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70 Cards in this Set
- Front
- Back
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Labor and Delivery:
When obtaining history, what 7 things should you ask to determine if there is adequate time for transport? |
1. Gravida – number of previous pregnancies.
2. Para – number of live births. 3. Expected due-date – (EDC) expected date of confinement. 4. How far apart are contractions? 5. Duration of contractions? 6. Involuntary pushing with contractions? |
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Labor and Delivery:
after you've received the history of the patient you should ask questions about her water. What questions should you ask? |
Is bag of water intact? What time did membranes rupture?
• Examine for bulging perineum. If crowning occurs prepare for delivery. |
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Labor and Delivery:
provide oxygen to mother if needed. Monitor pulse oximetroy and encourage her to do what? |
Encourage mother to take slow deep breaths; pant through contractions.
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Labor and Delivery:
After obtaining history and providing oxygen as needed, you should begin cardiac monitoring, record & evaluate EKG strip. What steps should you take next? |
Establish at least (1) large bore IV Normal Saline.
• If SBP Less than 90mmHg 1. Establish (2) large bore IV’s with 250cc bolus. 2. Watch for fluid overload. |
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Labor and Delivery:
After establishing an IV, you should perform _______. |
A glucose check. Follow hypoglycemia/hyperglycemia protocols as needed.
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meconium staining:
What do you do immediately after delivery? |
clamp and cut cord. Move infant to a warm, dry surface with a folded towel place underneath shoulder to open airway.
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Meconium Staining:
What is the next step after you move infant to warm, dry surface to open airway? |
Suction mouth and nose again with a bulb syringe. You must avoid stimulating the infant too much or the infant will draw in meconium into distal airway passages
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Meconium Staining:
What are the 3 steps in performing ALS care of an infant with meconium staining? |
ALS Care:
1. Use an Endotracheal tube as a suction catheter: • 2.5mm for premature and 3.0mm for full-term: 2. Intubate and apply suction to the ETT as you withdraw it from the trachea. 3. Repeat intubation and suctioning with a new ETT each time until the tube is free of meconium. |
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Meconium Staining:
how do u stimulate infant to breathe after suctioning has been completed? |
Stimulate infant to breathe by warming, drying, and tactile stimulation. Administer Post-Partum Care per protocol.
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Post Partum Care - Infant:
what is the first step to be taken for post partum care? |
Begin documentation of events.
• Note delivery time. |
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Post Partum Care - Infant:
If delivery is taking place in the ambulance, you should do what? |
Warm the patient compartment of Ambulance
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Post Partum Care - Infant:
After delivery, dry the infant thoroughly and remove wet linen. _______ is a major concern in newborns. |
HYPOTHERMIA
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Post Partum Care - Infant:
After stimulating the newborn by drying vigorously including head and neck what do you do next? |
Clamp cord at 6” and 8” from infant’s body and cut between clamps with sterile scalpel or scissors and Evaluate respiration rate and effort.
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Post Partum Care - Infant:
If the newborns respiratory rate or effort is absent or gasping, what do you provide? |
If absent or gasping, provide positive-pressure ventilations with 100% Oxygen and refer to Neonatal Resuscitation SMO Section 703.000.
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Post Partum Care - Infant:
When evaluating heart rate ( umbilical cord stump or apical), if it is below 100, you should provide what? |
If below 100, provide positive-pressure ventilations with 100% Oxygen and refer to Neonatal Resuscitation SMO Section 703.000.
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Post Partum Care - Infant:
Evaluate skin color of the newborn after birth. If centrally blue, then provide what? |
provide positive-pressure ventilations with 100% Oxygen and refer to Neonatal Resuscitation SMO Section 703.000
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Post Partum Care - Infant:
How often should you note and document APGAR scores? |
1 and 5 minute APGAR scores.
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Post Partum Care - Infant:
After all is done, what is the final step? |
`Place infant next to mother.
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what do the initials A P G A R stand for?
