6/7 Exam Review

Question 1

Uterus

Answer 1

Muscular Organ in which the fetus will grow within a female.

Question 2

PID

Answer 2

-Pelvic Inflammatory Disease -Infection of Female upper organs of reproduction system; namely: Uterus, Ovaries, & Fallopian Tubes -Occurs almost exclusively in sexual active women

Question 3

Ovary

Answer 3

-Primary reproductive organ within women -Produces an Ovam (egg) -Two on either side of lower abdomen.

Question 4

Ovum

Answer 4

-Egg used in reproduction. -Comes from Ovary. -Each ovary produces an ovum in alternating months, which is released in the Fallopian tubes (this is ovulation) Then will be fertilized within then moved to Uterus.

Question 5

Normal Menstruation

Answer 5

-Where lining of uterus begins to separate after egg is not fertilized. Is controlled by hormones of females with these ones being produced in ovaries -Starts happening within 14 days of egg not being fertilized. -Consists of blood from lining and will last 1 week. -Menstruation will begin to occur within 11 to 16 years of age. When this starts to occur it is called MENARCHE.

Question 6

Pelvic Inflammatory Disease (PID)

Answer 6

-Infection of the female upper organs of reproduction specifically in the uterus, ovaries, and Fallopian tubes. -Occurs ALMOST exclusively in sexually active women. -Occurs when diseases enter Vagina usually by sexual activity and migrate in past cervix. Will then expand to fallopian tubes producing scarring that can lead to life-threatening ectopic pregnancy of sterility. -Common signs: Generalized lower abdominal pain, abnormal and foul-smelling vaginal discharge, increased pain with intercourse, nausea and vomiting

Question 7

Gonorrhea

Answer 7

-Cause by bacteria called Neisseria gonorrhoeae. Bacteria can multiply rapidly in warm, moist areas of reproductive tract including upper reproductive organs. Can also grow in mouth, throat, eyes and anus. -SYMPTOMS: Painful urination, burning or itching, yellow/bloody vaginal discharge with foul odor and blood associated with vaginal intercourse. -SEVERE INFECTION SYMPTOMS: Cramping, abdominal pain, nausea and vomiting, bleeding between periods.

Question 8

Chlamydia

Answer 8

• Caused By Chlamydia trachomatis; affects estimated 2.8 million americans each year
• Symptoms are mild or absent:
• lower abdominal pain
• low back pain
• nausea
• Fever
• pain during intercourse

-Can lead to arthritis accompanied by skin lesions and inflammation of the eye and urethra.

Question 9

Patient History For Females

Answer 9

• Helps to determine if patient is pregnant
• Can lead to help on how much blood lost
• Can help to lead to informaton regarding when item, attack, etc. happend

Question 10

Abdominal Pain + Syncope=

Answer 10

-Shock???

Question 11

Vaginal Bleeding Causes

Answer 11

-Possible causes OTHER then natural Menstraution:

• Abnormal menstraution
• Vaginal Trauma
• Ectopic pregnancy
• Spontaneous Abortion/Miscarriage
• Cervical Polyps (relatively painless)
• Cancer(relatively painless)
• Trauma to internal female reproductive organs is rare beyond vaginal penetration cause of how deep they are.
• All Cases of Vaginal Bleeding Should be taken seriously

Question 12

Vaginal Bleeding Treatment

Answer 12

• Can lead to hypoperfusion or shock. Finding the cause is **less important then treating. **
• Control any external bleeding in area with the use of sanitary pads on it. Not necessary to remove tampon.
• Treat any external lacerations, abrasions, and tears with moist sterile compresses and use local pressure to control bleeding while using diaper bandage to keep it in place.

**-DO NOT REMOVE ANY FOREIGN BODIES LOCATED IN VAGINA. DO NOT PACK OR PLACE DRESSINGS IN VAGINA. **

Question 13

General Information About “Rape”

Answer 13

• Sadly a common occurance within United states with 1/3 women being raped in their lifetimes.
• 1/4 will be sexually molested, often before the age of 12.
• Rape is a crime; police involement will be necessary.
• Police’s job is to solve crime, arrest, and bring prepetrator to justic; you are to deal with all medical aspects of case.
• You are NOT legalized to confirm or diagnoise situation as RAPE as it is a legal diagnosis, not medical. Medical team can only establish if sexual intercourse occured.
• Don’t cross examine or try to get information for benefit of police.
• You will be at a “crime scene”; Do not pass judgement, collect evidence, and disturb the scene as little as possible.

Question 14

General Information on Rape (2nd Card)

Answer 14

• Try to gently persuade patient to not clean herself. This includes discouraging of urinating, changing clothes, moving bowls, rinsing out her mouth.
• Police will need to photograph her.
• If they cannot be dissauded, respect her feeligns. If they refuse transport, follow local protocls.
• Compassion is best tool to use to gain patient’s trust. Make sure to shield patient from others eyes as best as possible. Expose and examine vagina ONLY if necessary.
• Do not insert own opinion in PCR.

