Drill of the MonthDrill of the Month
Drill of the MonthDrill of the MonthDeveloped by Gloria BizjakDeveloped by Gloria Bizjak
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
22Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Student Performance Objective:Student Performance Objective:
Given information, resources, and opportunity Given information, resources, and opportunity for discussion and practice, EMTs will be able to:for discussion and practice, EMTs will be able to:• List and define childbirth structures and termsList and define childbirth structures and terms• Describe the stages of laborDescribe the stages of labor• List the steps of evaluationList the steps of evaluation•Describe potential complications and Describe potential complications and emergenciesemergencies•List and demonstrate steps of labor and List and demonstrate steps of labor and delivery delivery EMTs will follow acceptable Maryland medical practice EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical and Maryland Medical Protocols for Emergency Medical Providers.Providers.
33Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
OverviewOverview Anatomical Structures and TermsAnatomical Structures and Terms Stages of LaborStages of Labor Steps of EvaluationSteps of Evaluation Labor and DeliveryLabor and Delivery Complications, Emergencies, and Complications, Emergencies, and
ManagementManagement Post Natal CarePost Natal Care
44Drill of the MonthDrill of the Month
Anatomical Structures and Anatomical Structures and TermsTerms
StructuresStructures– Fetus: The developing babyFetus: The developing baby– Uterus (womb): A muscular organ in Uterus (womb): A muscular organ in
which the fetus developswhich the fetus develops– Amniotic sac: A membranous “bag of Amniotic sac: A membranous “bag of
waters” with 1—2 quarts of fluid in waters” with 1—2 quarts of fluid in which fetus floatswhich fetus floats Cushions and protects the fetus from injuryCushions and protects the fetus from injury Maintains a constant fetal body tempMaintains a constant fetal body temp Ruptures during laborRuptures during labor
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Anatomical Structures and Anatomical Structures and TermsTerms
StructuresStructures– Cervix: Narrow neck of uterus; dilates Cervix: Narrow neck of uterus; dilates
(widens or effaces) to allow infant’s head (widens or effaces) to allow infant’s head to emergeto emerge
– Mucous plug (bloody show): Like nasal Mucous plug (bloody show): Like nasal mucousmucous Forms at the neck of the cervixForms at the neck of the cervix Discharges as the cervix dilates and may go Discharges as the cervix dilates and may go
unnoticedunnoticed Usually tinged with blood as cervical vessels Usually tinged with blood as cervical vessels
rupturerupture
– Vagina: Birth canalVagina: Birth canal
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Anatomical Structures and Anatomical Structures and TermsTerms
StructuresStructures– Perineum: Area between vagina and anus; Perineum: Area between vagina and anus;
may tear during birthmay tear during birth– Placenta: Exchange organPlacenta: Exchange organ
Carries oxygen, nutrients, other ingestions Carries oxygen, nutrients, other ingestions (meds, drugs, alcohol) to fetal circulation from (meds, drugs, alcohol) to fetal circulation from mothermother
Carries carbon dioxide, wastes from fetal Carries carbon dioxide, wastes from fetal circulation to maternal circulation through cordcirculation to maternal circulation through cord
– Afterbirth: Placenta, amniotic sac, tissuesAfterbirth: Placenta, amniotic sac, tissues– Umbilical cord: Connects placenta to fetus; Umbilical cord: Connects placenta to fetus;
contains two arteries, one veincontains two arteries, one vein
77Drill of the MonthDrill of the Month
Anatomical Structures and Anatomical Structures and TermsTerms
TermsTerms– Dilation: Cervical widening measured in Dilation: Cervical widening measured in
centimeters (0—not dilated; 10—fully centimeters (0—not dilated; 10—fully dilated)dilated)
– Labor: Process of delivery in 3 stages of Labor: Process of delivery in 3 stages of contractions and dilation, birth, afterbirthcontractions and dilation, birth, afterbirth
– Meconium: First feces, greenish-black to Meconium: First feces, greenish-black to light brown, odorless, tarry; normally light brown, odorless, tarry; normally discharged a day or two after birthdischarged a day or two after birth
– Meconium staining: Fetal defecation in Meconium staining: Fetal defecation in uteroutero
88Drill of the MonthDrill of the Month
Anatomical Structures and Anatomical Structures and TermsTerms
TermsTerms– Delivery presentation: Fetal position in Delivery presentation: Fetal position in
birth canal, usually head firstbirth canal, usually head first– Crowning: Infant’s presenting part at Crowning: Infant’s presenting part at
vaginal opening—usually the headvaginal opening—usually the head– Cephalic presentation: Normal, head-first Cephalic presentation: Normal, head-first
presentationpresentation– Breech presentation: Feet or buttocks; Breech presentation: Feet or buttocks;
single foot: true emergencysingle foot: true emergency
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Anatomical Structures and Anatomical Structures and TermsTerms TermsTerms