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A- appearance, color
P- pulse, heart rate G- grimace, reflex irritability A- activity, muscle tone R- respiratory effort |
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APGAR SCORE:
How do you score "A" appearance/color? |
Appearance, color
0 = blue, pale 1 = blue hands/feet 2 = entire pink |
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APGAR SCORE:
How do you score "P" pulse, heart rate? |
Pulse, heart rate
0 = absent 1 = <100/min 2 = >100/min |
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APGAR SCORE:
How do you score "G" grimace, reflex irritability? |
Grimace, reflex irritability
0 = no response 1 = grimace 2 = cough/sneeze |
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APGAR SCORE:
How do you score "A" activity, muscle tone? |
Activity, muscle tone
0 = limp 1 = mild flexion 2 = active motion |
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APGAR SCORE:
How do you score "R" respiratory effort? |
Respiratory effort
0 = absent 1 = weak cry 2 = strong cry |
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Post Partum Care - Mother:
In caring for the mother, the placenta should be delivered within ______________ minutes |
Placenta should deliver in 20-30 minutes.
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Post Partum Care - Mother:
If you deliver the placenta what should you do with it? |
1. Collect the placenta in plastic bag and bring to the hospital.
2. Do not pull on cord to facilitate delivery. 3. Do not delay transport if placenta does not deliver spontaneously. |
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Post Partum Care - Mother:
If the perineum is torn and bleeding , what is the immediate step to helping the mother? |
If perineum is torn and bleeding, apply direct pressure with sanitary pads and have the patient close her legs together.
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Post Partum Care - Mother:
You should observe for excessive bleeding. If blood loss is greater than 500 cc , you should do what? |
Observe for excessive bleeding. If estimated blood loss is greater than 500 cc:
1. Normal Saline 250ml IV bolus 2. Massage fundus (top of uterus) until firm. |
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For the neonatal resuscitation, if the heart rate is less than 60/min, what should you do?
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A) Continue assisted ventilation with 100% Oxygen.
B) Begin chest compressions at 120/minute. C) If no improvement after 30 seconds • Intubate – Paramedic Only D) If no improvement, establish IV Normal Saline access E) ALS Care F) perform glucose check |
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For the neonatal resuscitation, if the heart rate is less than 60/min, what is ALS care?
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ALS Care:
Epinephrine (1:10,000) 0.1ml/kg IV OR Epinephrine (1:1000) 0.1mg/kg ETT every 3-5 minutes. Reassess heart rate and respirations enroute. |
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Neonatal Resuscitation for heart rate between 60-80/min, you should take the following steps.
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A) Continue assisted ventilation with 100% Oxygen.
B) If no improvement after 30 seconds • Begin chest compressions at 100/minute. C) Reassess heart rate and respirations enroute. D) perform glucose check |
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Neonatal Resuscitation for heart rate between 80-100/min, you should take the following steps.
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A) Provide Oxygen by mask or blow by.
B) Continue to stimulate. C) Reassess heart rate and respirations after 15-30 seconds - If heart rate is less than 100/min, provide assisted ventilation with 100% oxygen D) Reassess heart rate and respirations enroute E) Perform glucose check |
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Neonatal Resuscitation when heart rate is greater than 100/min, you should take the following steps
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A) Check skin color. If peripherally cyanotic, provide Oxygen by mask or blow by.
B) Reassess heart rate and respirations enroute. C) Perform glucose check |
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For a prolapsed cord, what steps should you take in caring for the mother?
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A) Provide Oxygen with NRB mask at 15 LPM.
B) Elevate mother’s hips with folded sheets/towels. C) Placed sterile gloved hand in vagina between pubic bone and presenting part and exert counter pressure against presenting part. -1. Keep exposed cord moist and warm 2. Keep hand in position D) Place mother in knee/chest position if possible E) Transport immediately |
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For a Breech delivery, you should provide _____ as needed to mom.
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Provide Oxygen as needed. Monitor Pulse Oximetry.
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Breech Delivery:
as soon as the legs are delivered you should do the following step. |
As soon as legs are delivered, support infant’s body, wrapped in towel.
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Breech Delivery:
After the shoulders are delivered you should do what to aid in the delivery? |
gently elevate trunk and legs to aid in delivery, if face down.