Question 15

Treatment Principles for Sexual Assault

Answer 15

1. You must document patient’s history, assessment, treatment and response to treatment in detal because you may have to appear in court as long as 2 or 3 years later. Do not speculate. Record only facts.
2. Make airway maintenance a major priority
3. Complete SAMPLE history objectively.
4. Follow any crime scene policy established by your system to protect the scene and any potential evidence for police, particularly that for evidence collection. If patient will tolerate being wrapped in sterile burn sheet, this may help investigators to find any hair, fluid, or fiber from the alleged offender.
5. Do not examine the genitalia unless there is major bleeding. If an object has been inserted into the vagina or rectum, do not attempt to remove it.
6. To reduce patient’s anxiety, make sure the EMT is the same sex as patient whenever possible.
7. Discourage patient form bathing, voiding or cleaning any wounds until the hosptial staff has completed an assessment. Handle patients clothes as litle as possible, placing articles and any other evidence in paper bags. If patient insists on urinating, ask patient to do s in sterile urine container if available. Deposit toliet paper in a paper bag. Seal and mark bag for police. This can be critical evidence.

Question 16

Placenta (chp 31)

Answer 16

• Disk shaped structure, attaches to inner lining of the wall of uterus and connected to fetus by umbilical cord.
• Consists of two layers of cells which keeps circulation of woman and the fetus seperate, but allows untrients, oxygen, waste and carbon dioxide and many toxins/medications to pass between the woman and fetus.

Question 17

Abruptio Placenta (chp 31)

Answer 17

• Where placenta seperates prematurely from wall of uterus. Most commonly occurs from hypertension in the mother and as a result of trauma.
• Patient will complain of severe pain and have vaginal bleeding.

Question 18

Placenta previa (chp 31)

Answer 18

-Where placenta develops over and covers the cervix.

-

Question 19

Nuchal Cord (31)

Answer 19

-Where during delivery, umbilical cord is wrapped around infant’s neck and could cause infant to become strangled.

Question 20

Eclampsia (31)

Answer 20

• A condition casued by delivery nearing; patient will have seizures that occur as a result of Hypertension.
• To treat, lie patient on her left side, maintain airway, and provide O2. Suction airway if needed and call for ALS intercept if possible.

Question 21

Changes to woman’s body when pregnant (31)

Answer 21

• Primary systems involved in changes are respiratory, cardiovascular, and musculoskeletal.
• HOrmone levels will increase to support fetal development.
• Uterus will grow and stretch.
• Rapid Uterine growth occus in second trimester.
• Growth of uterus affects respiratory system because it pushes up on diaphragm and displacces it from normal position which increase respiratory rates and decreases mintue volume.
• Overall blood volume will gradually increase. During third trimester, woman’s entire blood volume passes through the uterus every 8-11 minutes.
• Red blood cells will increase, and will in turn increase need for Iron.
• Woman’s ability to clot faster will start to occur.
• increased risk of vomiting and potentail aspiration following trauma if in third trimester.
• Workload of heart is increased because of above changes to cardiovascular system.
• Weight will be gained and may challenge heart.

Question 22

Braxton-Hicks Contractions (31)

Answer 22

• Also known as “false labor”
• Signs/Symptoms:
• Contractions are not regular and do not increase in intensity of frequency; contractions will come and go.
• Pain is in lower abdomen, contractions will start and stay in lower abdomen.
• Activity or chaning position will alleviate the pain and contractions
• If there is any bloody show, it is brownish.
• There may be some leakage of fluid, but it is usually urine and will be in small amounts and smell of ammonia.

Question 23

Stages of Labor (31)

Answer 23

Three stages:

First stage:

• Will last usually 16 hours for first delivery. Starts with contractions of the uterus and will begin with bloody show and rupture of the amniotic sac (water breaking). Frequency and intensity of uterine contractions will increas and become more regular lasting about 30-60 secs.

Second Stage:

• Begins when fetus enters to enter birth canal and ends when infant is born. Contractions aer usually closer together and last longer. Pressure on rectum may make mother feel as if shes having a bowel movement. She may also have uncontrollable urge to push down. Perineum will being to bulge significantly and the top of the infants head shoul begin to appear at vaginal opening (crowning).

Third Stage:

• Begins with birth of the infant and ends with delivery of placenta. Contractions will continue to assist and placenta must completely seperate from Uterine wall. May take up to 30 minutes.