– Shoulder presentation (transverse lie): Shoulder presentation (transverse lie): Shoulder presents first (about 0.3%); true Shoulder presents first (about 0.3%); true emergencyemergency
– Placenta previa: Placenta attaches low in Placenta previa: Placenta attaches low in womb (before infant)womb (before infant) May cover cervical opening and ruptures, bleeds May cover cervical opening and ruptures, bleeds
painlessly as cervix dilatespainlessly as cervix dilates
– Placenta abruptio: Premature, sudden Placenta abruptio: Premature, sudden (abrupt) separation of placenta from uterus (abrupt) separation of placenta from uterus (1%)(1%) Serious complication; common cause of late Serious complication; common cause of late
bleedingbleeding
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Drill of the MonthDrill of the Month
Anatomical Structures and Anatomical Structures and TermsTerms TermsTerms
– Braxton Hicks contractions: Rhythmic Braxton Hicks contractions: Rhythmic uterine clenching lasting 30—60 secondsuterine clenching lasting 30—60 seconds Occurs in some about mid—to—end of Occurs in some about mid—to—end of
pregnancypregnancy Different from labor contractionsDifferent from labor contractions
– Eclampsia: Causes seizures, sometimes Eclampsia: Causes seizures, sometimes coma, usually after 20coma, usually after 20thth week week Follows pre-eclampsia of high blood pressure, Follows pre-eclampsia of high blood pressure,
swelling of hands, feet, and protein in urineswelling of hands, feet, and protein in urine
– Fontanel: Soft (unossified) areas of Fontanel: Soft (unossified) areas of infant’s skull: anterior, posterior, medialinfant’s skull: anterior, posterior, medial
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Drill of the MonthDrill of the Month
Stages of LaborStages of Labor First stage (dilation stage)First stage (dilation stage)
– Begins: Regular contractions, cervical Begins: Regular contractions, cervical dilationdilation Contractions about 30 minutes apart; near Contractions about 30 minutes apart; near
birth—3 minutes apartbirth—3 minutes apart Mucous plug discharges with “bloody show” Mucous plug discharges with “bloody show” Amniotic sac breaks; EMTs may have to tearAmniotic sac breaks; EMTs may have to tear
– May break hours before (but body continues to May break hours before (but body continues to produce fluid) or after crowning/head deliveryproduce fluid) or after crowning/head delivery
– Fluid usually clear; staining indicates fetal defecationFluid usually clear; staining indicates fetal defecation
Ends: Fully dilated cervix, more frequent Ends: Fully dilated cervix, more frequent contractions, more severe labor painscontractions, more severe labor pains
Pressure on rectum—feel need to move bowelsPressure on rectum—feel need to move bowels
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Drill of the MonthDrill of the Month
Stages of LaborStages of Labor Second stage (Birth stage)Second stage (Birth stage)
– Begins: Infant enters birth canalBegins: Infant enters birth canal Decide whether to transport or stay and Decide whether to transport or stay and
deliverdeliver If birth appears imminent, prepare for If birth appears imminent, prepare for
deliverydelivery
– Ends: Birth of infantEnds: Birth of infant
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Drill of the MonthDrill of the Month
Stages of LaborStages of Labor Third stage (Afterbirth stage)Third stage (Afterbirth stage)
– Begins: After infant is bornBegins: After infant is born Contractions resume shortly after birthContractions resume shortly after birth Contractions continue until placenta and Contractions continue until placenta and
other tissue deliverother tissue deliver Contractions are usually milder than laborContractions are usually milder than labor
– Ends: Delivery of afterbirth: placenta Ends: Delivery of afterbirth: placenta and cord, amniotic sac, uterine liningand cord, amniotic sac, uterine lining May take 10—20 minutesMay take 10—20 minutes
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation On arrival: Size up the sceneOn arrival: Size up the scene Approach and perform initial Approach and perform initial
assessmentassessment– Mental statusMental status– Airway, breathing, circulation (heart Airway, breathing, circulation (heart
rate, bleeding)rate, bleeding)– DisabilityDisability– ExposureExposure– Clinical priority (1, 2, 3, or 4)Clinical priority (1, 2, 3, or 4)– Disposition (mode, status)Disposition (mode, status)
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation Perform history and physical Perform history and physical
assessmentassessment– General questionsGeneral questions
Name, age, due dateName, age, due date First pregnancy?First pregnancy?
– Labor for first pregnancy: 16—20 hoursLabor for first pregnancy: 16—20 hours– Labor for subsequent pregnancies progresses Labor for subsequent pregnancies progresses
more quicklymore quickly
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation Perform history and physical Perform history and physical
assessmentassessment– Questions about labor (help determine Questions about labor (help determine
transport or stay and deliver)transport or stay and deliver) How long having labor pains?How long having labor pains?
