EMR Labor Care, Child Care, Elderly Care

Question 1

Braxton Hicks contractions

Answer 1

False labor. False labor pains are not as a regular and rhythmic as true labor contractions. It may be difficult for you and the mother to distinguish false labor pains from true labor.

Question 2

Supplies and Materials for Delivery

Answer 2

• personal protective equipment, such as protective, gloves, facemasks, eye, shields, and gowns.
• Towels, sheets, and blankets for draping, the mother, for placement under the mother, and for drying and wrapping the baby
• gauze pad for wiping mucus from the baby’s mouth and nose
• Rubber bulb syringe for sectioning the baby’s airway only if the baby is not breathing normally after birth
• Clamps and ties for use on the umbilical cord before cutting
• Sterile scissors or a single edged razor for cutting the cord
• Sanitary pads or bulky dressings for vaginal bleeding
• a basin and plastic bags for collecting and transporting the placenta
• Plastic biohazard bags for storing and disposing of soiled linens and dressings

Question 3

Prenatal care

Answer 3

The routine medical care provided to a mother during her pregnancy. This is the regular care and monitoring of the fetus by healthcare provider throughout the pregnancy. A woman who has been receiving regular prenatal care will be more informed if there are any expected complications with the delivery. When preparing the delivery, it may be helpful to ask her if she has been receiving prenatal care.

Question 4

Questions to ask to evaluate the mother

Answer 4

• what is the expected due date?
• Has she been seeing a doctor during her pregnancy?
• Does she have other children?
• If so, how was her last labor? (Note that if this is her first delivery delivery, labor will typically last about 16 hours. Labor time is usually shorter for subsequent deliveries.)
• Were previous children delivered normally or did they require a cesarean or C-section?
• Is she aware of any known complications, particularly a multiple birth?
• Has there been any discharge of fluid or bloody mucus?
• How long has she been having liver pains?
• How frequent are the contractions?
• Has her water broke? If so, when, and what color (clear, which is normal; or cloudy or green, which indicates a stressed fetus and requires immediate transport)?
• does she feel the need to move her bowels? If so, can she feel the baby beginning to move into her vaginal opening?
• does she have any significant medical history, such as seizures, diabetes, or vaginal bleeding during the pregnancy? 

Question 5

Coaching Steps

Answer 5

• as each contraction begins, have the mother take a deep breath, hold it, and encourage her to gently bear down, or push
• Encourage her to rest between each contraction and to breathe normally
• If available, have the father or someone appropriate at the mothers to help coach her through each contraction

Question 6

Steps to prepare the scene and mother for delivery

Answer 6

1.) take BSI precautions.
2.) control the scene so the mother will have privacy.
3.) position the mother on her back with her knees, bent, feet flat, and leg spread wide apart. If this position causes her to feel dizzy and faint, it may be because the weight of the baby is pressing on the inferior vena cava, the vessel that returns blood from the lower part of the body to the heart, and is restricting blood flow to the heart. allow the mother to sit up slightly and support her back with pillows and/or blankets.
4.) palpate the mother‘s abdomen to feel for contractions when she says she is having a contraction. Explained what you were going to do, and place the palm of your hand on her abdomen above the naval. It is not necessary to remove any of the patient’s clothing to feel for contractions. If the mother says she can feel the baby coming, skip this step.feel for, and time, several contractions to help determine if birth is near.
5.) prepare the mother for examination. Tell her that you need to see if her baby has entered to the birth canal. Help her to remove clothing or underclothing that abstract your exam of her vaginal opening. Use clean sheets or towels to cover the mother. Make sure you have enough light to see what you were doing.
6.) check for crowning. Do not try to transport the mother at this point if the baby is crowning.
7.) do not attempt any type of internal or vaginal exam. Touch the vaginal area only as necessary during the delivery process.

