Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Seattle/King County EMT-B Class Topics 1 Environmental Emergencies: Chapter 18 2 Behavioral Emergencies: Chapter 19 3 Ob/Gyn Emergencies: Chapter 20 1 Environmental Emergencies 1 Factors Affecting Exposure • • • • Physical condition Age Nutrition and hydration Environmental conditions 1 Loss of Body Heat Conduction • Transfer of heat from body to colder object Convection • Transfer of heat through circulating air Evaporation • Cooling of body through sweating Radiation • Loss of body heat directly into a colder environment Respirations • Loss of body heat during breathing 1 Loss of Body Heat, continued Rate and amount of heat gain or loss can be modified in three ways: • Increase or decrease heat production. • Move to sheltered area where heat loss is increased or decreased. • Wear insulated clothing. 1 Hypothermia • Lowering of the body temperature below 95°F (35°C) • Weather does not have to be below freezing for hypothermia to occur. • Older persons and infants are at higher risk. • People with other illnesses and injuries are susceptible to hypothermia. 1 Mild Hypothermia Signs and symptoms include: • Shivering • Rapid pulse and respirations • Red, pale, cyanotic skin 1 Severe Hypothermia Signs and symptoms include: • Shivering stops. • Muscular activity decreases. • Fine muscle activity ceases. • Eventually, all muscle activity stops. 1 Core Temperature Less Than 80F • Patient may appear dead (or in a coma). • Never assume that a cold, pulseless patient is dead. 1 Scene Size-up 1. Scene Size-up • Note weather conditions. • Identify safety hazards such as icy roads, mud, or wet grass. 1 Initial Assessment 1. Scene Size-up 2. Initial Assessment • Decide SICK/NOT SICK • Check temperature on patient’s abdomen. • Ensure adequate airway. • Palpate for carotid pulse; wait 30–45 seconds. • ANY kind of pulse=NO CPR. • Transport immediately or move to warmer location. 1 Focused History/Physical Exam 1. Scene Size-up • If unconscious, do a rapid physical exam. 2. Initial • If conscious, obtain Assessment SAMPLE history. 3. Focused History/ • Determine how long the patient was exposed. Physical Exam • Medications can affect the patient’s metabolism. • Concentrate on areas of body directly affected by exposure. 1 Detailed Physical Exam 1. Scene Size-up • Aimed at determining degree and extent of cold 2. Initial injury Assessment • Evaluate skin temperature, texture, and 3. Focused History/ turgor. Physical Exam 4. Detailed Physical Exam 1 Ongoing Assessment 1. Scene Size-up • Rewarming can be harmful; monitor carefully. 2. Initial • Communicate conditions at Assessment scene, clothing, changes in mental status. 3. Focused History/ Physical Exam 4. Detailed Physical Exam 5. Ongoing Assessment 1 Baseline Vital Signs • Can be altered by hypothermia • Monitor for changes in mental status. • Check body temperature: (oral, tympanic or axillary) 1 Interventions • Move from cold environment. • Do not allow patient to walk, eat, use any stimulants, or smoke or chew tobacco. • Remove wet clothing. • Place dry blankets under and over patient. • Handle gently. • Do not massage extremities. 1 Local Cold Injuries Frostnip • Freezing of the skin but not the deeper surface Immersion (trench) foot • Prolonged exposure to cold water Frostbite • Freezing of a body part, usually an extremity 1 Emergency Care for Local Cold Injury • Remove the patient from further exposure to the cold. • Handle the injured part gently. • Administer oxygen. • Remove any wet or restrictive clothing. • Never rub the area. • Do not break blisters. • Transport. 1 Warm-Water Bath • Water temperature should be between 100-112oF. • Recheck water temperature and stir to circulate. • Keep body part in water until warm and sensation returns. • Dress with dry, sterile dressings. 1 Cold Exposure and You • EMT-Bs are at risk for hypothermia when working in a cold environment. • Stay aware of local weather conditions. • Dress appropriately and be prepared. • Vehicle must be properly equipped and maintained. • Never allow yourself to become a casualty! 1 Heat Exposure • Normal body temperature is 98.6°F. • Body attempts to maintain normal temperature despite ambient temperature. • Body cools itself by sweating (evaporation) and dilation of blood vessels. • High temperature and humidity decrease effectiveness of cooling mechanisms. 