– Several hours (possibly prepare to deliver)Several hours (possibly prepare to deliver)– Couple of hours (possibly transport)Couple of hours (possibly transport)
How often are pains? (Most mothers time How often are pains? (Most mothers time them)them)
– Far apart (transport)Far apart (transport)– Frequently (prepare to delivery)Frequently (prepare to delivery)
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation Perform history and physical Perform history and physical
assessmentassessment– Questions about laborQuestions about labor
Has water broken?Has water broken?– If so, how long ago?If so, how long ago?– Response may not affect delivery or transport Response may not affect delivery or transport
decisiondecision
Bleeding or bloody show?Bleeding or bloody show?– Response may not affect delivery or transport Response may not affect delivery or transport
decisiondecision
Straining or feeling urge to move bowels?Straining or feeling urge to move bowels?– If so, infant’s head is in birth canal (prepare to If so, infant’s head is in birth canal (prepare to
deliver)deliver)– If no, transportIf no, transport
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation Perform history and physical Perform history and physical
assessmentassessment– Questions about laborQuestions about labor
Examine mother for bleedingExamine mother for bleeding– Some bleeding is normal with dilationSome bleeding is normal with dilation– If excessiveIf excessive
Apply sanitary padsApply sanitary pads Treat for shockTreat for shock Consider ALSConsider ALS Rapid transportRapid transport Notify receiving facilityNotify receiving facility
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation Perform history and physical Perform history and physical
assessmentassessment– Questions about laborQuestions about labor
Examine mother for crowningExamine mother for crowning– Explain what you will do before visually Explain what you will do before visually
inspectinginspecting– Prepare for deliveryPrepare for delivery
If presenting part is visible, mother is crying If presenting part is visible, mother is crying out, straining, and wanting to move bowelsout, straining, and wanting to move bowels
– For first delivery with no straining or crowning, For first delivery with no straining or crowning, transporttransport
Transport rapidly if there is a single limb Transport rapidly if there is a single limb presentationpresentation
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Drill of the MonthDrill of the Month
Steps of EvaluationSteps of Evaluation Perform history and physical Perform history and physical
assessmentassessment– Questions about laborQuestions about labor
Feel abdomen for uterine contractionsFeel abdomen for uterine contractions– Explain what you will doExplain what you will do
Place gloved hand over navalPlace gloved hand over naval Time duration of contractionTime duration of contraction Time frequencyTime frequency
Take vital signsTake vital signs
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Labor (first stage)Labor (first stage)
– Normal labor painsNormal labor pains Begin with ache in lower backBegin with ache in lower back Become stronger in lower abdomenBecome stronger in lower abdomen Come at regular intervals lasting 30 seconds Come at regular intervals lasting 30 seconds
to a minuteto a minute
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Labor (first stage)Labor (first stage)
– ContractionsContractions Uterus contracts causing pain; relaxes Uterus contracts causing pain; relaxes
relieving painrelieving pain May start and last for a while, stop and start May start and last for a while, stop and start
againagain CharacteristicsCharacteristics
– Contraction time: beginning of uterine contraction Contraction time: beginning of uterine contraction until relaxationuntil relaxation
– Contraction interval (frequency): start of one Contraction interval (frequency): start of one contraction to start of nextcontraction to start of next
Contractions times of 30 seconds to 1 Contractions times of 30 seconds to 1 minute, intervals of 2—3 minutes: delivery is minute, intervals of 2—3 minutes: delivery is imminentimminent
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage)Delivery (second stage)
– Preparation: Assemble itemsPreparation: Assemble items Personal protective equipmentPersonal protective equipment Towels and sheetsTowels and sheets Gauze padsGauze pads Bulb syringeBulb syringe Clamps/hemostats/cord tapeClamps/hemostats/cord tape ScissorsScissors Baby blanket/towelsBaby blanket/towels Sanitary padsSanitary pads Plastic bag or containerPlastic bag or container
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage)Delivery (second stage)
– Preparation: Evaluate and prepare Preparation: Evaluate and prepare mothermother History: name, age, due date, first History: name, age, due date, first
pregnancy, attended by physician?pregnancy, attended by physician? Current condition: when labor pains started, Current condition: when labor pains started,
how often, bleeding/bloody show, straininghow often, bleeding/bloody show, straining Evaluate: examine for crowning, feel Evaluate: examine for crowning, feel
abdomen and time contraction frequency, abdomen and time contraction frequency, duration, take vital signsduration, take vital signs
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage)Delivery (second stage)
– Decision to transport or stay and deliverDecision to transport or stay and deliver Transport: first delivery, no straining, no Transport: first delivery, no straining, no
crowningcrowning Stay and deliver: not a first delivery and/or is Stay and deliver: not a first delivery and/or is
straining, needing to move bowels, straining, needing to move bowels, contractions 2 minutes apartcontractions 2 minutes apart
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– Ensure privacy; remove clothing (waist Ensure privacy; remove clothing (waist
down) position and drape motherdown) position and drape mother– Position on left side with signs of supine Position on left side with signs of supine
hypotension syndromehypotension syndrome– Elevate buttocks with bedding or towelsElevate buttocks with bedding or towels– Knees bent, legs apartKnees bent, legs apart
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– Have someone at mothers headHave someone at mothers head