Question 7

Steps for normal delivery

Answer 7

1.) wash your hands with soap and water, or use a commercial hand wash. Don personal protective equipment if you have not already done so.
2.) drape the mother and place her on top of clean sheets, her towels. Place a folded blanket, towels, or sheets under her buttocks to lift her pelvis about 2 inches. You may place a pillow under her head and shoulders for comfort.
3.) position someone near the mother’s head or use the mother’s coach to reassure and offer her encouragement and to turn her head in case she vomit. If no one is on hand to help, talk with the mother during the delivery process and be alert for vomiting.
4.) place one hand below the baby’s head as he or she delivers. Spread your fingers evenly around the head to support the baby, but avoid pressing the areas known as fontanels, at the top of the baby’s skull. They are areas where the skull bones have not completely closed together. Apply a slight pressure on the baby’s head as he or she emerges to control the speed of delivery. Sometimes the head can pop out too quickly quickly from the birth canal, which can tear the skin at the vaginal opening or perineum. Some stretching and tearing is normal. Use your other hand to help cradle the baby’s head. Do not pull on the baby.
5.) if the amniotic sac has not yet ruptured, use a Corey clamp or your gloved fingers to tear the membrane and pull it away from the baby’s mouth and nose.
6.) most babies are born face down as the head emerges. Then they rotate to the right or left. Once the head is delivered, instruct the mother to stop pushing. You need a few seconds to check for The presence of the umbilical cord wrapped around the babies neck. this is called a nuchal cord. If you find the cord is wrapped around the baby’s neck, use two fingers and attempt to slip it over the baby’s head or shoulders.
7.) the upper shoulder, usually delivers next, followed quickly by the lower shoulder. Continue to support the baby throughout the entire process. On the next contraction, gently guide the baby’s head downward, which will assist the mother in delivering the baby’s upper shoulder. Then gently guide the baby’s head upward to facilitate the delivery of the bottom shoulder.
8.) once the baby’s feet deliver, lay the baby on his or her side with his or her head slightly lower than their body. This position will enable blood, other fluids, and mucus to drain from the mouth and nose, wipe the baby’s mouth and nose with gauze pads.
9.) once the baby is completely delivered, note the exact time of birth.
10.) keeps the baby at the level of the vagina until the cord is cut.
11.) wait at least one minute following delivery, and clamp or tie the umbilical cord. The first clamp should be placed approximately 6 inches from the babies abdomen. The second clamp should be placed approximately 2 inches away from the first. Then cut the cord between the clamps. If you do not have sterile equipment, do not cut the cord. Simply clamp it. Follow local protocols.
12.) monitor and record the baby’s and mother’s vital signs. Supports the ABCs as necessary.
13.) watch for more contractions, which may signal the delivery of the placenta. It is important to save the placenta for examination. If any part of it remains attached inside the uterus, it can cause bleeding and an infection. Place the placenta in a plastic biohazard bag and give it to EMS personnel to transport to the hospital
14.) place a sanitary pad over the mothers vaginal opening. Lower her legs and place them together. Label the bag with the mother’s name.

Question 8

Caring for the baby

Answer 8

1.) clear the baby’s airway. position the baby on his or her side with head slightly lower than his or her body to allow for drainage. Keep the baby’s body at the level of the vagina and told the cord is clamped. Use a sterile, gauze pad or a clean handkerchief to clear mucus and blood from around the baby’s nose and mouth. Throughout the rest of your care, steps, be sure the baby’s nose remains clear. Babies are nose breathers. Plugged nostrils may prevent adequate breathing. Following delivery, if the baby is not breathing adequately or appears to be experiencing respiratory distress, it may be helpful to suction the air. Suctioning should be avoided if the baby is breathing normally. Suctioning can cause trauma to the airway and cause slowing of the heart rate by stimulation of the airway. the correct steps using the bulb syringe for that purpose are as follows:
- Squeeze the bulb first
- insert the tip about 1/2 inch (nose) or 1 inch (mouse)
- Gently release the pressure to allow the syringe to take up fluids
- remove the tip of the filled syringe from the baby, and squeeze out any fluids onto a towel or gauze pad
- this process two or three times for the mouth and for each nostril

2.) make certain that the baby is breathing. Usually the baby will be breathing on his or her own by the time you clear the airway, which will take about 30 seconds. If not, then you must encourage them to do so. Begin by vigorously, but gently rubbing the babies back. If this fails to stimulate breathing, snap one of your index fingers against the soles of the baby’s feet. (a newborn is a baby that is less than 28 days old. Also called neonate.)