1 Heat Cramps • Painful muscle spasms • Remove the patient from hot environment. • Rest the cramping muscle. • Replace fluids by mouth. • If cramps persist, transport the patient to hospital. 1 Heat Exhaustion Signs and symptoms include: • Dizziness, weakness, or fainting • Onset while working hard or exercising in hot environment • In older people and young, onset may occur while at rest in hot, humid, and poorly ventilated areas. • Cold, clammy skin 1 Heat Exhaustion, continued • Dry tongue and thirst • Patients usually have normal vital signs, but pulse can increase and blood pressure can decrease. • Normal or slightly elevated body temperature 1 Emergency Medical Care • Remove extra clothing and remove from hot environment. • Give patient oxygen. • Have patient lie down and elevate legs. • If patient is alert, give water slowly. • Be prepared to transport. 1 Heatstroke Signs and symptoms include: • Hot, dry, flushed skin • Change in behavior leading to unresponsiveness • Pulse rate is rapid, then slows. • Blood pressure drops. • Death can occur if the patient is not treated. 1 Care for Heat Stroke • Move patient out of the hot environment. • Provide air conditioning at a high setting. • Remove the patient’s clothing. • Give the patient oxygen. • Apply cold packs to the patient’s neck, armpits, and groin. 1 Care for Heat Stroke, continued • Cover the patient with wet towels or sheets. • Aggressively fan the patient. • Immediately transport patient. • Notify the hospital of patient’s condition. 1 Scene Size-up 1. Scene Size-up • Do environmental assessment. • Protect yourself from heat and biological hazards. • ALS may need to give IV fluids. 1 Initial Assessment 1. Scene Size-up 2. Initial Assessment • Decide SICK/NOT SICK • The more altered the mental status, the more severe the exposure. • Keep airway patent. • Oxygen may decrease nausea. • Treat for shock aggressively. 1 Focused History/Physical Exam 1. Scene Size-up • Note activities/medications that may make patient 2. Initial susceptible to heat-related Assessment problems. 3. Focused History/ • Determine exposure and activities prior to Physical Exam symptoms. • Assess for muscle cramps, confusion. • Examine for mental status, skin temperature, wetness. 1 Detailed Physical Exam 1. Scene Size-up • Pay attention to skin temperature, turgor, 2. Initial wetness. Assessment • Turgor = skin’s ability to resist deformity 3. Focused History/ • In dehydration, skin will Physical Exam tent when pinched on 4. Detailed Physical back of hand. Exam • Perform careful neurologic exam. 1 Ongoing Assessment 1. Scene Size-up • Watch for deterioration. • Reassess vital signs every 5 2. Initial minutes. Assessment • Do not cause shivering. 3. Focused History/ • Document weather Physical Exam conditions and activities prior to emergency. 4. Detailed Physical Exam 5. Ongoing Assessment 1 Baseline Vital Signs • May be tachycardic or tachypneic • In heat exhaustion, patient may have normal skin temp; may also be cool and clammy. • In heat stroke, patient will have hot skin. 1 Interventions • Remove from hot environment. • Give cool fluids by mouth. • Cover with sheet and soak with cool water. • Set A/C on high. • Place ice packs on groin and axillae. • Fan aggressively. 1 Drowning and Near Drowning Drowning • Death as a result of suffocation after submersion in water Near drowning • Survival, at least temporarily, after suffocation in water 1 Drowning Process 1 Spinal Injuries Suspect spinal injury if: • Submersion has resulted from a diving mishap or long fall. • Patient is unconscious. • Patient complains of weakness, paralysis, or numbness. 1 Spinal Stabilization in Water • Turn the patient supine. • Restore the airway and begin ventilation. • Secure a backboard under the patient. • Remove the patient from the water. • Cover the patient with a blanket. 