Partner: monitor vital signs, vomitingPartner: monitor vital signs, vomiting Family for comfort, emotional supportFamily for comfort, emotional support
– Position selfPosition self To view vaginal areaTo view vaginal area To assist birth with supplies close byTo assist birth with supplies close by
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– Deliver infantDeliver infant
Hands at vaginal opening when head Hands at vaginal opening when head appearsappears
Spread fingers, avoid pressure on fontanelsSpread fingers, avoid pressure on fontanels Support emerging headSupport emerging head
– Apply slight pressure to prevent explosive birthApply slight pressure to prevent explosive birth– Keep clear of anal area, dischargesKeep clear of anal area, discharges
Place pressure on perineum to prevent Place pressure on perineum to prevent tearingtearing
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– Unbroken amniotic sac: tear and peel Unbroken amniotic sac: tear and peel
from facefrom face Amniotic fluid should be clearAmniotic fluid should be clear Staining indicates fetal feces—suction Staining indicates fetal feces—suction
immediately, repeatedly: mouth then noseimmediately, repeatedly: mouth then nose Provide ventilations/compressions as neededProvide ventilations/compressions as needed Rapid transportRapid transport
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– After head delivers, ensure that After head delivers, ensure that
umbilical cord is not around infant’s umbilical cord is not around infant’s neckneck Cord around neck: tell mother to pant, not Cord around neck: tell mother to pant, not
pushpush Loosen cord with fingersLoosen cord with fingers Slip it from around neckSlip it from around neck Can’t remove cord: Clamp in two places, cut, Can’t remove cord: Clamp in two places, cut,
remove from neckremove from neck
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– Infant usually presents face down, Infant usually presents face down,
rotates to siderotates to side Support head with one hand and wipe Support head with one hand and wipe
nose, mouth with gauze padsnose, mouth with gauze pads Use bulb syringe to suction mouth first, Use bulb syringe to suction mouth first,
then nosethen nose– Suction the mouth 2-3 times, inserting the Suction the mouth 2-3 times, inserting the
syringe 1 ½ inchessyringe 1 ½ inches– Suction the nose 2-3 times, inserting the syringe Suction the nose 2-3 times, inserting the syringe
½ inch½ inch
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Drill of the MonthDrill of the Month
Labor and DeliveryLabor and Delivery Delivery (second stage): Stay and Delivery (second stage): Stay and
deliverdeliver– Upper shoulder delivers first: guide Upper shoulder delivers first: guide
infant’s head downwardinfant’s head downward– Lower shoulder delivers; guide infant’s Lower shoulder delivers; guide infant’s
head upwardhead upward– Deliver torso and legs: Infant is slipperyDeliver torso and legs: Infant is slippery
Position on side, head slightly lower than Position on side, head slightly lower than body, same level as mother until cord stops body, same level as mother until cord stops pulsingpulsing
Suction mouth and nose againSuction mouth and nose again
– Record time of birthRecord time of birth
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Positional complications: Supine Positional complications: Supine Hypotensive SyndromeHypotensive Syndrome
– Occurs in the third trimester Occurs in the third trimester – Weight of uterus, infant, placenta, amniotic Weight of uterus, infant, placenta, amniotic
fluid compress inferior vena cavafluid compress inferior vena cava– Pressure on inferior vena cave reduces Pressure on inferior vena cave reduces
blood flow return to heart and cardiac blood flow return to heart and cardiac outputoutput
– Body compensates: contracts uterine Body compensates: contracts uterine arteriesarteries Dangerous to fetus; restricts blood to mother’s Dangerous to fetus; restricts blood to mother’s
organsorgans
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Positional complications: Supine Positional complications: Supine Hypotensive SyndromeHypotensive Syndrome
– Signs and symptomsSigns and symptoms Dizziness and a drop in blood pressure Dizziness and a drop in blood pressure
when the mother is in a supine positionwhen the mother is in a supine position Other shock signs and symptoms but are Other shock signs and symptoms but are
also related to laboralso related to labor
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Positional complications: Supine Positional complications: Supine Hypotensive SyndromeHypotensive Syndrome
– ManagementManagement Check vital signs and continue to monitorCheck vital signs and continue to monitor Position mother on left side to relieve Position mother on left side to relieve
weight on vena cavaweight on vena cava Treat for shock: elevating legs will not Treat for shock: elevating legs will not
relieve low blood pressure or reduce relieve low blood pressure or reduce constriction of vena cavaconstriction of vena cava
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Birth complications: Breech Birth complications: Breech presentationpresentation
– Most common abnormal presentation: Most common abnormal presentation: buttocks, both legsbuttocks, both legs
– Can deliver spontaneouslyCan deliver spontaneously Risk of birth trauma is highRisk of birth trauma is high Meconium staining is frequentMeconium staining is frequent Risk of prolapsed cord is increasedRisk of prolapsed cord is increased
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Birth complications: Breech Birth complications: Breech presentationpresentation
– ManagementManagement Check for crowning; do not pull on legsCheck for crowning; do not pull on legs Provide oxygenProvide oxygen Consider ALS; rapid transportConsider ALS; rapid transport Notify receiving facilityNotify receiving facility Assist delivery if necessaryAssist delivery if necessary
– Deliver and support torsoDeliver and support torso– Insert gloved fingers in V to form airway for infantInsert gloved fingers in V to form airway for infant– Prevent explosive delivery of headPrevent explosive delivery of head– Provide post-natal careProvide post-natal care
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Birth complications: Prolapsed cordBirth complications: Prolapsed cord– Common in breech births; cord is pressed Common in breech births; cord is pressed