3.) you are sure that the baby is breathing, perform a quick assessment. Note skin color (blue, normal, pale), deformities, the strength of his or her cry (strong or weak), and whether he or she moves on their own or just lies still. After a few minutes, note if there are any changes in those conditions. It is important to give this information to the transport personnel for relay to the hospital staff, who will base the baby’s subsequent exam on the original assessment.

4.) clamp or tie off the umbilical cord if protocols allow.

5.) keep the baby warm. Dry the baby and discard the material in a biohazard bag. Wrap the baby in a clean, dry towel, sheet, or baby blanket, and place him or her mothers abdomen. The babies head covered to help reduce heat loss.

The mother may want to nurse. You may suggest an encourage the mother to do so, because it helps contract the uterus and control bleeding.

Question 9

Caring for the non-breathing newborn

Answer 9

If the baby is not breathing, you must provide rescue breaths. Begin with two gentle but adequate breaths, using the mouth-to-barrier or bag mask technique. Then assess breathing and heartbeat. To check the heartbeat of a newborn, listen at the chest with your stethoscope.
Do not use a bag mask device or airway adjuncts designed for older children, or adults to resuscitate a newborn. Be careful not to hyper extend the head and neck of the baby, which would close off the airway. Provide ventilations if breaths are shallow, slow, or absent. Ventilate at 40 to 60 breaths per minute (about one breath every second). Watch for the chest to rise, which is the best indication of adequate ventilation. Reassess breathing after 30 seconds of assisted ventilations. The next steps depends on the heart rate:

• If the heart rate is 100 bpm or greater and the newborn is breathing adequately, stop ventilations, but continue to provide gentle stimulation (rub the back) to help maintain and improve the baby’s breathing
• If you are allowed to provide oxygen to the baby, direct a stream of oxygen towards the babies face, either through a facemask or by passing an oxygen tube through the bottom of a paper cup. Hold the mask or cup several inches from the baby’s face, and allow the oxygen to below the face as the baby breathes. This is referred to as a blow-by oxygen and is a good technique when a traditional mask or cannula is not appropriate.
• If the newborn’s heart rate is below 100 bpm and respirations are inadequate, continue to assist ventilations with a bag mask device
• if the heart rate is less than 60 bpm, continue to assist ventilations and begin chest compressions. Perform CPR with your fingertips if you are alone or with your thumb with your hands and circling the chest if there are two rescuers. Continue resuscitation until the baby is able to maintain adequate breathing and a pulse, or a higher level of EMS provider relieves you. For the newborn, perform CPR using a compression-to-ventilation ratio of 30 to 2 for a lone rescuer or 15 to 2 for two rescuers. Continue to provide blow-by oxygen.

Question 10

Umbilical cord

Answer 10

Your instructor will tell you if local protocol allows emergency medical responders to clamp and cut the umbilical cord. If you are allowed to do so, remember that the baby can get an infection through the cord, so cut it only if you have sterile conditions. If you must cut the cord, you will need a sterile Pearis scissors, a single edge, razor blade, or a sharp edge knife. Cutting the umbilical cord is usually a low priority, and EMR may provide other care until transport person arrives. In cases, the transport unit should arrive before the cord needs to be clamped or tied. Usually, it is not necessary to tie and cut the cord until the after birth is delivered, and the cord is empty out of blood and stops pulsating. If you see or feel the cord, pulsating, it is still delivering oxygen to the baby from the mother. The baby will benefit from the oxygen, however, if during the delivery you see that the umbilical cord is around the babies neck, you must either insert one or two fingers under the cord and try to slip it back over the infants head, or you must cut it. If the cord cannot be slipped over the head, then quickly, place clamps or ties on it and cut it. If this is not done and the infant, the cord may strangle him or hurt. if you are allowed, take the following steps, a normal delivery when the cord has stopped pulsating:

1.) clamp or umbilical ties found in the OB kit.
2.) apply tie or clamp to cord about 6 inches from the babies abdomen.
3.) place a tie or clamp about 2 inches from the baby.
4.) between the two ties or clamp. Never untie or unclamped the cord once it has been cut. Examine the end of the cord. After trapped blood drains, bleeding should stop if the clamps or tires are secure. If bleeding continues, apply another tie or clamp as close to original as possible.

