janesville fr
TRANSCRIPT
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Obstetrics/Gynecology
Emergency Medical Technician - Basic
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Female Reproductive System
Uterus
Cervix
Vagina
Urinary Bladder
Rectum
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Female Reproductive System
Uterus
Vagina
Fallopian tube
OvaryCervix
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OB/Gyn Assessment
History When was your last normal menstrual
period (LNMP)? Abdominal pain? (location/quality) Vaginal bleeding/discharge?
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OB/Gyn Assessment
History Is there a possibility you might be
pregnant?Missed period?N/VIncreased urinary frequencyBreast enlargementVaginal discharge
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OB/Gyn Assessment
History If pregnant:
Para = # of live birthsGravida = # of pregnancies-3 /+ 7 to estimate due date
Subtract 3 from the month of the LNMPAdd 7 to the date of the LNMPLNMP - 12/9/98Due date - 9/16/99
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OB/Gyn Assessment
Vital signs Hypertension Hypotension Tilt test if blood loss is suspected
Focused exam Edema (particularly of face, hands)
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Gyn Emergencies
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Ectopic Pregnancy
Zygote implants in location other than uterine cavity
95% are in Fallopian tube (tubal ectopic)
Life threatening!
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Ectopic Pregnancy
Signs and Symptoms Missed period, other signs/symptoms of
early pregnancy Light vaginal bleed (spotting) 6-8 weeks
after LNMP Abdominal pain, may radiate to shoulder Positive “tilt” test Other signs/symptoms of hypovolemic
shock
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Ectopic Pregnancy
Signs and Symptoms Abdominal pain may be absent Some patients may NOT miss period Some patients may have NEGATIVE
pregnancy tests
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Ectopic Pregnancy
Lower abdominal pain or unexplained hypovolemic shock in
a woman of child-bearing ageequals
Ectopic Pregnancy Until Proven Otherwise
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Ectopic Pregnancy
Management 100% O2
Supportive care for hypovolemic shock Transport immediately
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Pelvic Inflammatory Disease
Acute or chronic infectionInvolves Fallopian tubes, ovaries,
uterus, peritoneumMost commonly caused by
gonorrheaStaph, strep, coliform bacteria also
cause infections
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Pelvic Inflammatory Disease
Signs and Symptoms Lower abdominal pain Gradual onset over 2-3 days, beginning
1-2 weeks after last period Fever, chills Nausea, vomiting Yellow-green vaginal discharge Walks bent forward, holding abdomen
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Pelvic Inflammatory Disease
Management High concentration O2
Transport
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Spontaneous Abortion
“Miscarriage”Pregnancy terminates before 20th
weekUsually occurs in first trimester (first
three months)
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Spontaneous Abortion
Signs and Symptoms Vaginal bleeding Cramping lower abdominal pain or pain
in back Passage of fetal tissue
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Spontaneous Abortion
Complications Incomplete abortion Hypovolemia Infection, leading to sepsis
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Spontaneous Abortion
Management High concentration O2
Shock position Transport any tissue to hospital Provide emotional support
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Pre-eclampsia
Acute hypertension after 24th week of gestation
5-7% of pregnanciesMost often in first pregnanciesOther risk factors include young
mothers, no prenatal care, multiple gestation, lower socioeconomic status
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Pre-eclampsia
Triad Hypertension Proteinuria Edema
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Pre-eclampsia
Sign and Symptoms Hypertension
Systolic > 140 mm HgDiastolic > 90mm HgOr either reading > 30 mmHg above
patient’s normal BP
Edema (particularly of hands, face) present early in day
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Pre-eclampsia
Signs and Symptoms Rapid weight gain
>3lbs/wk in 2nd trimester>1lb/wk in 3rd trimester
Decreased urine output Headache, blurred vision Nausea, vomiting Epigastric pain Pulmonary edema
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Pre-eclampsia
Complications Eclampsia Premature separation of placenta Cerebral hemorrhage Retinal damage Pulmonary edema Lower birth weight infants
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Pre-eclampsia
Management 100% O2
Left lateral recumbent position Avoid excessive stimulation Reduce light in patient compartment Avoid use of emergency lights, sirens
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Eclampsia
Gravest form of pregnancy-induced hypertension
Occurs in less than 1% of pregnancies
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Eclampsia
Signs and Symptoms Signs, symptoms of pre-eclampsia plus:
Grand mal seizures Coma
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Eclampsia
Complications Same as pre-eclampsia Maternal mortality rate: 10% Fetal mortality rate: 25%
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Eclampsia
Management 100% O2; assist ventilations, as needed Left lateral recumbent position Reduce light Manage like any major motor seizure Emergency transport Consider ALS intercept for anticonvulsant
medication administration
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Eclampsia
Assess every pregnant patient for Increased BP Edema
Take all reports of seizures in pregnant females seriously
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Abruptio Placentae
Premature separation of placenta from uterus
High risk groups Older pregnant
patients Hypertensives Multigravidas
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Abruptio Placentae
Signs and Symptoms Mild to moderate vaginal bleeding Continuous, knife-like abdominal pain Rigid, tender uterus Signs, symptoms of hypovolemia
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Abruptio Placentae
Third Trimester Abdominal Pain equals Abruptio Placentae until
proven otherwise
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Abruptio Placentae
Hypovolemic shock out of proportion to visible bleeding
equals Abruptio Placentae until
proven otherwise
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Abruptio Placentae
Management 100% O2
Left lateral recumbent position Supportive care for hypovolemic shock Rapid transport
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Placenta Previa
Implantation of placenta over cervical opening
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Placenta Previa
Signs and Symptoms Painless, bright-red vaginal bleeding Soft, non-tender uterus Signs and symptoms of hypovolemia