between vaginal wall and infant’s head, between vaginal wall and infant’s head, cutting off oxygen to infantcutting off oxygen to infant
– ManagementManagement Position mother: head down, buttocks raisedPosition mother: head down, buttocks raised Provide oxygenProvide oxygen Care for cord: wrap and keep moist, insert Care for cord: wrap and keep moist, insert
gloved hand to lift infant from vaginal tissuegloved hand to lift infant from vaginal tissue—provides airway, keeps head off cord, —provides airway, keeps head off cord, maintains pulsations maintains pulsations
Consider ALS; rapid transport; notify Consider ALS; rapid transport; notify receiving facilityreceiving facility
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Birth complications: Single limb Birth complications: Single limb – Arm, more commonly—one leg usually Arm, more commonly—one leg usually
with prolapsed cord; cannot be with prolapsed cord; cannot be delivered in fielddelivered in field
– ManagementManagement Care for cord: wrap, keep moist, ensure Care for cord: wrap, keep moist, ensure
pulsation by keeping infant’s head off cordpulsation by keeping infant’s head off cord Position mother: head down, buttocks Position mother: head down, buttocks
raisedraised Provide oxygenProvide oxygen Consider ALS, rapid transport, notify Consider ALS, rapid transport, notify
receiving facilityreceiving facility
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Other possible birth events: MultipleOther possible birth events: Multiple– ConsiderationsConsiderations
Usually twins, uncomplicatedUsually twins, uncomplicated Second infant may deliver in breech Second infant may deliver in breech
positionposition Rapid transport if complications developRapid transport if complications develop
– Determine multiple birthDetermine multiple birth Mother informs youMother informs you Unusually large abdomen, which remains Unusually large abdomen, which remains
large after first birthlarge after first birth Strong labor pains, contractions resume Strong labor pains, contractions resume
after first birthafter first birth
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Other possible birth events: MultipleOther possible birth events: Multiple– Management (Call for additional Management (Call for additional
personnel)personnel) Assist with delivery of first infantAssist with delivery of first infant Clamp/tie cord before birth of second infant Clamp/tie cord before birth of second infant Assist with delivery of second infant (may Assist with delivery of second infant (may
deliver before or after placenta)deliver before or after placenta) Provide post-natal careProvide post-natal care Assist with delivery of placenta(s)Assist with delivery of placenta(s) Transport and ensure infants’ warmthTransport and ensure infants’ warmth
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Other possible birth events: Other possible birth events: PrematurePremature
– Infant weights < 5 ½ lbs at birthInfant weights < 5 ½ lbs at birth– Head is large proportionate to bodyHead is large proportionate to body– Mother provides due date informationMother provides due date information– Infant delivers prior to 28Infant delivers prior to 28thth week week
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Other possible birth events: Other possible birth events: PrematurePremature
– Management: Follow Universal Management: Follow Universal Algorithm for Newly Born, Inverted Algorithm for Newly Born, Inverted Pyramid of Neonatal ResuscitationPyramid of Neonatal Resuscitation Suction mouth and nose; provide blow-by Suction mouth and nose; provide blow-by
oxygenoxygen Keep warm and dryKeep warm and dry Monitor airway, continue suctioning as Monitor airway, continue suctioning as
neededneeded Protect from exposure: birth discharges, Protect from exposure: birth discharges,
other individualsother individuals Notify receiving facilityNotify receiving facility
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Vaginal bleedingVaginal bleeding
– Considerations: Serious gynecological Considerations: Serious gynecological emergency if not trauma or menstrual emergency if not trauma or menstrual relatedrelated Potentially life-threatening with abdominal Potentially life-threatening with abdominal
painpain Hypovolemic shock a serious complicationHypovolemic shock a serious complication
– ManagementManagement BSIBSI Ensure Airway, assess/treat for shock, oxygenEnsure Airway, assess/treat for shock, oxygen Rapid transportRapid transport
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Placenta previa (potentially life Placenta previa (potentially life threatening)threatening)
– Placenta forms or attaches low in uterus, Placenta forms or attaches low in uterus, close to or over cervix previous to fetusclose to or over cervix previous to fetus
– It lies between infant and cervical opening It lies between infant and cervical opening preventing deliverypreventing delivery
– Cervix dilates, tears placenta, which Cervix dilates, tears placenta, which bleeds profuselybleeds profusely
– Infant’s head presses on placenta, causing Infant’s head presses on placenta, causing further bleeding to torn placentafurther bleeding to torn placenta
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Placenta abruptio (potentially life Placenta abruptio (potentially life threatening)threatening)
– Placenta partially or completely Placenta partially or completely separates from uterine wall separates from uterine wall
– Signs and symptomsSigns and symptoms Possible obvious profuse bleeding with Possible obvious profuse bleeding with
complete abruptioncomplete abruption Possible little or no obvious bleeding with Possible little or no obvious bleeding with
partial abruption: blood is trapped between partial abruption: blood is trapped between placenta and uterine wallplacenta and uterine wall
Signs of shockSigns of shock Abdominal pain may or may not be presentAbdominal pain may or may not be present
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Ectopic pregnancy (potentially life Ectopic pregnancy (potentially life threatening)threatening)
– Problems occur early in pregnancyProblems occur early in pregnancy– Egg implants outside uterus usually in a Egg implants outside uterus usually in a
fallopian tube, grows, ruptures tube, fallopian tube, grows, ruptures tube, causes internal bleeding, paincauses internal bleeding, pain