If you are still providing care and protocols do not allow you to cut the cord, then place the after birth at the same level as the baby or slightly higher. The placenta is still the baby’s blood source, and blood can continue to flow to him or her if the placenta is positioned as described. If the placenta is lower than the baby, blood can flow away from him or her, back into the placenta.

Question 11

Caring for the mother

Answer 11

Care for the mother includes helping her deliver the afterbirth (the placenta and other birth tissues), controlling vaginal bleeding, making her as comfortable as possible, and providing reassurance.

Question 12

Delivering the placenta

Answer 12

The delivery of the placenta or after birth is the third stage of labor. It delivers anywhere from a few minutes to 20 minutes or longer after the baby is born. Some women prefer to sit upright following delivery. You may have to remind them that they will have to remain at rest until they deliver the after birth. Make the mother as comfortable as possible, and wait for the delivery. However, if the baby requires immediate transport, or the ambulance arrives, do not delay transport by waiting on the placenta to deliver. When she begins to have more contractions, it will be evident that the delivery of the after birth is imminent. The contractions will be milder with less discomfort.
Save the placenta, all attached membranes, and all soiled sheets and towels. A physician must examine those items to ensure the entire organ and its membranes were expelled from the uterus. Try to position a Bassin or container at the vaginal opening so the after birth will deliver into it. Once you collect it, place the container in a biohazard bag. If no container is available, allow the after birth to deliver directly into a biohazard bag, and place the bag into another biohazard bag. Always label the bag with the mother’s name.

Question 13

Controlling vaginal bleeding after delivery

Answer 13

Bleeding from the vagina is normal after the mother has delivered the placenta. Performed the following steps to care for vaginal bleeding after delivery:

1.) place a sanitary pad or clean towel over the vaginal opening. Do not place anything in the vagina.
2.) have the mother lower her legs and keep them together.
3.) gently palpate the mothers abdomen until you find a grapefruit sized object. This is the uterus. Gently but firmly massage from the pubis bone at the front of the pelvis upward only and toward the naval. This will help stimulate the uterus to contract and stop bleeding.
4.) if bleeding continues, provide oxygen and maintain normal body temperature. Arrange transport as soon as possible. Continue to massage the uterus. If the mother wants to nurse, allow her to do so. Nursing stimulates contraction of the uterus and helps control bleeding.

Question 14

Providing comfort to the mother

Answer 14

Reassure the mother throughout the entire birth process, explaining what you are doing and what is happening. She will especially want to know about the baby. Once you have completed your duties with the after birth, replace any soil towels or sheets with clean, dry ones. Make sure both she and the baby remain warm and comfortable.

Question 15

Complications and emergencies

Answer 15

The risk of complications before, during, and after delivery increases when the patient has one or more of the following factors:
- Younger than 18 or older than 35 years of age
- First pregnancy or more than five pregnancies
- swollen face, feet, or abdomen from water retention
- High or low blood pressure
- Diabetes
- Illicit drug use during pregnancy
- history of seizures
- pre-delivery bleeding
- Infections
- Alcohol dependency
- Injuries from trauma
- premature rupture of membranes (water broke more than a few hours before delivery)

You will find out this information when you gather the patient’s history during the secondary assessment. As you assess the patient, ask her the questions and necessary to see if she is in a high risk group. Infections of the reproductive organs, especially infections, sexually transmitted diseases or STDs Can be transmitted to the baby during birth. Remember to take BSI precautions and wear all personal protective equipment.

