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November 2014 CE

Site code #107200E-1214

OB Emergencies

Objectives by Reviewed/revised by Sharon Hopkins, RN, BSN, EMT-P

To view on the Advocate Condell website visit:

http://www.advocatehealth.com/condell/2014-ems-continuing-education

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Date of CE presentation: November, 2014 Topic: OB Emergencies Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to:

1. Define obstetrical terms 2. Describe the physiological changes to the patient who is pregnant. 3. Describe potential complications in the antepartum and post partum periods. 4. Describe EMS interventions for a variety of obstetrical delivery emergencies following the Region X SOP. 5. Identify imminent delivery. 6. Describe components of an obstetrical kit and the use of the contents. 7. Discuss post-partum depression. 8. Actively participate in review of selected Region X SOP’s. 9. Actively participate in case scenario discussion. 10. Actively participate in return demonstration of BVM use with a neonate. 11. Actively participate in return demonstration of use of the meconium aspirator. 12. Actively participate in return demonstration of use of a BVM in a neonate. 13. Successfully complete the post quiz with a score of 80% or better. Bibliography: Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices, 4th edition. Brady. 2013. Mistovich, J., Karren, K. Prehospital Emergency Care 9th Edition. Brady. 2010. Region X SOP’s; IDPH Approved January 6, 2012. http://www.primehealthchannel.com/fetal-alcohol-syndrome-pictures-symptoms-statistics-and-treatment.html http://www.emedicinehealth.com/postpartum_depression/article_em.htm http://www.nlm.nih.gov/medlineplus/ency/article/003402.htm http://www.pphprevention.org/pph.php http://calsprogram.org/manual/volume1/Section4_Path/05-PATH4NeonatalEmergencies13.html http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html

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Stages of Labor 1st Stage of Labor – Dilation Begins with onset of true labor contractions and ends with complete dilation and thinning of cervix. This stage can last 8-10 hours for first time mothers and perhaps 5-7 hours for subsequent deliveries. In early phases mother can usually continue regular activities, often just pausing during the contractions. Contractions will start mild and last 30-90 seconds and move closer together. By the end of the first stage contractions move to 3 minutes apart. Mother will complain of a backache, will be more uncomfortable, may see a bloody show, mood more serious. 2nd Stage of Labor From full dilation of cervix (10 cm) until the infant is born. This stage could last 2 hours or more. Mother has the urge to push with contractions. There is not much reset between the contractions (2-3 minutes apart lasting 60-90 seconds. Do not want the mother pushing until crowning is evident. 3rd Stage of Labor From birth of the baby until the placenta is delivered. Placental delivery can occur up to 30 minutes after delivery of the newborn. Contractions are still felt by the mother but less intense.

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Inverted Pyramid Meconium Aspirator Suction must be turned down (80 mmHg). Anticipate the need and have equipment ready to be used prior to needing it. You are up against a time clock – suctioning must occur before the infant has to take their first breath.

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Neonatal CPR Guidelines 2010 AHA Neonatal Resuscitation Guidelines Need to evaluate and recognize when neonate is in trouble and needs interventions

- Heart rate <60 despite adequate ventilation and oxygenation for 30 seconds

Inadequate breathing with pulse present or ventilations via advanced airway

- ventilate 40/60 minute (1/second) to achieve heart rate >100 / minute Compression to ventilation ratio – 3:1 Compression depth – 1/3 AP diameter on lower half of sternum (1 ½ inches) File: CE, EMS; CE Packets; 2014; Nov Handout OB