– Signs and symptomsSigns and symptoms Shock: low blood pressure, rapid weak Shock: low blood pressure, rapid weak
pulse—late signspulse—late signs Abdominal painAbdominal pain
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Placenta previa, abriptio; ectopic Placenta previa, abriptio; ectopic pregnancypregnancy
– ManagementManagement Obtain baseline vital signs and monitorObtain baseline vital signs and monitor Treat for shock: position, oxygenTreat for shock: position, oxygen Manage bleedingManage bleeding Replace and save soaked pads, expelled Replace and save soaked pads, expelled
tissuestissues Consider ALS, rapid transportConsider ALS, rapid transport Notify receiving facilityNotify receiving facility
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Miscarriage—spontaneous abortionMiscarriage—spontaneous abortion
– Fetus miscarries/aborts before 28Fetus miscarries/aborts before 28thth weekweek
– Signs and symptomsSigns and symptoms Moderate to severe bleedingModerate to severe bleeding Abdominal pain, crampingAbdominal pain, cramping Tissue dischargeTissue discharge Signs and symptoms of shockSigns and symptoms of shock
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Miscarriage—spontaneous abortionMiscarriage—spontaneous abortion
– ManagementManagement Obtain baseline vitals and monitorObtain baseline vitals and monitor Provide care for shockProvide care for shock Manage bleedingManage bleeding Replace, save soaked pads, expelled tissuesReplace, save soaked pads, expelled tissues Provide emotional supportProvide emotional support Prepare for delivery if necessaryPrepare for delivery if necessary Notify receiving facility, rapid transport, call Notify receiving facility, rapid transport, call
ALS for neonatal intensive care of premieALS for neonatal intensive care of premie
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Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Pre-birth bleeding emergencies: Pre-birth bleeding emergencies: Miscarriage—spontaneous abortionMiscarriage—spontaneous abortion
– ManagementManagement Obtain baseline vitals and monitorObtain baseline vitals and monitor Provide care for shock, manage bleedingProvide care for shock, manage bleeding Replace, save soaked pads, expelled tissuesReplace, save soaked pads, expelled tissues Provide emotional supportProvide emotional support Prepare for delivery if necessaryPrepare for delivery if necessary Notify receiving facility, rapid transport, call Notify receiving facility, rapid transport, call
ALS for neonatal intensive care of premieALS for neonatal intensive care of premie
5522
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Seizures: Caused by eclampsiaSeizures: Caused by eclampsia– Occurs late in pregnancy or after Occurs late in pregnancy or after
deliverydelivery– May result in comaMay result in coma
Precursor is pre-eclampsiaPrecursor is pre-eclampsia Begins mid-way through pregnancyBegins mid-way through pregnancy
– Swollen hands and feetSwollen hands and feet– Increasing hypertensionIncreasing hypertension– Headaches Headaches
5533
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Seizures: Caused by eclampsiaSeizures: Caused by eclampsia– Signs and symptomsSigns and symptoms
High blood pressure, rapid pulseHigh blood pressure, rapid pulse High temperatureHigh temperature Headache, dizziness, seeing spotsHeadache, dizziness, seeing spots Epigastric pain, nauseaEpigastric pain, nausea Puffy face, swollen hands, ankles, feetPuffy face, swollen hands, ankles, feet Excessive weight gainExcessive weight gain Seizures beginning with twitching of face, Seizures beginning with twitching of face,
arms, handsarms, hands ComaComa
5544
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Seizures: Caused by eclampsiaSeizures: Caused by eclampsia– ManagementManagement
Check for and maintain patent airwayCheck for and maintain patent airway Administer oxygenAdminister oxygen Suction as neededSuction as needed Position and transport on left sidePosition and transport on left side Maintain body warmthMaintain body warmth Handle patient gentlyHandle patient gently Rapid transportRapid transport
5555
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Trauma: TypesTrauma: Types– Falls (soft tissue injuries, fractures)Falls (soft tissue injuries, fractures)– Violence, e.g., beatings (soft tissue Violence, e.g., beatings (soft tissue
injuries)injuries)– External force blunt trauma, e.g. External force blunt trauma, e.g.
vehicle collisions (fractures, ruptured vehicle collisions (fractures, ruptured organs, soft tissue injuries)organs, soft tissue injuries)
– Penetrating injuries (soft tissue injuries)Penetrating injuries (soft tissue injuries)– Sexual assault (soft tissue injuries)Sexual assault (soft tissue injuries)
5566
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Trauma: PhysiologyTrauma: Physiology– Fetus is relatively protected in first two Fetus is relatively protected in first two
trimesters: amniotic fluid, muscular trimesters: amniotic fluid, muscular uterusuterus
– Minor trauma poses no harmMinor trauma poses no harm– Vehicle collisions: grater magnitude of Vehicle collisions: grater magnitude of
forceforce Fetus: more likely injured in last trimesterFetus: more likely injured in last trimester Mother: injury w/shock, bleeding affects Mother: injury w/shock, bleeding affects
fetusfetus
5577
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Trauma: PhysiologyTrauma: Physiology– Blunt trauma injuries in last trimesterBlunt trauma injuries in last trimester
Uterus: rupture, placenta abruptioUterus: rupture, placenta abruptio Rupture other organs: internal bleeding, Rupture other organs: internal bleeding,
difficulty breathingdifficulty breathing– Spleen, liver, diaphragmSpleen, liver, diaphragm
– Soft tissue injuries, fracturesSoft tissue injuries, fractures Massive bleeding, shockMassive bleeding, shock Affects mother and fetusAffects mother and fetus
5588
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Trauma: ManagementTrauma: Management– Size-up scene for safety (collisions, violence)Size-up scene for safety (collisions, violence)– Check ABC’s, treat for shockCheck ABC’s, treat for shock– Patient history, specifically blunt force Patient history, specifically blunt force
traumatrauma Blows to abdomen, pelvis, backBlows to abdomen, pelvis, back Has water broken, vaginal/genitalia bleeding?Has water broken, vaginal/genitalia bleeding?
