefit of the fetus Maintain adequate perfusion Consider fluid challenge as needed Expedited transport; transport as soon as possible Early report to receiving facility Hypertensive disorder of pregnancy 18 Major cause of maternal, fetal and neonatal morbidity and mortality Morbidity – presence of a disease state Mortality – relating to death A common medical problem in pregnancy Includes gestational hypertension (hypertension that develops during pregnancy usually after the 20th week) and pre-existing hypertension (typically defined as a blood pressure > 140/90) Preeclampsia 19 Most common hypertensive disorder of pregnancy Increased risk in diabetics, those with history of preeclampsia, and those carrying more than one fetus Progressive disorder; most commonly seen last 10 weeks of gestation, during labor, or first 480 postpartum Have a 30 mmHg increase in systolic B/P and 15 mmHg increase in diastolic B/P over baseline Signs and symptoms pre-eclampsia 20 Elevated blood pressure Headache Visual disturbances – blurred vision, flashing before the eyes Severe epigastric pain Vomiting Shortness of breath Tissue edema related to third spacing with fluid shift into tissues Swelling of face, hands, and feet Eclampsia 21 Most serious side of hypertensive disorders of pregnancy Generalized tonic-clonic seizure activity Often preceded by flashing lights or spots before their eyes Epigastric pain or pain RUQ often precedes seizure Note grossly edematous patient with markedly elevated B/P High mortality rates for mother and fetus Definitive treatment is delivery EMS needs to provide support until delivery at closest appropriate facility Managing seizures during pregnancy 22 Positioning of patient To protect from harm, protect airway Maintain patent airway Potential need for intermittent suction Support ventilations Patient’s respirations altered during active seizure activity Will need supportive ventilations especially in presence of long lasting seizure activity Manage seizure with Versed 2 mg IN/IVP/IO every 2 minutes up to 10 mg (does cross the placental barrier; could depress fetus) Supine hypotensive syndrome 23 Usually occurs in 3rd trimester Gravid uterus compresses inferior vena cava when mother lies supine Mother may experience dizziness Evaluate for volume depletion versus positioning problem Place mother in left lateral recumbent position (“lay left”) for assessment, treatment, and transportation to prevent this problem Identifying imminent delivery 24 Mother entering the 2nd stage of labor Measured from complete dilation of cervix (10cm) to delivery of fetus Could last 50-60 minutes for first pregnancy Contractions strong lasting 60-75 seconds and 2 -3 minutes apart Membranes may rupture Has urge to push Perineum bulging Crowning evident when head or other presenting part is evident at vaginal opening during a contraction Ob kit contents 25 Cap Ob kit contents ID bands EMERGENCY CHILDBIRTH LABOR: Region 10 SOP Review 26 1. Obtain history. Initiate Adult Routine Medical Care. Gravida (# of pregnancies) Length of previous labors Para (# of live births) Bag of waters (amniotic sac) Intact? Broken? Due date, Duration and frequency of contractions High risk concerns 2. Position patient and evaluate for: SIGNS OF IMMINENT DELIVERY-crowning, bulging, in voluntary pushing SIGNS OF COMPLICATIONS-prolapsed cord, profuse bleeding, meconium staining 3. If delivery is not imminent, transport on left side. DELIVERY: Region 10 SOP Review 27 1. If contractions are 2 minutes apart, or signs of imminent delivery are present, open OB pack and don sterile gloves as well as standard precautions. Drape mother’s abdomen and perineum. Prepare to assist the delivery. 2. Initiate Adult Routine Medical Care. 3.
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