Question 16

Prebirth bleeding

Answer 16

When a pregnant woman has vaginal bleeding early in pregnancy, it may be that she is having a miscarriage or spontaneous abortion. Light, a regular discharges of blood, spotting, our normal in early pregnancy, but may concern the patient. If bleeding occurs late in pregnancy or while the patient is in labor, the problem may be with the placenta. Regardless of the cause of bleeding or stage of pregnancy, you must:

1.) make certain an ambulance is on its way
2.) take a BSI precautions if you have not done so already.
3.) patient on her left side, but do not hold her legs together.
4.) provide care for shock, monitor the patient’s airway, and administer oxygen as per local protocols.
5.) place a sanitary pad or bulky dressings over the vaginal opening.
6.) replace pads or dressings become soaked. Do not place anything in the vagina.
7.) save all blood-soaked pads and dressings, as well as any tissues the mother passes. Place them in a biohazard bag for transport to the hospital and examination by a physician.
8.) monitor and reassure the patient while you wait for transport personnel.

Question 17

Ectopic pregnancy

Answer 17

A leading cause of pregnancy related death is ectopic pregnancy. This occurs when the fertilized egg implant somewhere other than the uterus. Most commonly, ectopic pregnancies occur within a fallopian tube or the tube black structure that connects the ovary to the uterus. Normally, just prior to conception, the un fertilized egg from the female leaves the ovary, or the structure that produces the ovum, and begins a journey through a fallopian tube on its way to the uterus. During conception, the sperm from the male joins up with the egg while it is still in a fallopian tube. Eventually, the fertilized egg implants along the wall of the uterus. This is normal. However, when the fertilized egg implants along the wall of the fallopian tube, it will not take long before the developing fetus outgrows the narrow space, causing the tube to rupture. This will always result in the loss of the fetus and is a life-threatening emergency for the mother. The most common signs and symptoms of an ectopic pregnancy Include abdominal pain, absence of normal menstrual cycle, and vaginal bleeding. The care is the same for any woman with a general complaint of abdominal pain, including a thorough history and physical, oxygen is available, and transport to a hospital.

Question 18

Meconium staining

Answer 18

A stressful or difficult delivery affects both the mother and the baby. When the baby is stressed during delivery, he or she may defecate or empty the bowel. The fecal matter is called meconium. When this material mixes with amniotic fluid, the normally clear fluid is stained green or brownish yellow and is called meconium staining. if the baby inhales the fluid on his or her first attempt to breathe, the newborn can develop aspiration pneumonia, a lung infection caused by aspirating or breathing in the meconium. Sometimes the amniotic sack will rupture many hours before delivery. You will have to rely on information from the mother to determine if the fluids were clear or stained. Ask the mother if she noticed the color of the fluid when her water broke. If you witnessed the rupture, look for meconium staining. Be prepared to wipe the baby’s mouth and nose. Suction the meconium only if it is significantly interfering with the baby’s breathing.

Question 19

Breech birth

Answer 19

In a breech birth, the buttocks or feet present first. it is possible for the baby to be delivered; however, it usually requires the skills of an experience physician. If, upon examination, you see anything other than the top of the babies head presenting, initiate transport immediately. A breech birth can be a complication if the babies head will not deliver. While waiting for a transport unit to arrive, do the following:
1.) place the mother on a high concentration of oxygen
2.) create an airway for the baby because the umbilical cord will be compressed between the infant and the vaginal wall, shutting off blood flow. Tell the mother what you must do and why. Insert your gloved hand into the vagina, with your palm toward the babies face. Form a V by placing one finger on each side of the babies nose. Push the wall of the birth canal away from the babies face. If you cannot complete this process, then try to place one finger into the infant mouth and push away the birth canal wall with your other finger. Place the mother in the knee chest position to reduce pressure on the birth canal.
3.) maintain the airway. Once you have created an airway for the baby, keep the airway open. Do not pull on the baby. Allow delivery to take place while you continue to support the babies body and head. Instruct the mother not to hold her breath and to pant with each contraction.
4.) initiate transport to a medical facility immediately. Maintain the airway throughout all stages of care until higher level. EMS personnel relieve you. Expedite transport to the nearest medical facility.