– Assess based on mechanism of injuryAssess based on mechanism of injury Not significant: focused history, physical examNot significant: focused history, physical exam Significant: rapid trauma assessmentSignificant: rapid trauma assessment
– Check for bruised abdomen, vaginal bleedingCheck for bruised abdomen, vaginal bleeding
5599
Drill of the MonthDrill of the Month
Complications, Emergencies, Complications, Emergencies, ManagementManagement
Trauma: ManagementTrauma: Management– Take baseline vitals, monitor (Vital signs Take baseline vitals, monitor (Vital signs
may not indicate shock in a pregnant may not indicate shock in a pregnant woman)woman) Heart rate: 10—15 beats fasterHeart rate: 10—15 beats faster Blood volume: 48% higher; loses 35% blood Blood volume: 48% higher; loses 35% blood
volume before showing signs of shockvolume before showing signs of shock
– Treat for shock and watch for vomitingTreat for shock and watch for vomiting Have suction readyHave suction ready
– Provide emotional supportProvide emotional support
6600
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: Initial impression at Care of infant: Initial impression at
birthbirth– Breathing easilyBreathing easily– Heart beatingHeart beating– Crying vigorouslyCrying vigorously– Moving extremitiesMoving extremities– Hands and feet only are cyanoticHands and feet only are cyanotic
6611
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: APGAR check at 1 and Care of infant: APGAR check at 1 and
5 minutes after birth: 0—1—2 scale5 minutes after birth: 0—1—2 scale– Activity—muscle tone/movementActivity—muscle tone/movement– PulsePulse– Grimace—reflex irritability/reaction to Grimace—reflex irritability/reaction to
suction, flicking feetsuction, flicking feet– Appearance—color (hands/feet are Appearance—color (hands/feet are
cyanotic for a few minutes shortly after cyanotic for a few minutes shortly after birth)birth)
– RespirationsRespirations
6622
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: Universal Algorithm Care of infant: Universal Algorithm
for the Newly Born for BLS/Inverted for the Newly Born for BLS/Inverted Pyramid of Neonatal ResuscitationPyramid of Neonatal Resuscitation– Dry, warm, position, stimulate, suction Dry, warm, position, stimulate, suction
mouth/nose (multiple times mouth/nose (multiple times w/meconium)w/meconium) Position infant on side, suctionPosition infant on side, suction Ensure breathing after suctioning w/i 30 Ensure breathing after suctioning w/i 30
secondsseconds No breathing: rub back; still no breathing: No breathing: rub back; still no breathing:
snap finger against footsnap finger against foot
6633
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: Universal Algorithm Care of infant: Universal Algorithm
for the Newly Born for BLS/Inverted for the Newly Born for BLS/Inverted Pyramid of Neonatal ResuscitationPyramid of Neonatal Resuscitation– If cyanotic: If cyanotic: Provide oxygenProvide oxygen– Apnea/gasping, heart rate ,100Apnea/gasping, heart rate ,100
Ventilate with neonatal BVM at 40—60/min Ventilate with neonatal BVM at 40—60/min or small puffs via mouth-to-maskor small puffs via mouth-to-mask
6644
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: Universal Algorithm Care of infant: Universal Algorithm
for the Newly Born for BLS/Inverted for the Newly Born for BLS/Inverted Pyramid of Neonatal ResuscitationPyramid of Neonatal Resuscitation– Heart rate <60 after 30 seconds of BVMHeart rate <60 after 30 seconds of BVM
Provide chest compressions: 120/min at 3:1 Provide chest compressions: 120/min at 3:1 ratioratio
If no change, continue ventilations, If no change, continue ventilations, reassessmentreassessment
Heart rate > 100 but infant shows cyanosis Heart rate > 100 but infant shows cyanosis in face/torso, provide blow=by oxygen, 10—in face/torso, provide blow=by oxygen, 10—15 lpm15 lpm
6655
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: Cut the cordCare of infant: Cut the cord
– Before cuttingBefore cutting Ensure infant is warm and dryEnsure infant is warm and dry Ensure cord has stopped pulsatingEnsure cord has stopped pulsating
– Clamp/tie 10” and 7” from infantClamp/tie 10” and 7” from infant– Cut between two clamps/tiesCut between two clamps/ties
Do not unclamp/untie; add a second Do not unclamp/untie; add a second clamp/tie if bleeding continuesclamp/tie if bleeding continues
Protect placental end from exposure to Protect placental end from exposure to contaminantscontaminants
6666
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of infant: Keep infant warmCare of infant: Keep infant warm
– Warmed towel and blanket or warmed Warmed towel and blanket or warmed bubble wrap and blanketbubble wrap and blanket
– Place wrapped infant on mother’s Place wrapped infant on mother’s abdomenabdomen
– Transport in warmed ambulanceTransport in warmed ambulance
6677
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Delivery of afterbirth (third stage of Delivery of afterbirth (third stage of
labor)labor)– Include placenta, attached umbilical Include placenta, attached umbilical
cord, amniotic sac, uterine liningcord, amniotic sac, uterine lining– Delivery: brief, milder labor pains resumeDelivery: brief, milder labor pains resume
Usually w/i 20 min of delivery; longer—Usually w/i 20 min of delivery; longer—transporttransport
