OB Emergencies

Module 1 2016 CE- ECRN

Condell Medical Center EMS SystemIDPH Site Code: 107200E-1216

PREPARED BY: DEBORAH SEMENEK RN, EMT-P

MARK DZWONKIEWICZ FP-C, LI

REVISED 7/11/16

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OBJECTIVESUpon 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.

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36. Review selected Region X SOP’s as related to the

topics presented.

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

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

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Terminology cont’d

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

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Physiological Changes During

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

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Physiological changes during

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

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Physiological changes cont’d

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

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Fetal blood supply

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

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Umbilical cord

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”

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Normal pregnancy – 20 weeks & term11

Antepartum Complications

Vaginal bleeding

Ectopic pregnancy

Placenta previa

Placenta abruptio

Hypertensive disorders

Preeclampsia, eclampsia

Supine Hypotensive Syndrome

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Vaginal Bleeding

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

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Ectopic Pregnancy

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

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Placenta previa

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

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Abruptio placenta

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

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Pre-hospital Care of antepartum

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

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Hypertensive disorder of pregnancy

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)

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Preeclampsia

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

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Signs and symptoms pre-eclampsia

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

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Eclampsia

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

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Managing seizures during pregnancy

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)

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Supine hypotensive syndrome

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

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Identifying imminent delivery

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

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Ob kit contents 25Cap

ID bands

Ob kit contents

26EMERGENCY CHILDBIRTH LABOR:

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.

Region 10 SOP Review

DELIVERY:

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. Protect perineum with gentle hand pressure while supporting the newborn’s head as it emerges from the vagina. Tear amniotic membrane if it is still intact at this point.

4. Check for nuchal cord (cord wrapped around the neck).

5. Clear airway, if necessary, with a bulb syringe. Suction mouth, then nose as soon as head is delivered.

6. To facilitate delivery of the upper shoulder, gently guide the head downwards. Support and lift the head and neck slightly to deliver the lower shoulder. The rest of the newborn should deliver with minimal assistance. Get a firm grasp on newborn. Note time of delivery and record on newborn’s PCR.

27Region 10 SOP Review

281. Spontaneous respirations should begin within 15 seconds after stimulating newborn by drying,

rubbing back or flicking the soles of the feet. Do not shake newborn. Rapid assessment should

include the following characteristics: term gestation, crying or breathing and good muscle tone.

2. Suctioning with the bulb syringe should be reserved for a newborn with obvious obstruction to

spontaneous breathing. If meconium is present and the newborn is not vigorous (decreased RR,

decreased muscle tone, HR <100) use meconium aspirator for direct tracheal suctioning

a. If still no respirations, begin ventilating at 40-60 breaths/minute. After 30 seconds of

ventilation and if pulse < 60 begin chest compressions at a ratio of 3 compressions to 1 ventilation.

Refer to Resuscitation of the Newborn/Neonate protocol.

3. Obtain 1 minute APGAR SCORE.

4. Keep newborn level with the vagina until the cord is double-clamped. The cord should be clamped

8 inches from the newborn’s navel with 2 clamps placed 2 inches apart. Cut the cord between the

two clamps.

5. Continue to dry the newborn and wrap in a dry blanket to provide and maintain body warmth.

Wrap the newborn in silver swaddler or blanket, ensuring the head is covered. If the newborn is

cyanotic, but breathing spontaneously, place infant NRB mask next to newborn’s face and run

OXYGEN at15 liters/minute.

NEWBORN and POST PARTUM CARE:Region 10 SOP Review

NEWBORN and POST PARTUM CARE: Cont.29

6. Obtain 5 minute APGAR score.

7. Allow placenta to deliver spontaneously. Do not delay transport while waiting for placenta to deliver.

Do not pull on cord to facilitate placental delivery. When delivered, collect placenta in plastic bag,

bring to hospital and document time of placental delivery.

8. Check perineum for tears. If torn and bleeding, apply direct pressure with sanitary pads, and have

patient bring legs together.

9. Observe for excessive vaginal bleeding (more than 500 mL).

a. IV FLUID CHALLENGE in 200 mL increments. Titrate to desired patient response.

b. Following delivery of the placenta, massage fundus of uterus until firm. Check every five (5)

minutes for firmness and massage as necessary.

10. Utilize identification tags for mother and newborn, must include mothers name, gender of newborn,

time of delivery.

11. Every reasonable attempt should be made to secure the mother and the newborn for transport

Region 10 SOP Review

Steps to take during delivery

Try for a private area if out in public

Place patient on her back with room to flex knees and hips

Prepare equipment – OB kit

Coach mother to breath between contractions and to push with contractions once crowning is evident

Support head as it emerges

Check for nuchal cord

If necessary clear the airway with a bulb syringe.