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Placenta Previa
Management 100% O2
Left lateral recumbent position Supportive care for hypovolemic shock Never perform a vaginal exam on a pt in
the 3rd trimester with vaginal bleeding
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Placenta Previa
A vaginal exam should NEVER be performed on a patient in the 3rd trimester with vaginal
bleeding
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Uterine Rupture
Causes Blunt trauma to pregnant uterus Prolonged labor against an obstruction Labor against weakened uterine wall
Old Cesarian section scarGrand multiparous patients
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Uterine Rupture
Signs and Symptoms “Tearing” abdominal pain Severe hypovolemic shock Firm, rigid abdomen Possible palpation of fetal parts through
abdominal wall Vaginal bleeding may or may not be
present
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Uterine Rupture
Management 100% O2
Anticipate shock ALS/helicopter intercept
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Emergency Childbirth
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Developing Fetus
Placenta
Amniotic Sac “Bag of waters”
Umbilical cord
Fetus
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Labor
1st stage: Onset of contractions to dilation of cervix
2nd stage: Complete dilation of cervix to delivery of baby
3rd stage: Delivery of baby to delivery of placenta
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Signs of Imminent Delivery
CrowningRupture of Amniotic SacNeed to bear downSensation of needing to move bowelsContractions
1 to 2 minutes apart Regular Lasting 45 to 60 seconds
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Delivery
Place gloved hand on presenting part to prevent “explosive” delivery
On delivery of head, suction mouth then nose
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Delivery
Gently guide baby’s head down to deliver upper shoulder
Gently guide baby’s head up to deliver lower shoulder
Gently assist with delivery of rest of baby; Do NOT pull
Note time of delivery of baby
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Delivery
Control slippery baby during delivery Support head, shoulders, feet Keep head lower then feet to facilitate
drainage of secretions from mouthDry baby Keep baby warm
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Delivery
Clamp, cut cord First clamp about 4” from baby Second clamp 2” further away from first Cut between clamps Use umbilical tape to control any
bleeding from cord
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Delivery
Flick baby’s feet, rub back to stimulateDo NOT shake infantDo NOT slap buttocks“Blow by” O2 if:
Heart rate < 100 Persistent central cyanosis present
Resuscitate if necessary
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Delivery
“Deliver” Placenta Place placenta in plastic bag and deliver
to hospital to be examined for completeness
If placenta does not deliver within 10 minutes, transport
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APGAR Score
Developed by Virginia ApgarQuick evaluation of infant’s
pulmonary, cardiovascular, neurological function
Useful in identifying infant’s needing resuscitation
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APGAR Score
Determine at 1 and 5 minutes postpartum!
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Maternal Care: Postpartum
Bleeding Place sterile pad over vaginal opening If bleeding is excessive:
Rapidly transport to hospitalUterine massageEncourage breastfeeding
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Maternal Care: Postpartum
Shock If mother shows signs, symptoms of
shock:High concentration O2
Rapid transportALS intercept
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Complicated Deliveries
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Breech Presentation
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Breech Presentation
Management High concentration O2
Rapid transport Prepare for neonatal resuscitation Assist delivery
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Breech Presentation
Management If head does not deliver within 3
minutes of body:Insert gloved hand into vagina forming “V”
around baby’s nose, mouth Push vaginal wall away from baby’s face to
create airway
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Limb Presentation
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Limb Presentation
Management High concentration O2
Rapid transport
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Prolapsed Cord
Umbilical cord enters vagina before infant’s head
Pressure of head on cord occludes blood flow, O2 delivery to fetus
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Prolapsed Cord
Management High concentration O2
Knee-chest position or exaggerated shock position
Place gloved hand in vagina Apply gentle pressure inward to
presenting part; relieve pressure on cord
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Umbilical Cord around Neck
Management Upon delivery of head look for cord is
looped around neck GENTLY slip cord over head if possible If cord cannot be slipped over head:
Clamp in two placesCut between clamps with surgical
scissors
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Amniotic Sac Intact
Management Use clamp to tear sac, release fluid Move sac away from baby’s nose,
mouth
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Meconium
First stool of newbornMeconium-stained amniotic fluid
Baby has had bowel movement in utero Greenish, black (pea soup) color Indicative of distress
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Meconium
Meconium can: Occlude airway Cause pneumonitis
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Meconium
Management Avoid early stimulation of baby to
prevent aspiration Aggressively suction airway until all
meconium is removed
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Multiple Births
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Multiple Births
Consider as possibility if: Mother’s abdomen appears abnormally
large prior to delivery Mother’s abdomen remains large after
delivery of first baby Contractions continue after delivery of
first baby
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Multiple Births
Delivery Clamp cord of first baby before delivery
of second Usually second baby will deliver shortly
after first Care for babies, mother, and placenta(s)
as you would in a single birth
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Multiple Births
Multiple babies are usually small
It is important to keep them warm!
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Premature Infants
Definition < 28 weeks gestation, or < 5.5 pounds birth weight
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Premature Infants
Management Keep baby warm Keep airway clear Assist ventilations if
necessary Resuscitate if
necessary
Watch umbilical cord for bleeding
“Blow by” O2
Avoid contamination
Consider ALS intercept