Question 24

Preeclampsia (31)

Answer 24

• Also known as “pregnancy induced hypertension”.
• Commonly occurs in patients who are pregnant for the first time.
• Can develop after 30th week of gestation and characterized by following:
• Headache
• Seeing Spots
• Swelling in the hands and feet (edema)
• Anxiety
• High Blood Pressure

Question 25

Leading Cause of Death in.First Trimester

Answer 25

-Leading cause of death is internal hemorrhage into the abdomen following rupture of an ectopic pregnancy. For this reason, you should consider the possibility of an ectopic pregnancy in women who have missed a menstrual cycle and complain of sudden stabbing and usually unilateral pain the lower abdomen.

Question 26

APGAR (31)

Answer 26

Five areas, with a score of 0-2 for each. Perfect score is 10; should be calculated **at 1 minute five seconds after birth and note that most infants will have a score of 7 or 8 at one minute with the score going up to 8 to 10 four minutes later. **:

Appearance:

• 2:Infant is entirely pink
• 1: Body is pink but hands and feet blue
• 0: Entire infant is blue.

Pulse:

• 2: More than 100 beats/min
• 1: Less than 100 beats/min
• 0: Absent Pulse

Grimace/Irritability:

• 2: Infant cries and tries to move foot away from finger snapped against sole of foot.
• 1: Infant gives a weak cry in response to stimulus.
• 0: Infant does not cry or react to stimulus.

Activity or Muscle Tone:

• 2: Infant resists attempts to straighten the hips and knees
• 1: Infant makes weak attempts to resist straightening
• 0: Infant is completely limp, with no muscle tone.

Respiration:

• 2: Rapid Respirations
• 1: Slow Respirations
• 0: Absent Respirations

Question 27

Signs of Imminent Birth (31)

Answer 27

• Patient will have very firm abdomen, or will say she feels the need to move bowels or push. This shows that infants head is pressing rectum and delivery is about to occur.
• Visualize Vagina; if crowning is occuring, delivery is imminent. At this point, spread patient’s legs apart after explaining that you are doing so to determine if you need to deliver right there or at the hospital.
• Once labor has began, there is NO WAY to stop it or slow it. Do not try to close legs nor lett her go to the restroom.
• Ask these questions of patient to help determine further:
• How long have you been pregnant?
• When are you due?
• Is this your first baby?
• Are you having contractions? How far apart are they? How long do they last?
• Do you feel as though you will have a bowel movement?
• Have you had any spotting or bleeding?
• Has your water broke?
• Were any of your previous children delievered by c-section?

Ask the following to help determine any potential complications:

• Have you had problems in a previous pregnancy?
• Do you use drugs, drink alcohol, or take any medications?
• Do you know if there is a chance of a multiple birth (having twins, more than one baby?)
• Does your doctor expect any complicatoins.

Question 28

Delivering a Baby (31)

Answer 28

• Partner should be at head to comfort, soothe, and reassure during delivery. May vomit, make sure partner helps to clear it.
• Position yourself to see perineal area at all times and time conractions from teh beginning of one to the beginning of the next to deterimne frequency of such by feeling patient’s abdomen.
  1. Allow mother to push head out, and support babies head by pushing a gloved hand over its bony parts. Feel to see if nuchal cord is occuring, if so, try to gentle remove it.
  2. Sucution fluid from babies mouth first, THEN the nostrils with soft blub suctioneer. Make SURE to squeeze the bulb first before inserting it into the infants muoth or nose.
• If amniotic sac has come out unruptured, pull it out, push it away from the babies head, and clamp it to puncture it, making sure that it wont spill on the baby. DO NOT puncture if babies head is not crowning yet.
  3. Supprt the head and upper body as shoulders deliver and guide head down slightly.
  4. Once body is dlievered, handle infant firmly but gently with mind of it being slippery. Keep infants head in neutral position.
  5. Place umbilical cord clamps 2” to 4” apart, about four fingerbreathts from the infants body. Depending on local protocal, cut cord in between clamps.
  6. Placenta will deliver itself within about 30 minutes. NEVER pull on the end of the umbilical cord in an atttempt to speed said delivery.

Question 29

Additional Info on Baby Resitaction

Answer 29

If heart is more than 100 bpm:

• Keep newborn warm, transport, and assess newborn continuously.

If 60 to 100 bpm:

• Begin assisted ventilation with bag-mask device and 100% oxygen. Reassess every 30 seconds until heart rate and respirations are normal. Continue to reassess and call for ALS backup. Keep infant warm.

If fewer than 60 bpm:

• being assisted ventilations at 100% oxygen. Reassess every 30 seconds until heart rate and respirations are normal. Begin chest compressions and call for ALS backup. If heart rate does not increase, medicatino and ALS will be needed.