Question 20

Limb presentation

Answer 20

The presentation of an arm or a single leg is called a limb presentation and is an emergency requiring immediate transport. Do not pull on the limb or try to place your gloved hand into the birth canal. Do not try to place the limb back into the vagina. Place the mother in the knee chest position to help reduce pressure on the fetus and the umbilical cord. Medical direction and protocols may instruct you to keep the mother in the typical delivery position. follow your protocols.

Question 21

Prolapsed cord

Answer 21

When you examine the mother for crowning, you may find the umbilical cord protruding from the vaginal opening. When the umbilical cord delivers first, this is called a prolapsed cord and is common in a breech birth. A prolapsed cord endangers the life of the baby. as the baby emerges from the vaginal opening, his or her head presses the umbilical cord against the vaginal wall, reducing or completely cutting off blood flow and oxygen. When oxygen flow through the cord is obstructed, the baby will try to breathe. But because the babies face is pressed against the wall of the birth canal, the mouth and nose cannot take in air. To help the baby breathe, provide an airway, using the same method described for breech birth. That is, place your fingers into the vaginal opening in front of the infants face and make a V. Do not try to push the cord back into the birth canal. In addition, take the following steps:
- place the mother in a knee chest position to reduce pressure on the cord
- Try to maintain a pulse in the cord
- place wet dressings (use sterile water or saline if it is available) over the cord to keep it moist
- Wrap the cord in a towel or dressings to keep it warm
- Provide the mother with a high concentration of oxygen as soon as possible
- Monitor vital signs and arrange for transport immediately

Question 22

Multiple births

Answer 22

Multiple births are not necessarily abnormal, but they do frequently involve premature delivery. Premature infants may not be fully developed, and often have respiratory complications. If the mother is giving birth to more than one infant, she will have contractions begin again shortly after the birth of the first baby. The contractions made deliver the after birth of the first or another baby. The procedures for assisting the mother remain the same. if the umbilical cord has stopped pool, seating, will tie or clamp the cord of the first baby before the second baby is born. Once the baby are delivered in, they are breathing, assess each one, noting skin color, deformity, strength of their cries, and whether they move on their own or just lie still. When assessing the quality of skin color on dark skin and babies, check the nailbeds, lips, and palms of hands for signs of cyanosis. After a few minutes, note if there are any changes in those conditions. If necessary, perform resuscitation. Document the time of birth for each baby. Call for assistance as soon as possible.

Question 23

Preterm births

Answer 23

Any baby weighing less than 5.5 pounds at birth or any baby born before the 37th week of pregnancy is considered a preterm birth. If the mother tells you the babies early by more than two weeks, play it safe and consider the baby premature. In addition to the procedures for normal births, You must take special steps to keep a premature baby warm. It is important to dry the baby. Wrap him or her in a blanket, sheet, or towel. A blanket covered with foil is ideal. Cover the babies head, but keep his or her face arm covered. Placed the infant skin to skin with the mother for warmth. It is not possible, transfer the baby to a warm and environment place a heat source too close to the baby. Ventilate a premature baby who needs resuscitation using a mouth to mask technique or an appropriately sized bag to mask device. Wipe or suction blood and mucus from the mouth and nose first before ventilating.

Question 24

Stillborn deliveries

Answer 24

A fetus that is delivered dead is called stillborn. This is a very traumatic event for the mother and father or partner, family members, and care providers. Do not feel embarrassed to show your emotions, but be prepared to continue to act professionally and provide comfort to the mother, father or partner, and other family members who are present. If the infant shows no signs of life at birth or goes into respiratory or cardiac arrest, provide resuscitation measures. Do not stop resuscitation until the baby regain, respirations and a heartbeat, other emergency care, providers, relieve you, or you are too exhausted to continue. If and doubt, always be begin resuscitative efforts, and a lot of transport team to decide if further resuscitation is warranted. There are cases in which a baby has died or longer before birth. Do not attempt to resuscitate a stillborn infant who has large ab blisters and a strong, unpleasant odor. There may be other indications that the infant died earlier in the uterus, such as a very soft head, swollen body parts, or obvious deformities.