1 Resuscitation Efforts • Hypothermia can protect vital organs from hypoxia. • Documented case of a survivor of a 66-minute cold water submersion • Diving reflex may cause heart rate to slow. 1 Diving Problems Descent problems • Usually due to the sudden increase in pressure on the body as the person dives Bottom problems • Not commonly seen Ascent problems • Air embolism and decompression sickness 1 Air Embolism Signs and symptoms include: • Blotching • Froth at the mouth and nose • Severe pain in muscle, joints, or abdomen • Dyspnea and/or chest pain 1 Air Embolism, continued Signs and symptoms include: • Dizziness, nausea, and vomiting • Dysphasia • Difficulty with vision • Paralysis and/or coma • Irregular pulse or cardiac arrest 1 Decompression Sickness (Bends) • Can result from rapid ascent • Most common symptom is abdominal and/or joint pain. • Symptoms may develop after hours. • Treatment is BLS and hyperbaric chamber. 1 Scene Size-up 1. Scene Size-up • Never drive through moving water; be cautious driving through still water. • Never attempt water rescue without proper training and equipment. • Consider trauma and spinal stabilization. • Check for additional patients. 1 Initial Assessment 1. Scene Size-up 2. Initial Assessment • Decide SICK/NOT SICK. • Pay attention to chest pain, dyspnea, complaints of sensory changes. • Be suspicious of alcohol use. • Maintain airway; suction. • If pulse cannot be obtained, begin CPR. • Evaluate for shock and adequate perfusion. 1 Focused History/Physical Exam 1. Scene Size-up • If responsive, listen to breath sounds. 2. Initial • If unresponsive, look for Assessment signs of trauma. 3. Focused History/ • Check divers for indications of air embolism Physical Exam or bends. • Focus on pain in joints and abdomen. • Check for signs of hypothermia. 1 Detailed Physical Exam 1. Scene Size-up • Examine respiratory, circulatory, neurologic 2. Initial systems. Assessment • Distal circulatory, sensory, and motor function tests 3. Focused History/ determine extent of Physical Exam injury. 4. Detailed Physical • Examine for peripheral Exam pulses, skin color, and discoloration, itching, pain, numbness/tingling. 1 Ongoing Assessment 1. Scene Size-up 2. Initial Assessment 3. Focused History/ Physical Exam 4. Detailed Physical Exam 5. Ongoing Assessment • Assess mental status frequently. • Document: — Circumstances of drowning and extrication — Time submerged — Temperature of water — Clarity of water — Possible spinal injury — Bring dive log, dive computer, and dive equipment to hospital. 1 Transport Decision • Always transport near-drowning patients to hospital. • Decompression sickness and air embolism must be treated in recompression chamber. • Perform interventions en route. 1 Baseline Vital Signs/ SAMPLE History • • • • Check pulse rate, quality, rhythm. Check peripheral, central pulses. Check for pupil size, reactivity. Determine length of time patient was underwater or time of onset of symptoms. • Note physical activity, alcohol/drug use, other medical conditions. • Determine dive parameters in history depth, time, previous dive activity. 1 Drowning Interventions • Begin artificial ventilations as soon as possible. • Stabilize and protect spine. • Maintain patent airway. If there is no spinal injury, turn patient on side to allow draining from upper airway. • Make sure patient is warm, especially after cold-water immersion. 1 Diving Interventions • Remove patient from water. • Begin BLS; administer oxygen. • Place patient in left lateral recumbent position with head down. • Provide prompt transport to nearest recompression facility. • Administer oxygen and provide rapid transport. 1 Other Water Hazards • Hypothermia from water immersion • Breath-holding syncope • Injuries from recreational equipment or marine animals 1 Prevention • Pools should be surrounded with appropriate enclosures. • Alcohol involved in adult and teenage drownings. 1 Lightning • Strikes boaters, swimmers, golfers, anyone in large, open area • Cardiac arrest and tissue damage are common. • Three categories of lightning injuries —Mild: Loss of consciousness, amnesia, tingling, superficial burns —Moderate: Seizures, respiratory arrest, asystole (spontaneously resolves), superficial burns —Severe: Cardiopulmonary arrest 1 Emergency Medical Care • Protect yourself. • Move patient to sheltered area or stay close to ground. • Treat as for other electrical injuries. • Transport to nearest facility. 