Question 30

Ventilating A Newborn (31)

Answer 30

• Newborn will usually begin to breath spontaneously within 15-30 secs after birth and heart rate will be 120 beats/min or higher.
• If these are not observed, gently tap or flick the soles of the infants feet or rub back to stimulate breathing. If Infant does not breathe after 10 to 15 secs, start to resuscitate.
• Position infant on his or her back with head down and neck slightly extended. Place towel or blanket under the infants shoulders to help maintain position.
• Suction mouth and nose using the same bulb, and suction back areas of mouth WITHOUT going too deep. Aim BLOW BY OXYGEN at infants nose and mouth.
• Dry and warm infant, stimulate, use a BVM mask if needed but is seldom required. IF REQUIRED VENTILATE AT RATE OF 40-60 breaths per min.
• If it comes to it, perform chest compression if there is no pulse or if the heart rate is less then 60 and after 30 seconds of ventilation with the heart rate still not increasing. Use hand encircling technique or two finger technique for compressions. BVM is perfored during a pause after **EVERY THIRD COMPRESSION. **
• Ratio will be 3:1 yeilding a total of 120 actions per minute or 90 compressions and 30 ventilations.
• If Meconium, a thick green fecal matter, is present in amniotic fluid or is staining the infant and the infant is not breathing right, you should continue vigorous suctioning of the infant after delivery.

Question 31

Treatment for Breech Presentations (31)

Answer 31

Vertex Presentation: Where head is born first; normal and healthy birth.

Breech Presentation: Buttocks will be delivered first. This gives infant large chance for trauma to occur during delivery. To treat, call ALS and transport fast. If you have to deliver, support the body in the same manner and do not let rapidly come out. When head comes out however, you will need to perform a potentatially life saving procedure by maknig a V in your gloved hands and position them IN the vagina to keep the walls of such to compress airway of baby as it comes out. Place finger over the babies face, just across the eyes.

Question 32

Treatment for Limb Presentation (31)

Answer 32

• Where a single arm, or leg, or foot is presenting instead of head or buttocks.
• **You cannot sucessfully deliver an infant with a limb presentation in the field. **
• Transport immediatly. If limb is protruding, cover it with a warm sterile towel. NEVER TRY TO PUSH IT BACK IN AND NEVER PULL DOWN ON IT.
• Woman and fetus will be highly stressed so give woman high-flow oxygen.

Question 33

Treatment of Proplase of Umbilical Cord (31)

Answer 33

• Where umbilical cord comes out of vagina before the infant.
• **Cannot be treated in field. **
• Situation is dangers as infants head will compress cord during birth and cut off circulatoin to the infant, depriving it of oxygenated blood. Do not attempt to push it back in, and transport immediatly.
• Place patient in trendelenburg’s position, hips elevated on a pillor or folded sheet. Can alternatively be placed in a knee-chest position (kneeling and bent forward, facedown)This is meant to help keep the weight of the infant off the prolasped cord.
• Carefully insert gloved hand into vagina and push babies head away from umbilical cord gently. You must maintain this position and continue to try your best to keep the pressure off of the cord continuously throughout transport to hospital and even possibly until the operating room. Wrap a steril towel mositened wtih saline around exposed cord.

Question 34

Fetal Demise (31)

Answer 34

• Where baby died in mothers uterus before labor. The Book says this will be a true test of your medical, emotional, and social abilities.
• If an intrauetrine infection has caused the demise, you may note an extrememly foul odor. Delivered infant may have skin blisters, skin sloughing, and a dark discoloration depending on stage of decomposition. Head may be soft and grossely deformed.
• Do not attempt to resuscitate an obviously dead infant. However, do not confuse such an infant with infants who have had a cardiopulmonary arrest as a complicatoin of the birthing process. Make sure to try and resuscitate normal appearing infants.

Question 35

Considerations for Equipment Storage on the Ambulance (36)

Answer 35

• Store equipment and supplies in the ambulance according to how urgently and how often they are used.
• Give priority to items that are needed to care for life-threatening conditions such as equipment for airway management, artificial ventilation, and oxygen delivery. Place said items within easy reach such as at head of stretcher. Place items for cardiac care, control of external bleeding, and monitoring blood pressure at the side of the stretcher.
• Storage cabines and kits should open easy. But they should not fly open as amubulance is moving. Label each container to make sure you know what is in each.

Question 36

The Star of Life (36)

Answer 36

-This six sided symbol is used to identify vehicles as ambulances. Often affixed to sides, rear, and roof of ambulance. Local regulatory authorities determine what emblems bay be displayed on the side of a prehospital ambulance.

Question 37

The Purpose of Jump Kit (36)

Answer 37

• A portable, durable, waterproof kit that you can carry to the patient. Think of the jump kit as a “five-min kit”; it should contain anything you might need in the first five minutes with the patient except for teh semiautomated external defibrillator, possibly the oxygen cylinder, and portable suctioning unit.
• jump kit should be easy to open and secure. Will contain: gloves, triangle bandages. trauma shears, adhesive tape, trauma dressing, bvm, blood pressure cuff, penlight, stethescope, oral glucose, charcoal, etc.