emt obgyn reproduksi
DESCRIPTION
Emt ObgynTRANSCRIPT
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Obstetrics/GynecologyEmergency Medical Technician - Basic
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Female Reproductive SystemUterusCervixVaginaUrinary BladderRectum
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Female Reproductive SystemUterusVaginaFallopian tubeOvaryCervix
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OB/Gyn AssessmentHistoryWhen was your last normal menstrual period (LNMP)?Abdominal pain? (location/quality)Vaginal bleeding/discharge?
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OB/Gyn AssessmentHistoryIs there a possibility you might be pregnant?Missed period?N/VIncreased urinary frequencyBreast enlargementVaginal discharge
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OB/Gyn AssessmentHistoryIf pregnant:Para = # of live birthsGravida = # of pregnancies-3 /+ 7 to estimate due dateSubtract 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 signsHypertensionHypotensionTilt test if blood loss is suspectedFocused examEdema (particularly of face, hands)
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Gyn Emergencies
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Ectopic PregnancyZygote implants in location other than uterine cavity95% are in Fallopian tube (tubal ectopic)Life threatening!
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Ectopic PregnancySigns and SymptomsMissed period, other signs/symptoms of early pregnancyLight vaginal bleed (spotting) 6-8 weeks after LNMPAbdominal pain, may radiate to shoulderPositive tilt testOther signs/symptoms of hypovolemic shock
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Ectopic PregnancySigns and SymptomsAbdominal pain may be absentSome patients may NOT miss periodSome patients may have NEGATIVE pregnancy tests
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Ectopic PregnancyLower abdominal pain or unexplained hypovolemic shock in a woman of child-bearing ageequalsEctopic Pregnancy Until Proven Otherwise
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Ectopic PregnancyManagement100% O2Supportive care for hypovolemic shockTransport immediately
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Pelvic Inflammatory DiseaseAcute or chronic infectionInvolves Fallopian tubes, ovaries, uterus, peritoneumMost commonly caused by gonorrheaStaph, strep, coliform bacteria also cause infections
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Pelvic Inflammatory DiseaseSigns and SymptomsLower abdominal painGradual onset over 2-3 days, beginning 1-2 weeks after last periodFever, chillsNausea, vomitingYellow-green vaginal dischargeWalks bent forward, holding abdomen
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Pelvic Inflammatory DiseaseManagementHigh concentration O2Transport
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Spontaneous AbortionMiscarriagePregnancy terminates before 20th weekUsually occurs in first trimester (first three months)
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Spontaneous AbortionSigns and SymptomsVaginal bleedingCramping lower abdominal pain or pain in backPassage of fetal tissue
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Spontaneous AbortionComplicationsIncomplete abortionHypovolemiaInfection, leading to sepsis
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Spontaneous AbortionManagementHigh concentration O2Shock positionTransport any tissue to hospitalProvide emotional support
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Pre-eclampsiaAcute hypertension after 24th week of gestation5-7% of pregnanciesMost often in first pregnanciesOther risk factors include young mothers, no prenatal care, multiple gestation, lower socioeconomic status
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Pre-eclampsiaTriadHypertensionProteinuriaEdema
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Pre-eclampsiaSign and SymptomsHypertensionSystolic > 140 mm HgDiastolic > 90mm HgOr either reading > 30 mmHg above patients normal BPEdema (particularly of hands, face) present early in day
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Pre-eclampsiaSigns and SymptomsRapid weight gain>3lbs/wk in 2nd trimester>1lb/wk in 3rd trimesterDecreased urine outputHeadache, blurred visionNausea, vomitingEpigastric painPulmonary edema
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Pre-eclampsiaComplicationsEclampsiaPremature separation of placentaCerebral hemorrhageRetinal damagePulmonary edemaLower birth weight infants
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Pre-eclampsiaManagement100% O2Left lateral recumbent positionAvoid excessive stimulationReduce light in patient compartmentAvoid use of emergency lights, sirens
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EclampsiaGravest form of pregnancy-induced hypertensionOccurs in less than 1% of pregnancies
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EclampsiaSigns and SymptomsSigns, symptoms of pre-eclampsia plus: Grand mal seizures Coma
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EclampsiaComplicationsSame as pre-eclampsiaMaternal mortality rate: 10%Fetal mortality rate: 25%
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EclampsiaManagement100% O2; assist ventilations, as neededLeft lateral recumbent positionReduce lightManage like any major motor seizureEmergency transportConsider ALS intercept for anticonvulsant medication administration
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EclampsiaAssess every pregnant patient forIncreased BPEdemaTake all reports of seizures in pregnant females seriously
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Abruptio PlacentaePremature separation of placenta from uterusHigh risk groupsOlder pregnant patientsHypertensivesMultigravidas
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Abruptio PlacentaeSigns and SymptomsMild to moderate vaginal bleedingContinuous, knife-like abdominal painRigid, tender uterusSigns, symptoms of hypovolemia
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Abruptio PlacentaeThird Trimester Abdominal Pain equals Abruptio Placentae until proven otherwise
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Abruptio PlacentaeHypovolemic shock out of proportion to visible bleeding equals Abruptio Placentae until proven otherwise
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Abruptio PlacentaeManagement100% O2Left lateral recumbent positionSupportive care for hypovolemic shockRapid transport
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Placenta Previa Implantation of placenta over cervical opening
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Placenta PreviaSigns and SymptomsPainless, bright-red vaginal bleedingSoft, non-tender uterusSigns and symptoms of hypovolemia