1 Spider Bites • Spiders are numerous and widespread in the US. • Many species of spiders bite. • Only the female black widow spider and the brown recluse spider deliver serious, even life-threatening bites. • Your safety is of paramount importance. 1 Black Widow Spider • Found in all states except Alaska • Black with bright red-orange marking in hourglass shape on abdomen • Venom poisonous to nerve tissue • Requires patient transport as soon as possible 1 Brown Recluse Spider (Hobo) cousin • Mostly in southern and central US • Short-haired body has violinshaped mark, brown to yellow in color, on its back. • Venom causes local tissue damage. • Area becomes swollen and tender, with pale, mottled, cyanotic center. • Requires patient transport as soon as possible. 1 Snake Bites • 40,000 to 50,000 reported snake bites in the US annually. • 7,000 bites in the US come from poisonous snakes. —Death from snake bites is rare. —About 15 deaths occur each year in the US. 1 Poisonous Snakes in the US Rattlesnake Copperhead Cottonmouth Coral snake 1 Pit Vipers • Rattlesnakes, copperheads, and cotton mouths • Store poison in pits behind nostrils • Inject poison to victim through fangs 1 Pit Viper Bite Signs and symptoms include: • Severe burning at the bite site • Swelling and bluish discoloration • Bleeding at various distant sites Other signs may include: —Weakness —Fainting —Sweating —Shock 1 Care for Pit Viper Bites • • • • • Calm the patient. Locate bite and cleanse the area. Do not apply ice. Splint area to minimize movement. Watch out for vomiting caused by anxiety. • Do not give anything by mouth. 1 Care for Pit Viper Bites, cont'd • If the patient is bitten on the trunk, lay the patient supine and transport quickly. • Monitor patient’s vital signs. • Mark the swollen area with a pen. • Care for shock if signs and symptoms develop. • Bring the snake to hospital if it has been killed. 1 Coral Snakes • Small snake with red, yellow, and black bands • “Red on yellow will kill a fellow, red on black, venom will lack.” • Injects venom with teeth, using a chewing motion that leaves puncture wounds • Causes paralysis of the nervous system 1 Care for Coral Snake Bites • Quiet and reassure the patient. • Flush the area with 1 to 2 quarts of warm, soapy water. • Do not apply ice. • Splint the extremity. • Check and monitor baseline vital signs. 1 Care for Coral Snake Bites, cont'd • Keep the patient warm and elevate the lower extremities to help prevent shock. • Give supplemental oxygen if needed. • Transport promptly. Give advance notice to hospital of coral snake bite. • Give the patient nothing by mouth. 1 Scorpion Stings • Venom gland and stinger found in the tail end. • Mostly found in southwestern US • With one exception, the Centruroides sculpturatus, most stings are only painful. • Provide BLS care and transport. 1 Tick Bites • Ticks attach themselves to the skin. • Bite is not painful, but potential exposure to infecting organisms is dangerous. • Ticks commonly carry Rocky Mountain spotted fever or Lyme Disease. 1 Tick Bites, continued • Rocky Mountain spotted fever develops 7 to 10 days after bite. • Symptoms include: —Nausea, vomiting —Headache —Weakness —Paralysis —Possible cardiorespiratory collapse 1 Tick Bites, continued • Lyme Disease has now been reported in over 35 states. • Lyme Disease symptoms may begin 3 days after the bite. • Symptoms include: —Target bull’s-eye pattern —Rash —Painful swelling of the joints 1 Caring for a Tick Bite • Do not attempt to suffocate or burn tick. • Use fine tweezers to grasp tick by the body and pull it straight out. • Cover the area with disinfectant and save the tick for identification. • Provide any necessary supportive emergency care and transport. 1 Injuries from Marine Animals • Coelenterates are responsible for more envenomations than any other marine life animal • Have stinging cells called nematocysts • Results in very painful, reddish lesions • Symptoms include headache, dizziness, muscle cramps, and fainting. 1 Care for Marine Stings • Limit further discharge by minimizing patient movement. • Inactivate nematocysts by applying alcohol. • Remove the remaining tentacles by scraping them off. • Provide transport to hospital. 