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Delivery cont’d

Gently guide baby’s head downward

Facilitates delivery of upper shoulder

Then gently guide baby’s body upward

Facilitates delivery of lower shoulder

Rest of baby quickly delivers

Be prepared!

Infant will be slippery!

Note time of delivery – when baby totally out

Keep baby in head down position

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Use of bulb syringe

Routine suctioning is no longer recommended

Suctioning has been associated with bradycardia and other problems

Suctioning is limited to necessity

If performed, suction MOUTH, then nose

Suctioning the nose is the stimulus to breath

Want the airway clear prior to stimulation to take a breath

Infant will not start to breathe until their chest clears the birth canal and can then expand

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Delivering the baby33

Normal appearance of a new born

Infants will be wet and slippery

Covered with a cheesy like substance that wears off shortly after delivery

Hands and feet may be cyanotic longer than other parts of the body

Extremities should be actively moving

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Newly born appearance

Risk for blood and body fluid contamination during all deliveries

Have high regard for use of appropriate PPE’s!

Drying off preserves heat and acts as a stimulus by the rubbing activity

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Initial assessment of newborn

Begin steps of inverted pyramid as you are assessing newborn

Begin to dry infant; change to dry towel as needed

Cold infants can deteriorate quickly

Infants have difficult time generating & maintaining body heat;

they cannot shiver to generate heat

Suction with bulb syringe only when secretions are present

Assess newborn as soon as possible after birth

Normal respiratory rate averages 30-60 breaths per minute

Normal heart rate ranges from 100 – 180 beats per minute

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Inverted pyramidRoutine suctioning removed in 2015 AHA Guidelines 37

(Always needed)

(Infrequently

needed)

Apgar score

Developed in 1953 by Dr. Apgar, a surgeon turned anesthesiologist

An assessment is taken at 1 and 5 minutes after birth

The 1 minute score reflects how well the infant tolerated the birthing process and indicates need for early intervention

The 5 minute score reflects how well the infant is tolerating being outside the womb as well as response to interventions provided

The higher the score (closer to 10), the better the infant’s transition

Early duskiness of distal extremities is common often leading to a 1 minute score of 9

The score does NOT predict the future health of the child

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APGAR cont’d

Any score less than 7 merits an intervention

Supplemental airway

Clearing the airway

Physical stimulation

Rubbing the back

Flicking the bottom of the foot

Most low initial scores at 1 minute improve with the usual interventions listed at the top of the pyramid and by the 5 minute assessment, are usually at higher, acceptable scores

Providing assessment/reassessment is key

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Care of the cord

Do not pull on the cord

Avoid cutting the cord prematurely

Want the last kick of blood available to be delivered to the infant

Once the cord has stopped pulsating and gone limp, can prepare to clamp and tie it

Place one clamp 8 inches from newborn’s navel

Place 2nd clamp about 2 inches further away

Cut exposed cord between the clamps – it’s tougher than anticipated

Continue to assess the newborn’s end of exposed cord for any bleeding

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Care of the cord

There is no rush to clamp and cut the cord

You want to give enough time for all blood possible to

infuse from mother to the placenta to the infant

Infant's have a very limited blood volume to begin with

(80 ml/kg)

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Preventing heat loss

Heat loss can be life threatening for the newborn

Most heat loss is via evaporation while wet with

amniotic fluid

Can lose heat via convection depending on

temperature of room and movement of air around

newborn

Can lose heat via conduction if in contact with

cooler objects

Can radiate heat to colder nearby objects

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Preserving the newborn’s body

temperature

Dry the newborn immediately after birth

Maintain a warm ambient temperature

Close all windows and doors

Replace wet towels with dry

Keep infant wrapped and head covered to

prevent heat loss

Mother holding the newborn transfers her body

heat. Ensure Mother /Infant safety during transport.

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Newborn resuscitation

Additional efforts required when the respiratory rate is decreased, heart rate <100, or there is decreased muscle tone

Attempt positive pressure ventilations via BVM

Rate of 40-60 breaths per minute

Watch that the volume is enough to make the chest rise and fall

Reassess after 30 seconds

IF heart rate is 60 -100 beats per minute

Continue positive pressure ventilation

IF heart rate is less than 60

Begin chest compressions at a ratio of 3:1; reevaluate every 30 seconds

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3rd stage of labor – placental stage

Uterus continues to contract

Cord appears to lengthen

May have increase in bloody

discharge

If delivered, transport with

mother to the hospital

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Complications – prolapsed cord

Umbilical cord visible prior to delivery

Cord will be compressed if fetus passes through

birth canal

Goal

Prevent mother from

delivering vaginally

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Prolapsed cord

This is one of the complications you want to visually check for as quickly as possible once on the scene of an imminent delivery