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Placenta PreviaManagement100% O2Left lateral recumbent positionSupportive care for hypovolemic shockNever perform a vaginal exam on a pt in the 3rd trimester with vaginal bleeding
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Placenta PreviaA vaginal exam should NEVER be performed on a patient in the 3rd trimester with vaginal bleeding
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Uterine RuptureCausesBlunt trauma to pregnant uterusProlonged labor against an obstructionLabor against weakened uterine wallOld Cesarian section scarGrand multiparous patients
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Uterine RuptureSigns and SymptomsTearing abdominal painSevere hypovolemic shockFirm, rigid abdomenPossible palpation of fetal parts through abdominal wallVaginal bleeding may or may not be present
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Uterine RuptureManagement100% O2Anticipate shockALS/helicopter intercept
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Emergency Childbirth
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Developing FetusPlacentaAmniotic Sac Bag of watersUmbilical cordFetus
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Labor1st stage: Onset of contractions to dilation of cervix2nd stage: Complete dilation of cervix to delivery of baby3rd stage: Delivery of baby to delivery of placenta
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Signs of Imminent DeliveryCrowningRupture of Amniotic SacNeed to bear downSensation of needing to move bowelsContractions1 to 2 minutes apartRegularLasting 45 to 60 seconds
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DeliveryPlace gloved hand on presenting part to prevent explosive deliveryOn delivery of head, suction mouth then nose
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DeliveryGently guide babys head down to deliver upper shoulder Gently guide babys head up to deliver lower shoulderGently assist with delivery of rest of baby; Do NOT pullNote time of delivery of baby
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DeliveryControl slippery baby during deliverySupport head, shoulders, feetKeep head lower then feet to facilitate drainage of secretions from mouthDry baby Keep baby warm
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DeliveryClamp, cut cordFirst clamp about 4 from babySecond clamp 2 further away from firstCut between clampsUse umbilical tape to control any bleeding from cord
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DeliveryFlick babys feet, rub back to stimulateDo NOT shake infantDo NOT slap buttocksBlow by O2 if:Heart rate < 100Persistent central cyanosis presentResuscitate if necessary
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DeliveryDeliver PlacentaPlace placenta in plastic bag and deliver to hospital to be examined for completenessIf placenta does not deliver within 10 minutes, transport
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APGAR ScoreDeveloped by Virginia ApgarQuick evaluation of infants pulmonary, cardiovascular, neurological functionUseful in identifying infants needing resuscitation
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APGAR ScoreDetermine at 1 and 5 minutes postpartum!
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Maternal Care: PostpartumBleedingPlace sterile pad over vaginal openingIf bleeding is excessive:Rapidly transport to hospitalUterine massageEncourage breastfeeding
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Maternal Care: PostpartumShockIf mother shows signs, symptoms of shock:High concentration O2Rapid transportALS intercept
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Complicated Deliveries
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Breech Presentation
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Breech PresentationManagementHigh concentration O2Rapid transportPrepare for neonatal resuscitationAssist delivery
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Breech PresentationManagementIf head does not deliver within 3 minutes of body:Insert gloved hand into vagina forming V around babys nose, mouth Push vaginal wall away from babys face to create airway
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Limb Presentation
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Limb PresentationManagementHigh concentration O2Rapid transport
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Prolapsed CordUmbilical cord enters vagina before infants headPressure of head on cord occludes blood flow, O2 delivery to fetus
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Prolapsed CordManagementHigh concentration O2Knee-chest position or exaggerated shock positionPlace gloved hand in vaginaApply gentle pressure inward to presenting part; relieve pressure on cord
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Umbilical Cord around NeckManagementUpon delivery of head look for cord is looped around neckGENTLY slip cord over head if possibleIf cord cannot be slipped over head:Clamp in two placesCut between clamps with surgical scissors
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Amniotic Sac IntactManagementUse clamp to tear sac, release fluidMove sac away from babys nose, mouth
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MeconiumFirst stool of newbornMeconium-stained amniotic fluidBaby has had bowel movement in uteroGreenish, black (pea soup) colorIndicative of distress
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MeconiumMeconium can:Occlude airwayCause pneumonitis
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MeconiumManagement Avoid early stimulation of baby to prevent aspirationAggressively suction airway until all meconium is removed
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Multiple Births
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Multiple BirthsConsider as possibility if: Mothers abdomen appears abnormally large prior to deliveryMothers abdomen remains large after delivery of first babyContractions continue after delivery of first baby
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Multiple BirthsDeliveryClamp cord of first baby before delivery of secondUsually second baby will deliver shortly after firstCare for babies, mother, and placenta(s) as you would in a single birth
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Multiple BirthsMultiple babies are usually smallIt is important to keep them warm!
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Premature InfantsDefinition< 28 weeks gestation, or< 5.5 pounds birth weight
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Premature InfantsManagementKeep baby warmKeep airway clearAssist ventilations if necessaryResuscitate if necessaryWatch umbilical cord for bleedingBlow by O2Avoid contaminationConsider ALS intercept
Temple College EMS Professions