2 Behavioral Emergencies 2 Myth and Reality • Everyone has symptoms of mental illness problems at some point. • Only a small percentage of mental health patients are violent. • Perfectly healthy people may have symptoms occasionally. 2 Defining Behavioral Emergencies Behavior • What you can see of a person’s response to the environment and his or her actions Behavioral crisis • Any reaction to events that interferes with activities of daily living or that becomes unacceptable to the patient, family, or others • A pattern, not an isolated incident 2 Causes of Behavioral Emergencies Organic Brain Syndrome • Caused by disturbance in brain tissue function Functional Disorder • Cannot be traced to change in structure or physiology of the brain 2 Organic Brain Syndrome Causes include: • • • • • • • • Sudden illness Recent trauma Drug or alcohol intoxication Diseases of the brain Low blood glucose Lack of oxygen Inadequate blood flow to the brain Excessive heat or cold 2 Safety Guidelines • Be prepared to spend extra time. • Have a plan of action. • Identify yourself. • Be calm. • Be direct. • Assess the scene. • Stay with patient. • Encourage purposeful movement. • Express interest. • Do not get too close. • Avoid fighting. • Be honest and reassuring. • Do not judge. 2 Scene Size-up 1. Scene Size-up • Scene safety is most important. Consider calling appropriate resources if needed. • Take BSI precautions at all times. • Avoid tunnel vision. 2 Initial Assessment 1. Scene Size-up 2. Initial Assessment • • • • • Start from the doorway. State why you are there. Decide SICK/NOT SICK. Be calm and relaxed. Provide appropriate interventions. • Transport to appropriate facility based on condition. 2 Focused History/Physical Exam 1. Scene Size-up • If unconscious, do rapid exam for life threats. 2. Initial • Assess three major areas Assessment as contributors: 3. Focused History/ • Is patient’s CNS functioning properly? Physical Exam • Are hallucinogens or other drugs or alcohol a factor? • Are psychogenic circumstances, symptoms, or illness involved? 2 Focused History/Physical Exam 1. Scene Size-up • Use reflective listening: repeating what the patient 2. Initial has said in question form Assessment to help patient expand thoughts. 3. Focused History/ • Tears, sweating, blushing Physical Exam may be indicators. • Look at patient’s eyes. • Coping mechanisms are stressed; perception of reality may be distorted. 2 Detailed Physical Exam 1. Scene Size-up 2. Initial Assessment 3. Focused History/ Physical Exam 4. Detailed Physical Exam • Rarely called for. 2 Ongoing Assessment 1. Scene Size-up • Never let your guard down. • Use law enforcement 2. Initial personnel with transport if Assessment available. 3. Focused History/ • Give advance warning to hospital. Physical Exam • Can involve legal matters; 4. Detailed Physical document clearly and well. Exam • Be clear and specific on restraint use. 5. Ongoing Assessment 2 Interventions • Be caring and careful. • Intervene only to safely transport. 2 Suicide • Depression is the single most significant factor that contributes to suicide. • An attempted suicide is a cry for help. • Immediate intervention is necessary. • Suicidal patients will usually exhibit warning signs. 2 Critical Warning Signs of Suicide • Does the patient have an air of tearfulness, sadness, deep despair, or hopelessness? • Does the patient avoid eye contact, speak slowly, or project a sense of vacancy? • Does the patient seem unable to talk about the future? • Is there any suggestion of suicide? • Does the patient have any specific plans relating to death? 2 Risk Factors for Suicide • Are there any unsafe objects in the patient’s hands or nearby? • Is the environment unsafe? • Is there evidence of self-destructive behavior? • Keep in mind the suicidal patient may be homicidal as well. 2 Medicolegal Considerations • Mental incapacity may take many forms. • Once a patient has been determined to have an impaired mental capacity, you must decide if care is needed. • Do not leave the patient alone. • Obtain help from law enforcement as necessary. 2 Consent • When a patient is not mentally competent, the law assumes that there is implied consent. • The matter is not always clear-cut with psychiatric emergencies. • If you are not sure about the situation, request law enforcement assistance. 