If the cord is visible protruding from the vagina

Elevate the mother’s hips

Instruct patient to pant during contractions or just keep her breathing during a contraction

Place gloved hand into vagina between pubic bone and presenting part

Monitor cord between fingers for pulsations

Keep exposed cord moist with dressings and keep warm

Transport with hand in place – DO NOT REMOVE YOUR FINGERS

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Meconium Staining

Occurs in approximately 10-15% of deliveries

Meconium is dark green and can be of thin or thick consistency

Fetal distress and hypoxia cause meconium to pass from the fetal GI tract into the amniotic fluid

If infant is breech, meconium staining is anticipated and expected as the abdomen is compressed in the birth canal

Meconium aspiration increases neonatal mortality rate

If aspirated can obstruct small airways & cause aspiration pneumonia and lead to respiratory distress

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Normal meconium stool

Usually passed within 480 of birth

Typically transitions to normal stool beginning

by day 4

Meconium is thick, dark almost black stool

normally found in the infant’s intestines

Becomes a problem when aspirated or

otherwise blocks the infant’s small airway

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AHA revised guidelines for

Meconium and Tracheal Suctioning

Suctioning Nonvigorous Infants Through Meconium-Stained Amniotic Fluid 2015 (Updated): If an infant born through meconium stained amniotic fluid presents with poor muscle tone and inadequate breathing efforts, the initial steps of resuscitation should be completed under the radiant warmer. PPV should be initiated if the infant is not breathing or the heart rate is less than 100/min after the initial steps are completed. Routine intubation for tracheal suction in this setting is not suggested, because there is insufficient evidence to continue recommending this practice. However, a team that includes someone skilled in intubation of the newborn should still be present in the delivery room.

© 2015 American Heart Association

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Meconium and Tracheal Suctioning?

Non-vigorous newborns with meconium-stained fluid do not require routine intubation and tracheal suctioning; however, meconium-stained amniotic fluid is a perinatal risk factor that requires presence of one resuscitation team member with full resuscitation skills, including endotracheal intubation.

Summary AAP/AHA 2015 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care of the Neonate

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Equipment for meconium aspiration

Suction tool

Suction force turned down to

80 mmHg

Meconium aspirator

Intubation blade and handle

2 ETT of anticipated size

Additional ETT sized below and above anticipated size to use

Neonatal BVM

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Meconium aspirator

Connect small end of meconium aspirator to suction connecting tube

Set suction down to 80 mmHg

Endotracheal tube inserted using blade and handle

Meconium may obscure your view

Wider end of aspirator connected to proximal end of ETT

Thumb placed over suction port while withdrawing ET tube within 2 seconds

Discard ETT after 1 sweep and use new ETT if 2nd attempt made

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Supportive ventilation

Proper positioning is a small towel under the torso

Volume is enough to make the chest rise gently

Rate is 40-60 breaths per minute

Do not flow oxygen into the infant’s

eyes or put pressure over the eyes

Newborns are sensitive to vagal

stimulation and will respond with

bradycardia

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Nuchal cord

Cord is wrapped around the infant’s neck

Problem exists if the cord is too tight and prevents infant from delivering

Remember: fetus is receiving their oxygen and blood supply via the cord

If cord clamped and cut prematurely, infant needs to be delivered without delay to begin to ventilate on own

Goal:

If cord too tight for infant to deliver, then unwrap or clamp & cut

Prevent mother from pushing until cord is unwrapped or cut

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Postpartum hemorrhage

Loss of more than 500 ml of blood immediately following delivery

500 ml = 2 cups = 16 oz = 1 pint = 1 pound by weight of soaked pad

Most common cause is uterine atony – lack of uterine tone; failure of uterus to contract after delivery

Occurs more frequently in multigravida and more common following multiple births or births of large infants

Rely on clinical appearance of mother and vital signs

Uterus often feels boggy on palpation

Need to perform fundal massage

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Fundal massage – 2 handed technique

Must NOT be performed until after delivery of the placenta

Is a 2 handed technique

Performed to get uterus to contract to minimize blood loss

Need the uterus to firm up

Should feel like a grapefruit or fist

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Fetal alcohol syndrome (FAS)

Life-long effects started from the womb

When the mother drinks, alcohol crosses the

placenta and passes to the fetus

Alcohol affects neurons and the central nervous

system (CNS) of the fetus

Damages physical structures and growth

Defects more pronounced as the child grows

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Crisis at birth

If FAS is suspected:

Anticipate a small weight newborn

Anticipate a newborn who may need some

resuscitative efforts

Assisted ventilations

Extra attention to be kept warm due to typically

a smaller birth weight

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SIDS

Sudden Infant Death Syndrome describes the unexplained sudden death of an infant

Major cause of death in infant’s first month of life

Most victims appear healthy prior to death

There is still no cause of SIDS but theories do exist

Stress in infant possibly from infection or other factors

A birth defect

Failure to develop

A critical period of rapid growth

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Case scenario discussion

Review the following cases and determine

what your general impression is

Discuss what your intervention needs to be

Refer to the Region X SOP’s as necessary

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Case scenario #1

EMS is called to the scene of a mother who is in labor

What information should the ECRN collect from EMS early?

