Emergency childbirth - Endotracheal and tracheostomy suctioning/reinsertion

Question 1

What are the indications for the emergency childbirth m.d.

Answer 1

Pregnant patient experiencing labour
OR
Post-partum patient immediately following delivery and/or placenta

Question 2

What kind of drug is OXYTOCIN

Answer 2

Naturally hormone that controls/reduces the risk of postpartum hemorrhage through production of uterine contractions.

Question 3

What are the conditions for external uterine massage (emergency childbirth m.d.)

Answer 3

Age: Childbearing years
Other: Post-placental delivery

Question 4

What are the conditions for delivery (emergency childbirth m.d.)

Answer 4

Age: childbearing years
Other: Second stage labour AND/OR imminent birth AND/OR shoulder dystocia AND/OR breech delivery AND/OR prolapsed cord

Question 5

What are the conditions for umbilical cord management (emergency childbirth m.d.)

Answer 5

Age: childbearing years
Other: Cord complications OR if neonatal or maternal resuscitation is required OR due to transport considerations

Question 6

What are the conditions for oxytocin (emergency childbirth m.d.)

Answer 6

Age: childbearing years
SBP: < 160 mmHg
Other: Postpartum delivery AND/OR placental delivery

Question 7

What are the contraindications to delivery and umbilical cord management? (emergency childbirth m.d.)

Answer 7

N/A

Question 8

What are the contraindication to external uterine massage (emergency childbirth m.d.)

Answer 8

Placenta not delivered

Question 9

What are the contraindication to Oxytocin (emergency childbirth m.d.)

Answer 9

• Allergy or sensitivity to oxytocin
• Undelivered fetus
• Suspected or known pre-eclampsia with current pregnancy
• Eclampsia (seizures) with current pregnancy
• ≥ 4 hours post placental delivery

Question 10

What’s the treatment for prolapsed cord delivery (emergency childbirth m.d.)

Answer 10

• fetal part should be elevated to relieve pressure on the cord.
• Assist the patient into a knee-chest position or exaggerated Sims position, and insert hand into the vagina.
• Apply manual digital pressure
• Maintain until transfer of care in hospital.

Question 11

What is the treatment for delivery (emergency childbirth m.d.)

Answer 11

Position the patient and deliver neonate

Question 12

What is the treatment for shoulder dystocia delivery (emergency childbirth m.d.)

Answer 12

Perform ALARM twice on scene.
A - Ask for help
L - lift legs, hyperflex thighs
A - Adduct shoulder (suprapubic pressure)
R - roll over
M - manual delivery of posterior arm
If successful; deliver neonate. If unsuccessful; transport to closest appropriate facility

Question 13

What is the treatment for breech delivery (emergency childbirth m.d.)

Answer 13

• HANDS OFF the breech. Allow neonate to deliver to umbilicus; consider carefully releasing the legs and arms as they are delivered; otherwise hands off.
• Once hairline is visible AND/OR 3 mins has passed since umbilicus was visualized attempt the Mauriceau Smellie-Veit maneuver (fingers on occipital bone) .
• If successful; deliver neonate. If unsuccessful; transport to closest appropriate
  facility

Question 14

What is the treatment for umbilical cord management (emergency childbirth m.d.)

Answer 14

• If a nuchal cord is present and loose, slip cord over the neonate’s head. Only if a nuchal cord is tight and cannot be slipped over the neonate’s head, clamp and cut the cord, encourage rapid delivery.
• Following delivery of the neonate, the cord should be clamped and cut
  immediately if neonatal or maternal resuscitation is required. Otherwise, after pulsations have ceased (approximately 2-3 minutes), clamp the cord in two places and cut the cord.

Question 15

What is the treatment for external uterine massage (emergency childbirth m.d.)

Answer 15

Post-placental delivery

Question 16

What is the treatment for oxytocin (emergency childbirth m.d.)

Answer 16

Route: IM
Dose: 10 unites
Max single doses: 10 units
Max # of doses: 1

Question 17

What are the important patient assessment findings (emergency childbirth m.d.)

Answer 17

• Lack of progression of labour
• Multiple births expected
• Neonate presents face-up
• Pre-eclampsia
• Presence of vaginal hemorrhage
• Premature labour
• Primip

Question 18

How/Where to cut the umbilical cord?

Answer 18

• Clamp the cord in 2 places
• Approximately 15 cm from the neonates abdomen and approximately 5-7 cm from the first clamp
• Cut the umbilical cord between the clamps using the OBS scissors.

Question 19

What are signs of second stage labour?

Answer 19

• Contractions every 2 to 3 minutes, lasting 60-90 seconds
• Contractions associated with maternal urge to push or to move the bowels
• Heavy red show visible at the vaginal opening
• Presenting part or buldging membranes visible at vaginal opening and/or perineum bulging with contraction.

Question 20

What are signs of imminent birth

Answer 20

• Crowning or other presenting part is visible
• In primips, presenting part is visible during and between contractions, maternal urge to push or beard down, and contractions are less than 2 minutes apart.
• In multips, contractions 5 minutes apart or less and any other signs of second stage labor present.

Question 21

What are the indications for the endotracheal and tracheostomy suctioning and reinsertion m.d.

Answer 21

Patient with endotracheal or tracheostomy tube
AND
Airway obstruction or increased secretions

Question 22

What are the conditions for suctioning? (endotracheal and tracheostomy suctioning and reinsertion m.d.)

Answer 22

N/A

Question 23

What are the conditions for emergency tracheostomy reinsertion (endotracheal and tracheostomy suctioning and reinsertion m.d.)

Answer 23

Other:
- Patient with an existing tracheostomy where the inner and/or outer cannulas have been removed from the airway
AND
- Respiratory distress
AND
- Inability to adequately ventilate
AND
- Paramedics are presented with a tracheostomy cannula for the identified patient.

Question 24

What are the contraindications for suctioning (endotracheal and tracheostomy suctioning and reinsertion m.d.)

Answer 24

N/A

Question 25

What are the contraindications to emergency tracheostomy reinsertion (endotracheal and tracheostomy suctioning and reinsertion m.d.)

Answer 25

Inability to landmark or visualize.

Question 26

What’s the treatment for suctioning (endotracheal and tracheostomy suctioning and reinsertion m.d.)

Answer 26

Age < 1 year
- Dose: 60-100 mmHg
- Max single dose: 10 seconds
- Dosing interval: 1 minute
- Max # of doses: N/A
≥ 1 year to < 12 years
- Dose: 100-120 mmHg
- Max single dose: 10 seconds
- Dosing interval: 1 minute
- Max # of doses: N/A
≥ 12 years
- Dose: 100-150 mmHg
- Max single dose: 10 seconds
- Dosing interval: 1 minute
- Max # of doses: N/A

Question 27

What is pre-oxygenation?

Answer 27

Pre-oxygenate with 100% oxygen

Question 28

What is the treatment for tracheostomy reinsertion

Answer 28

Maximum number of attempts is 2

Question 29

What are the 2 ways to control post-partum hemorrahge (not including oxytocin)?

Answer 29

External uterine massage
External bimanual compression (can be done regardless of placental delivery)