2 Limited Legal Authority • As an EMT-B, you have limited legal authority to require or force a patient to undergo care. • Police may put a patient in protective custody to allow you to provide care. • Know your local laws and protocols. 2 Restraints • You cannot restrain a patient unless it is an emergency. • Transport a disturbed patient without restraints if possible. • If you must restrain the patient, use only reasonable force. —Law enforcement personnel should be involved. 2 Potentially Violent Patients Use a list of risk factors to assess the level of danger: • Past history • Posture • Scene • Vocal activity • Physical activity 2 Other Factors to Consider • • • • • • Poor impulse control History of uncontrollable temper Low socioeconomic status Substance abuse Depression Functional disorders 3 Ob/Gyn Emergencies 3 Female Reproductive System 3 Three Stages of Labor First stage: Dilation of the cervix Second stage: Expulsion of the infant Third stage: Delivery of the placenta 3 Predelivery Emergencies Preeclampsia • Headache, vision disturbance, edema, anxiety, high blood pressure Eclampsia • Convulsions resulting from hypertension Supine hypotensive syndrome • Low blood pressure from lying supine 3 Hemorrhage • Vaginal bleeding that occurs before labor begins • If present in early pregnancy, it may be a spontaneous abortion or ectopic pregnancy. 3 Ectopic Pregnancy • Pregnancy outside of the uterus • Should be considered for any woman of childbearing age with unilateral lower abdominal pain and missed menstrual period • History of PID, tubal ligation, or previous ectopic pregnancy 3 Placenta Problems Placenta abruptio • Premature separation of the placenta Placenta previa • Development of placenta over the cervix 3 Gestational Diabetes • Develops only during pregnancy. • Treat as regular patient with diabetes. 3 Scene Size-up 1. Scene Size-up • Woman’s balance is altered. Be aware for falls and the need for spinal stabilization. • Use BSI. • Usual threats to your safety still exist. • Be calm. • Protect the mother and the child. 3 Initial Assessment 1. Scene Size-up 2. Initial Assessment • Is the mother in active labor? • Evaluate trauma or medical problems first. • Treat ABCs in line with local protocols. 3 Focused History/Physical Exam 1. Scene Size-up • Obtain full SAMPLE history, and also: 2. Initial • Prenatal history Assessment • Complications during pregnancy 3. Focused History/ Physical Exam • Due date • Number of babies (twins) • Drugs or alcohol • Water broken • Green fluid (meconium) 3 Focused History/Physical Exam 1. Scene Size-up • Mainly abdomen and delivery of fetus 2. Initial • Based on her chief Assessment complaints and history 3. Focused History/ • Pay close attention to tachycardia, hypotension, Physical Exam or hypertension. 3 Detailed Physical Exam 1. Scene Size-up 2. Initial Assessment 3. Focused History/ Physical Exam 4. Detailed Physical Exam • Only if other treatments are not required. 3 Ongoing Assessment 1. Scene Size-up • Continue to reassess the patient for changes in vital 2. Initial signs. Watch for Assessment hypoperfusion. 3. Focused History/ • Notify hospital of your preparations for delivery. Physical Exam • Document carefully, 4. Detailed Physical especially baby’s status. Exam • Obstetrics is one of the most litigated specialties in 5. Ongoing medicine. Assessment 3 Transport Decision • If delivery is imminent, prepare for delivery in warm, private location. • If delivery is not imminent, transport on left side if in last two trimesters of pregnancy. • If the patient was subject to spinal injury, stabilize and prop backboard with towel roll on right side. 3 Interventions • Childbirth is natural, does not require intervention in most cases. • Treating the mother will benefit the baby. 3 When to Consider Field Delivery • Delivery can be expected within a few minutes • A natural disaster or other catastrophe makes it impossible to reach a hospital • No transportation is available 3 Preparing for Delivery • Use proper BSI precautions. • Be calm and reassuring while protecting the mother’s modesty. • Contact medical control for a decision to deliver on scene or transport. • Prepare OB kit. 3 Positioning for Delivery 3 Delivering the Baby • Support the head as it emerges. • Once the head emerges, the shoulders will be visible. 