Due Date

Number of pregnancies

Known complications

Previous labor history if any

If bag of waters are intact or broken

The duration and frequency of contractions

In given report, weeks of gestation should be provided and not the months

Provides more precise picture of age of infant (i.e.: premature or not)

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Case scenario #1

What indicates that delivery is imminent?

Crowning

Bulging of the perineum

Contractions that are lasting 60-75 seconds and coming every 2-3 minutes

Urge to push

Feeling that she wants to have a bowel movement

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Case scenario #1

What is assessed with the APGAR score?

A – appearance or coloring

Fingers and toes often bluish for a few minutes

P – pulse

Best to have a pulse over 100 beats per minute

G – grimace or reflexes

Grimacing, coughing, sneezing are good to see

A – activity or muscle tone

Want to see flexed extremities

R – respiratory effort

Want to hear a strong cry

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Case scenario #1

What are the interventions listed at the top of the inverted pyramid that each newborn typically receives?

Drying – to prevent heat loss by evaporation

Warming the infant to stop the heat loss

Stimulation by touching and rubbing the infant

Flicking the bottom of the feet or rubbing the back if more tactile stimulation is required

Keeping the newborn in a head down position to facilitate drainage from the lungs

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Case scenario #2

EMS has arrived on the scene and determined that they will need to deliver a newborn

During assessment and in preparation of the event, EMS notices dark, thick greenish-black flecks of material in the leaking bag of waters

What does this indicate?

Evidence of meconium staining

What does this mean?

If not a breech delivery, the fetus may be in distress and require extra resuscitative efforts

Review new AHA guidelines concerning the presence of meconium.

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Case scenario #3

EMS is on the scene and has just assisted a mother in delivering her 3rd child

The infant is not as responsive to drying and stimulation as EMS feels they should be and extremities are dusky- What direction should you provide?

You want to provide blow-by oxygen

How would you deliver blow-by oxygen?

Hold a source of oxygen next to the infant's nose and mouth and let the oxygen source “blow-by”

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Case scenario #3

The infant is not responding to the blow-by efforts

The respiratory rate is low and the heart rate is less than 100

What is the next intervention?

Begin positive pressure ventilations at 40-60 breaths per minute

Ventilate with small puffs of air

Reevaluate every 30 seconds

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Case Scenario #3

What intervention would you recommend

if the pulse remained between 60 and 100?

Continue positive pressure ventilations

Reassess every 30 seconds

What would intervention would you recommend

if the pulse dropped below 60 in the newborn?

Begin chest compressions

3 compressions to 1 ventilation

Depress the sternum 1/3 the AP diameter of the chest on lower half of sternum

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Case Scenario #4

EMS is on the scene for a patient who fell

Upon EMS arrival they note on report an unresponsive adult on the floor who is obviously pregnant

This patient is in a tonic-clonic seizure

What is your general impression?

First thought is eclampsia

Need to consider an epileptic seizure

Need to be thinking possible hypoglycemia

Need to determine presence of head injury

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Case Scenario #4

What is your recommended actions during this on-

going seizure activity?

Protect the patient from harm

Maintain a patent airway

Suction available

Turn patient on left side

Also avoids supine hypotensive syndrome

Consider supporting ventilations via BVM

1 breath every 5-6 seconds (10-12 breathe per minute)

Obtain any medical history available

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Case Scenario #4

What medication is used in the presence of seizure activity in the patient who is pregnant?Versed 2mg IN/IVP/IO

May repeat every 2 minutes titrated to desired effect

Maximum dose of 10 mg

If seizure activity continues or reoccurs, contact Medical Control for additional orders of Versed up to an additional 10 mg

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Case scenario #4

What would be important to be relayed in face to face

hand-off report with this case once at the hospital?

Fact that Versed was administered

Versed crosses the placental barrier

If administered close to the time of delivery, may witness side

effects in the newborn related to the Versed

Respiratory depression

Hypotension

Would be important for OB to try to differentiate if signs or

symptoms are due to the condition of the newborn or

related to interventions performed

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Double Knotted Cord – found on delivery – Healthy Baby!

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https://www.youtube.com/watch?v=AgkCmJNbEwo&oref=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DAgkCmJNbEwo&has_verified=1

Copy and paste the link below to view delivery video

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 April 10, 2014.

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

Highlights of the 2015 AHA Guidelines Update for CPR and ECC

CMC EMS System, April 2014 CE Module

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