Midterm Lab Testing Flashcards
Epinepherine Conditions (Bronchoconstriction)
RR: BVM ventilation
Other: Hx of asthma
Epinepherine Contraindications (Bronchoconstriction)
Allergy or sensitivity to epinepherine
Epinepherine Treatment (Bronchoconstriction)
Route: IM
Concentration: 1mg/ml=1:1000
Dose: 0.01mg/kg
Max Single Dose: 0.5mg
Max # of Doses: 1
Epinepherine Conditions (Allergic Reaction)
For anaphylaxis only
Epinepherine Contraindications (Allergic Reaction)
Allergy or sensitivity to epinepherine
Epinepherine Treatment (Allergic Reaction)
Route: IM
Concentration: 1mg/m=1:1000
Dose: 0.01mg/kg
Max Single Dose: 0.5mg
Dosing Interval: minimum 5 min
Max # of Doses: 2
Indications for Bronchoconstriction MD
Respiratory Distress and Suspected Bronchoconstriction
Indications for Moderate to Severe Allergic Reaction
Exposure to a probable allergen
AND
Signs and/or symptoms of a moderate to severe allergic reaction (including anaphylaxis)
Diphenhydramine Conditions (Allergic Reaction)
Weight: > or equal to 25kg
Diphenhydramine Contraindications (Allergic Reaction)
Allergy or sensativity to diphenhydramine
Diphenhydramine Treatment (Allergic Reaction) > or equal to 25kg and <50kg
Route: IV/IM
Dose: 25mg
Max Single Dose: 25mg
Max # of Doses: 1
Diphenhydramine Treatment (Allergic Reaction) > or equal to 50kg
Route: IV/IM
Dose: 50mg
Max Single Dose: 50mg
Max # of Doses: 1
Indications for Analgesia MD
Pain
Ketorolac Conditions (Analgesia)
Age: > or equal to 12 years
LOA: Unaltered
SBP: Normotension
Ketorolac Treatment (Analgesia)
Route: IM/IV
Dose: 10-15mg
Max Single Dose: 15mg
Max # of Doses: 1
Indications for Nausea/Vomiting MD
Nausea OR Vomiting
Dimenhydrinate Conditions (Nausea/Vomiting)
Age: <65 years
Weight: > or equal to 25kg
LOA: Unaltered
Dimenhydrinate Contraindications
(Nausea/Vomiting)
Allergy or sensitivity to dimenhydrinate or other antihistamines
Overdose on antihistamines or anticholinergics or tryclic antidepressants
Co-administration of diphenhydramine
Dimenhydrinate Treatment (Nausea/Vomiting) > or equal to 25kg to <50kg
Route: IV/IM
Dose: 25mg
Max Single Dose: 25mg
Max # of Doses: 1
Dimenhydrinate Treatment (Nausea/Vomiting) > or equal to 50kg
Route: IV/IM
Dose: 50mg
Max Single Dose: 50mg
Max # of Doses: 1
Indications for Opioid Toxicity MD
Altered LOC
AND
Respiratory depression
AND
Inability to adequately ventilate OR persistent need to ventilate
AND
Suspected opioid overdose
Naloxone Conditions (Opioid Toxicity)
Age: > or equal to 24 hours
LOA: altered
RR: <10 breaths/min
Naloxone Contraindications (Opioid Toxicity)
Allergy or sensitivity to naloxone
Naloxone Treatment (Opioid Toxicity)
SAME DOSING INTERVAL AND MAX # OF DOSES FOR ALL ROUTES, 5 MIN INTERVAL CAN GIVE 3 TIMES
Route: IV
Dose: Up to 0.4mg
Max Single Dose: 0.4mg
Route: IM
Dose: 0.4mg
Max single Dose: 0.4mg
Route: IN
Dose: 2-4mg
Max Single Dose: 2-4mg
Route: SQ
Dose: 0.8mg
Max Single Dose: 0.8mg
How do you position patient in a breech delivery?
To allow gravity to birth the baby.
- upright or supported squat position
- Bring buttocks to edge of bed, place feet on chair ( if possible)
How do we manually deliver legs in a breech delivery
- Apply pressure to the popliteal fossa once visible AND
- Gently sweep foot down and out
How much time do you have from the umbilicus in a breech delivery?
4 minutes to complete delivery of the head
How do we manually deliver arms in breech delivery?