Question 25

Supine hypotensive syndrome

Answer 25

Supine hypotensive syndrome is a condition that can occur during the last couple of months of pregnancy. It is caused Used when the mother lies on her back and the weight of the fetus and other organs press on the mothers inferior vena cava, the large vessel in the abdomen that returns blood to the heart. The pressure on the vena cava restrict blood return to the heart, causing signs of shock such as low blood pressure, increased pulse, pale skin, and in some cases, and altered mental status. Care for supine, hypotensive syndrome is usually as simple as repositioning the mother to more of a seated position semi fowler’s or having her lie on her left side. The weight of the fetus will shift to the left and off the vena cava, allowing better blood flow to the heart.

Question 26

Preeclampsia and eclampsia

Answer 26

Another potentially dangerous condition that affects approximately 5% of all pregnant women is known as preeclampsia. While it’s exact causes are not well understood, it most often occurs after the 20th week of pregnancy and seems to affect women in their teens, women over 40, and woman who are pregnant Aunt for the first time. Signs and symptoms of pre-eclampsia include:
- Abnormally high blood pressure
- Fluid retention, causing swelling of the arms, hands, legs, and face
- Headache
- Nausea

Is left untreated, preeclampsia can lead to eclampsia, which is characterized by seizures,,, and eventually death of both the mother and the baby. The only treatment for preeclampsia is the delivery of the baby. If you should see signs of either condition in a pregnant woman, rapid transport to a hospital is essential. While waiting for transport, provide the following care:
- Support the ABCs as necessary
- provide high flow oxygen, if protocols allow
- have suction ready and be prepared for seizures

Question 27

Trauma

Answer 27

Vital signs of a pregnant woman are usually different from a woman who is not pregnant. A pregnant woman’s blood volume increases up to about 45%, a natural protection and preparation for the mother who will lose blood during delivery. Her heart rate increases by about 15 bpm, and her blood pressure falls 10 to 15 mm Hg. do not mistake the high pulse rate and low blood pressure for signs of shock in the normal non trauma, pregnant woman. But in a trauma situation, the mother is a larger blood volume allows her body to compensate for blood loss and, therefore, she may not show early signs of shock. A pregnant woman can lose almost 40% of her blood before she shows any signs of shock.
The greatest danger to both the mother and the baby is bleeding and shock. First, ensure an open airway and adequate breathing and look for and control external bleeding. Provide a high concentration of oxygen as soon as possible, and keep the patient warm, but do not overheat her. The steps that prevent or shock will assist the fetus. Arrange for immediate transport and, while waiting for transport Personnel to arrive, provide appropriate care based on the mechanism of injury, such as immobilization for possible spinal injuries, splinting, or possible, fractures, and dressing of wounds

Question 28

Vaginal bleeding

Answer 28

There are many reasons for excessive vaginal bleeding during pregnancy. EMR must be aware of them and look carefully for the mechanism of injury that caused them, including the following:
-Blunt force and penetrating trauma
- Intercourse
- Sexual assault
- Reproductive organ problems
- Abnormal pregnancy
- Placental tears and uterine rupture
The two types of terrace are placenta, previa, and placenta abruptio. In placenta previa, the placenta lies low in the uterus and attaches itself over the opening of the cervix, meaning it would have to emerge prior to the fetus during birth. In this position, the placenta tears and bleeds when the cervix dilates during labor. Placenta abruptio can occur in a trauma situation when the force of the trauma abruptly tears the placenta partially or completely away from the wall of the uterus. The pregnant woman may have major internal blood loss because blood can be trapped between the placenta and the uterine wall. She may also lose blood vaginally. The only indications you may have of internal blood loss and developing shock or changes in vital science, feeling a heart uterus when examining the abdomen, and the mothers complaint that her abdomen is painful or tender. Get a set of baseline vital signs as soon as possible in your assessment, and monitor the vital signs by retaking them every few minutes. Provide high concentration oxygen as soon as possible if protocols allow and maintain body temperature to help reduce the effects of shock. Arrange for immediate transport.