3 Delivering the Baby, cont'd • Support the head and upper body as the shoulders deliver. 3 Delivering the Baby, cont'd • Handle the infant firmly but gently as the body delivers. 3 Complications Unruptured amniotic sac • Puncture the sac and push it away from the baby. Umbilical cord around the neck • Gently slip the cord over the infant’s head. • It may have to be cut. 3 Postdelivery Care • Immediately wrap the infant in a towel with the head lower than the body. • Suction the mouth and nose again. • Clamp and cut the cord. • Ensure the infant is pink and breathing well. 3 Delivery of Placenta • Placenta is attached to the end of the umbilical cord. • It should deliver within 30 minutes. • Once the placenta delivers, wrap it and take to the hospital so it can be examined. • If the mother continues to bleed, transport promptly to the hospital. 3 APGAR Scoring A Appearance P Pulse G Grimace A Activity R Respirations 3 Neonatal Resuscitation 3 Chest Compressions to an Infant 1. Find the proper position • Just below the nipple line • Middle third of the sternum 2. Wrap your hands around the body, with your thumbs resting at that position. 3. Press your thumbs gently against the sternum, compressing 1/3 to 1/2 the depth of the patient’s chest. 3 Chest Compressions to an Infant • Ventilate with a BVM device after every third compression. • 100 compressions to 20 ventilations per minute • Continue CPR during transport. 3 Breech Delivery • Presenting part is the buttocks or legs. • Breech delivery is usually slow, giving you time to get to the hospital. • Support the infant as it comes out. • Make a “V” with your gloved fingers then place them in the vagina to prevent it from compressing infant’s airway. 3 Rare Presentations Limb presentation • This is a very rare occurrence. • This is a true emergency that requires immediate transport. 3 Rare Presentations, cont'd Prolapsed cord • Transport immediately. • Place fingers into the mother’s vagina and push the cord away from the infant’s face. 3 Excessive Bleeding • Bleeding always occurs with delivery but should not exceed 500 mL. • Massage the mother’s uterus to slow bleeding. • Treat for shock. • Place pad over vaginal opening. • Transport to hospital. 3 Spina Bifida • Defect in which the portion of the spinal cord or meninges may protrude outside the vertebrae or body. • Cover area with moist, sterile compresses to prevent infection. • Maintain body temperature by holding baby against an adult for warmth. 3 Abortion (Miscarriage) • Delivery of the fetus or placenta before the 20th week • Infection and bleeding are the most important complications. • Treat the mother for shock. • Transport to the hospital. • Bring tissue that has passed through the vagina to the hospital. 3 Twins • Twins are usually smaller than single infants. • Delivery procedures are the same as that for single infants. • There may be one or two placentas to deliver. 3 Delivering for Addicted Mothers • Ensure proper BSI precautions • Deliver as normal. • Watch out for severe respiratory depression and low birth weight. • Infant may require immediate care. 3 Premature Infants and Procedures • Delivery before 8 months or weight less than 5 lbs at birth. • Keep the infant warm. • Keep the mouth and nose clear of mucus. • Give oxygen. • Do not infect the infant. • Notify the hospital. 3 Fetal Demise • An infant that has died in the uterus before labor • This is a very emotional situation for family and providers. • The infant may be born with skin blisters, skin sloughing, and dark discoloration. • Do not attempt to resuscitate an obviously dead infant. 3 Delivery Without Sterile Supplies • You should always have goggles and sterile gloves with you. • Use clean sheets and towels. • Do not cut or clamp umbilical cord. • Keep placenta and infant at same level. 3 Gynecologic Emergencies • Do not examine genitalia unless there is obvious bleeding. • Leave any foreign bodies in place, after packing with bandages • Treat as any other patient with blood loss. Questions • What questions do you have? To review this presentation, go to: http://www.emsonline.net/emtb