- If hand or elbow on fetal chest
- Gently sweep hand down and out
How do we do Mauriceau-Smellie-Veit Manoeuvre?
- Discourage patient from pushing
- Support baby with forearm, palm supporting chest
- Place second and fourth fingers on the cheekbones
- Exert pressure on cheekbones to increase flexion of the neck
- Place other hand on babys back with two middle fingers hooked over the shoulders
- Middle finger pushes occiput to aid flexion
- Life body in an arc and assist head to pivot around symphysis pubis
When do we do Mauriceau-Smellie-Veit Manoeuvre?
In breech deliveries when…
Hairline/nape of neck is visible
OR
If head does not delivery within 3 minutes after umbilicus
How long do you have after babys head delivered in shoulder dystocia?
8 minutes
What is the first A in ALARM?
Ask for assistance
- Ask patient to lay flat on firm surface
- Ask spouse/family/other healthcare professionals to assist during ALARM
- Call for second crew if not done
What is the L in ALARM
Legs abduction (McRobert’s Manoeuver)
- Hyperflex hips by lifting legs and knees
- Aim to bring knees to ears and form squatting position
What is the second A in ALARM
Adduct shoulder (Suprapubic Pressure)
- Apply suprapubic pressure before the next contraction
- Maintain throughout entire contraction
- Instruct patient to push
- Apply gentle downward lateral flexion of the head
What is the R in ALARM?
Roll over (Gaskins Maneouver)
- Ask patient to roll over onto hands and knees
- Apply upward lateral flexion of baby’s head to facilitate delivery of the body
What is the M in ALARM?
Manually release posterior arm
- If hand is visible…
- Follow humorous
- Sweep arm across fetal chest and out
How do we deliver the placenta
Guard the uterus and use gentle controlled cord traction during contraction with the patient pushing
What do you do if delivery of placenta is unsuccessful and exhibiting signs of post-partum hemorrhage?
Ensure resuscitative measures are in place and perform external bimanual compression
How do we perform external bimanual compression?
Place one hand on the lower portion of the abdomen, at symphysis pubis; cup hand, supporting lower portion of uterus.
Place the other hand at the top of the uterine fundus
Compress the uterus between each hand continuously until post-partum hemorrhage stops.
When do we perform external uterine massage?
Once placenta has been delivered if fundus remains soft/boggy or there is continuous bleeding.
How do we perform external uterine massage?
Place one hand on lower portion of abdomen, at the level of symphysis pubis in cupped position supporting lower portion of uterus.
Place one hand at the top of the uterine fundus. The uterus should now be palpable between hands.
Begin massaging with upper hand using a circular motion, lower hand remains still. Continue until bleeding stops.
What are the things we assess a neonate for?
term gestation, breathing, crying, good muscle tone.
What do we do if the neonate is not breathing or crying and does not have good muscle tone?
For 30 SECONDS, provide warmth, position/clear airway, dry, stimulate, reposition.
What do we do if breathing and HR are not > or equal to 100
PPV for 30 SECONDS
What do we do if heart rate is not > or equal to 60
Start CPR and connect the BVM to oxygen.
Indications for Emergency Childbirth MD
Pregnant patient experiencing labour
OR
Post-partum patient immediately following delivery and/or placenta
Delivery Conditions (Emergency Childbirth)
Age: Childbearing years
Other: Second stage labour
AND/OR
Imminent birth
AND/OR
Shoulder Dystocia
AND/OR
Breech Delivery
AND/OR
Prolapsed cord
Umbilical Cord Management Conditions (Emergency Childbirth)
Age: Childbearing years
Other: Cord complications
OR
if neonate or maternal resuscitation is required
OR
due to transport considerations
External Uterine Massage (Emergency Childbirth)
Age: Childbearing years
Other: Post placental delivery
Oxytocin Conditions (Emergency Childbirth)
Age: Childbearing years
SBP: < or equal to 160 mmHg
Other: Postpartum delivery
AND/OR
Placental delivery
Contraindications of External Uterine Massage (Emergency Childbirth)
Placenta not delivered
Contraindications of Oxytocin (Emergency Childbirth)
Allergy or sensitivity to oxytocin
Undelivered fetus
Suspected or known pre-eclampsia with current pregnancy
Eclampsia (seizures) with current pregnancy
>4 hours post placenta delivery