– May take 30 min to deliverMay take 30 min to deliver Save all tissues in container or towel, wrap in Save all tissues in container or towel, wrap in
plastic, labelplastic, label
– Transport decisionTransport decision Mother, infant stable: stay and deliverMother, infant stable: stay and deliver Mother, infant unstable: rapid transportMother, infant unstable: rapid transport
6688
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Control bleedingControl bleeding
– Sanitary pads over vaginal opening; Sanitary pads over vaginal opening; nothing in vaginanothing in vagina
– Mother holds pads in place with legsMother holds pads in place with legs– Elevate legsElevate legs– Massage abdomen from pubis to Massage abdomen from pubis to
umbilicusumbilicus Helps contract uterus, control bleedingHelps contract uterus, control bleeding
– Allow mother to nurseAllow mother to nurse Helps contract uterus, control bleedingHelps contract uterus, control bleeding
6699
Drill of the MonthDrill of the Month
Post Natal CarePost Natal Care Care of motherCare of mother
– Take vital signs and monitorTake vital signs and monitor– Make comfortableMake comfortable
Wipe faceWipe face Cover and keep her and infant warmCover and keep her and infant warm Remove blood-soaked towels, drapesRemove blood-soaked towels, drapes Replace blood-soaked padsReplace blood-soaked pads
– TransportTransport
7700
Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Student Performance Objective:Student Performance Objective:Given information, resources, and opportunity Given information, resources, and opportunity for discussion and practice, EMTs will be able for discussion and practice, EMTs will be able to:to:• List and define childbirth structures and List and define childbirth structures and termsterms• Describe the stages of laborDescribe the stages of labor• List the steps of evaluationList the steps of evaluation•Describe potential complications and Describe potential complications and emergenciesemergencies•List and demonstrate steps of labor and List and demonstrate steps of labor and delivery delivery
EMTs will follow acceptable Maryland medical practice EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency and Maryland Medical Protocols for Emergency Medical Providers.Medical Providers.
7711
Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Review:Review: Anatomical Structures and TermsAnatomical Structures and Terms
– List and describe the structures of pregnancyList and describe the structures of pregnancy– Name and define the terms of pregnancyName and define the terms of pregnancy
Stages of LaborStages of Labor– List and describe the beginning and endings of List and describe the beginning and endings of
the three stages of laborthe three stages of labor Steps of EvaluationSteps of Evaluation
– Describes the steps to take on arrival at the Describes the steps to take on arrival at the scenescene
– Describe the steps to take to evaluate the Describe the steps to take to evaluate the mothermother
7722
Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Review: Review: Labor and DeliveryLabor and Delivery Describe labor and EMT actions Describe labor and EMT actions
during laborduring labor List preparation steps for deliveryList preparation steps for delivery Explain decision to transport or stay Explain decision to transport or stay
and deliverand deliver Describe delivery process and EMT Describe delivery process and EMT
actions during deliveryactions during delivery
7733
Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Review: Review: Complications, Emergencies, and Complications, Emergencies, and ManagementManagement
Describe Supine Hypotensive Syndrome, Describe Supine Hypotensive Syndrome, list signs and symptoms and EMS carelist signs and symptoms and EMS care
Describe birth complications and Describe birth complications and managementmanagement– Breech presentationBreech presentation– Prolapsed cordProlapsed cord– Limb presentationLimb presentation
Describe other birth incidents and Describe other birth incidents and management management – Multiple birthMultiple birth– Premature birthPremature birth
7744
Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Review: Complications, Emergencies, Review: Complications, Emergencies, ManagementManagement
List pre-birth bleeding emergencies and List pre-birth bleeding emergencies and management management – Vaginal bleedingVaginal bleeding– Placenta previo and abruptionPlacenta previo and abruption– Ectopic pregnancyEctopic pregnancy– Miscarriage (spontaneous abortion)Miscarriage (spontaneous abortion)
Describe eclampsia, signs and symptoms, Describe eclampsia, signs and symptoms, management of seizuresmanagement of seizures
List types of trauma, physiological effects List types of trauma, physiological effects on mother and fetus, and managementon mother and fetus, and management
7755
Drill of the MonthDrill of the Month
Assessing and Assisting Assessing and Assisting ChildbirthChildbirth
Review: Post Natal CareReview: Post Natal Care Describe care of the newly bornDescribe care of the newly born
– Initial impressionsInitial impressions– APGAR scoringAPGAR scoring– Universal AlgorithmUniversal Algorithm– How to cut the cordHow to cut the cord
Delivery of afterbirthDelivery of afterbirth– List afterbirth tissuesList afterbirth tissues– Describe delivery process and EMT actions Describe delivery process and EMT actions
Describe care of motherDescribe care of mother