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Breech Delivery:
if the newborns head does not deliver within 2 minutes what should you immediately do? |
If head does not deliver within 2 minutes, keep your hand position and transport IMMEDIATELY
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what should you NEVER EVER do in delivering a breech baby?
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NEVER ATTEMPT TO PULL THE INFANT FROM THE VAGINA BY THE LEGS OR TRUNK.
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For the third trimester bleeding (6th to 9th month) what should you provide to the mother?
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A) Provide Oxygen as needed. Monitor Pulse Oximetry.
1. If level of consciousness is decreased then provide 100% Oxygen / BVM with assisted ventilations as needed. 2. Consider need for EARLY INTUBATION (Paramedic). |
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Pre-Eclampsia:
After providing oxygen as needed, place the mother on her left side and note the blood pressure. After this procedure you should maintain what? |
Maintain gentle handling of mother and minimal CNS stimulation.
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Pre-Eclampsia:
You should establish IV normal Saline at what rate? |
at a KVO rate
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Pre-Eclampsia:
You should contact Medical control for advice on what medication? |
Contact Medical Control for advice on Magnesium Sulfate as needed (Paramedic Only)
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Pre-Eclampsia:
should you transport with or without light and siren? |
Transport without lights and siren.
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Post Partum Care - Infant:
After assessing infant and before placing infant next to mother, you should do what? |
Perform glucose check. Follow protocols for hypo/hyperglycemia.
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Breech Delivery:
If head does not deliver within 30 seconds, what 3 steps should you take? |
1. Reach (2) sterile gloved fingers into the vagina to locate infant's mouth
2. Press vaginal wall away from infant's mouth to form an airway 3. Apply gentle pressure to mother's fundus |
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Third Trimester Bleeding (6th to 9th month):
What steps should you take in treating the mother? |
A) Provide Oxygen as needed. Monitor Pule Oximetry.
B) Place mother on her left side. C) Not type and amount of bleeding and/or discharge. D) If SBP less than 90mmHg 1. Then establish (2) large bore IV's with 250cc bolus 2. Watch for fluid overload E) DO NOT PACK THE VAGINA, use trauma dressing to collect the blood |
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Third Trimester Bleeding (6th to 9th month):
In what position should you place the mother? |
on her left side
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Third Trimester Bleeding (6th to 9th month):
How do you assess the type and amount of bleeding? |
Determine how many pads have been used
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Third Trimester Bleeding (6th to 9th month):
What should you do if SBP is less than 90mmHg? |
1. Establish (2) large bore IV's with 250cc bolus
2. Watch for fluid overload |
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Third Trimester Bleeding (6th to 9th month):
What should you not do when treating the mother for bleeding? |
DO NOT PACK THE VAGINA, use trauma dressing to collect the blood.
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Eclampsia:
What are the steps taken in assessment/treatment of pt with Eclampsia? |
A) Provide Oxygen as needed.
B) Monitor Pulse Oximetry. 1. If LOC is decreased then provide 100% Oxygen / BVM with assisted ventilations as needed. 2. Consider need for EARLY INTUBATION (Paramedic). C) Begin Cardiac Monitoring, record, and evaluate EKG strip. D) Place mother on her left side. E) Establish IV Normal Saline at KVO rate. F) ALS Care: 1. Magnesium Sulfate 4 grams slow IV over 5 minutes. 2. Watch for signs of Hypermagnesemia: a. 2nd or 3rd degree heart block b. Asystole c. Cardiac arrest d. Widening of QRS e. Profound hypotension f. Profound muscle weakness g. Respiratory arrest 3. If Magnesium Sulfate toxicity persists, give 10% Calcium Chloride 1gram. G) Medical Control Options: • If patient is still actively seizing, call for orders for further treatment. |
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Eclampsia:
What position should the mother be placed in? |
on her left side
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Eclampsia:
You should establish an IV NS at what rate? |
KVO rate
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Eclampsia:
What is the ALS Care for a mother with Eclampsia? |
ALS Care:
1. Magnesium Sulfate 4 grams slow IV over 5 minutes. 2. Watch for signs of Hypermagnesemia: a. 2nd or 3rd degree heart block b. Asystole c. Cardiac arrest d. Widening of QRS e. Profound hypotension f. Profound muscle weakness g. Respiratory arrest 3. If Magnesium Sulfate toxicity persists, give 10% Calcium Chloride 1gram |
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Eclampsia:
What is the dosage of Mag Sulfate needed? |
Magnesium Sulfate 4 grams slow IV over 5 mins
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Eclampsia:
What are the signs of Hypermagnesemia to watch for? |
a. 2nd or 3rd degree heart block
b. Asystole c. Cardiac arrest d. Widening of QRS e. Profound hypotension f. Profound muscle weakness g. Respiratory arrest |
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Eclampsia:
If Magnesium Sulfate toxicity persist, give ______. |
10% Calcium Chloride 1 gram
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Eclampsia:
If pt is still actively seizing, call ____ for orders for further treatment. |
Medical Control
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If a woman states she is currently pregnant for the fifth time and has had two children and two miscarriages then she would currently be classified as:
A. Gravida 5 Para 5 B. Gravida 4 Para 5 C. Gravida 5 Para 2 D. Gravida 5 Para 3 SMO 701.001 A |
C. Gravida 5 Para 2
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With a pregnant woman presenting with a prolapsed cord the ideal position to place her in would be,
A. knee/chest position if possible B. left lateral C. supine D. semi-fowler SMO 704.001 D |
A. knee/chest position if possible
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A woman just gave birth and the child has a heart rate of less than 60 bpm. What is your first line of treatment?
A. Immediately intubate B. Start IV, ventilate with 100% oxygen, and begin chest compressions at 100/minute C. Provide blow-by oxygen, begin chest compressions at 120/minute D. Assisted ventilation at 100% oxygen, chest compressions at 120/minute, IV, and D-stick SMO 703.001 |
D. Assisted ventilation at 100% oxygen, chest compressions at 120/minute, IV, and D-stick
-At least 100 Compressions |
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After placing the patient on oxygen and establishing IV access your next drug of choice in the patient suffering from eclampsia would be,
A. Ativan 2 mg SIVP B. Magnesium sulfate 4g over 5 minutes C. Versed 10 mg IN D. Magnesium sulfate 4g over 15 minutes SMO 705.003 F1 |
B. Magnesium sulfate 4g over 5 minutes
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What does APGAR stand for?
A- P- G- A- R- SMO 702.001 |
-Activity
-Pulse -Grimace -Appearance -Respirations |
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APGAR score should be attained at what times?
A. at birth, 1 minute, and 5 minutes after birth B. 1 minute after birth and 5 minutes after birth C. at birth, 5 minutes and 10 minutes after birth D. whenever you get a chance SMO 702.001 J |
B. 1 minute after birth and 5 minutes after birth
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If the newborn’s heart rate is between 60-80 bpm then you should provide chest compressions at:
A. 80 bpm B. 100 bpm C. 120 bpm D. 160 bpm SMO 703.002 B |
B. 100 bpm
At least 100 Compressions on all age ranges |
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A woman suffering from significant bleeding in her third trimester should be placed in what position?
A. knee/chest position if possible B. left lateral C. supine D. semi-fowler SMO 705.001 B |
B. left lateral
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When assessing a pregnant woman what question is not pertinent to your assessment?
A. How many times have you had sex? B. How many times have you been pregnant? C. When is your due date? D. Do you feel any contractions and how far apart are they? SMO 701.001 A |
A. How many times have you had sex?
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After the infant is delivered you should clamp the cord at_________and_________from the infant’s body and cut between the clamps with sterile scalpel or scissors.
A. 4” and 8” B. 4” and 6” C. 6” and 8” D. 6” and 12” SMO 702.001 E |
C. 6” and 8”
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You deliver a full-term 8 pound male child. The patient’s hands and feet are blue, heart rate 150/minute, he coughs, has mild flexion, and a weak cry. What is the child’s APGAR score?
A. 10 B. 9 C. 8 D. 7 SMO 702.001 |
D. 7
-A = 1 - (MILD FLEXION) -P = 2 - (ABOVE 100) -G = 2 - (HE COUGHS) -A = 1 - (HANDS/FEET ARE BLUE) -R = 1 - (WEAK CRY) |
