Module 5 - Medical Emergencies I Flashcards
Identify the age ranges associated with the following terms:
Neonate, Infant, Toddler,
Pre-schooler, School age, Adolescent, Early adulthood, Middle adulthood, and Late
adulthood
Neonate : birth - 1 month
Infant: 1 month- 1 year
Toddler: 1-3 yo
Pre-schooler: 3-5 yo
School aged: 6-11 yo
Adolescent: 12-15 yo
Early adulthood: 20-40
Middle adulthood: 41-60
Late adulthood: 61
What are some chronic changes in elderly patients that may affect Chief Complaint, Mental Status, and the ABCs?
- Respiratory system changes diminish ability to cough, lung capacity, and gas exchange
- memory problems
- Cardiovascular system changes increase the myocardial workload
- depression, isolation and loss of independence can affect mental status
What are the 4 essential features & associated aspects of PTSD?
- Response:
veteran responds to the experience with feelings of anger, fear, horror, and helplessness
- Reliving:
Flashbacks, unwanted thoughts or nightmares
- Avoiding:
PT avoids anything that reminds them of the event
- Anxiety/hyperarousal:
Being on constant hypervigilance. When activated causes “Flight or Fight”
List the signs and symptoms of respiratory distress in pediatrics versus respiratory
failure.
Respiratory Distress:
- Normal appearance
- Normal Circulation to skin
- abnormal work of breathing
Respiratory Failure:
- Abnormal appearance and work of breathing
- normal or abnormal circulation to skin
Describe the anatomy of menstrual cycle :
- Cycle last 24-35 days with a average of 28 days
- Day 1 begans with menustration
- blood loss over 3-5 days is 60-80 mL
- Day 14: Ovalulation occurs and egg is released
- The egg takes 5-7 days to travel to the fallopian tubes and implants itself in the uterus
- Fertilization of the ovum typically occurs in last third of fallopian tube
- If not fertizilized, it is discharged with lining 14 days after ovulation
Describe the stages of labor:
1st Stage: Dilation Phase
- Most painful stage for mother and baby.
- Longest and hardest stage.
- Cervix begins to dilate and Uterus is contracting
- contractions start at 5-30 minutes apart
- contractions become 3-5 minutes
2nd Stage of labor: Expulsion Phase
- Shortest stage of labor
- Mother is fully dilated and baby will be crowning
- Contractions are 2-3 minutes apart (60-90 seconds each)
- Baby will be delivered
3rd Stage of Labor: Placenta Phase
- Once baby is done, placenta will detach from uterine wall and be expelled
- Happens within 5-20 minutes after birth of baby
Signs: - Increase bleeding in vagina
- uterus becomes smaller in size
- umbilical cord begins to lengthen
- Mother has urge to push to again
Describe the steps of assisting with a normal prehospital obstetric
deliver:
- Select a suitable location away from public view (first Surface PT can lay on)
- administer oxygen (2-4 lpm nasal cannula)
- Have the PT lay on her back with knees drawn up and spread apart
- Place towels under PT buttocks
- As head begins to emerge, apply gentle pressure with a gloved hand to prevent explosive delivery
- Support the head as it exits the vaginal canal
- Once head is out, instruct PT to stop pushing
- Inspect baby’s neck to make sure umbilical cord is not wrapped around the neck (nuchal cord)
- Suction airway only if obvious obstruction exist
- Instruct PT to began pushing again
- As the shoulders and full body is delivered, support baby with both hands
- DO NOT pull on umbilical cord
- Dry, wrap, and warm baby
- Clamp umbilical cord, Approximately 6 inches away from baby’s abdomen and again at 3 inches part first clamp
- Once cord has stopped pulsating, cut cord between clamps
- Observe for delivery of the placenta
- If placenta delivers, transport it with PT to hospital
- Place sanitary pad over vagina opening
- Record time of birth and transport to hospital
Define gravida and para:
Gravida:
Refers to # of times a PT has been pregnant
Para:
Refers to # of times PT has given birth (after 20 weeks)
Describe palliative care in regards to hospice:
specialized medical care that focuses on providing relief from pain and other symptoms rather than cure it
What is antepartum emergency?
emergencies are those that occur in the pregnant patient prior to the onset of labor
What are the 7 different types of Antepartum Emergencies?
- Spontaneous abortion
- Placenta Previa
- Abruptio placentae
- Rupture uterus
- Ectopic pregnancy
- Preeclampsia
- Supine hypotensive syndrome
What is the cause and findings of Spontaneous Abortion?
“Miscarriage”
Cause:
Delivery of the fetus and placenta before it is viable
Findings:
- Cramp like abdominal pain
- vaginal bleeding
- passage of tissue and blood clots
What is the treatment of Spontaneous Abortion?
- ABC’s
- Place a pad over vaginal opening
- Treat for shock
- Transport on her side
- Ask patient when last menstrual period began
- Emotional support
What is the cause and findings of Placental Previa?
Cause: Abnormal implantation of the placenta over or near the opening of the cervix
Findings:
- predisposing factors:
- Multiparity
- age 35 and up
- Previous placenta previa
- History of vaginal bleeding
- Bleeding after intercourse
- 3rd trimester painless bleeding
List and describe the 3 classifications Placental Previa may be listed as and
- Total: placenta completely covers cervical opening and blocks birth canal
- Partial: Placenta partially covers cervical opening
- Marginal : Placenta is implanted near neck of cervix and may tear
What is the cause and findings of Abruptio Placentae?
Cause:
- Separation of the placenta from the uterine wall prior to birth of baby
Findings:
- Abdominal pain
- Vaginal bleeding
- Uterine contractions
- Abdominal tenderness on palpation
- Signs of hypovolemic shock
- NOTE: Bleeding may not be visible if unable to exit uterus
Treatment:
- ABCs and prn O2
- sanitary pad
- Place PT on side
- treat for shock
What is the treatment of Abruptio Placentae, ruptured uterus, ectopic pregnancy, placenta previa ?
- ABC’s
- Place pad of vagina
- Treat for shock
- Transport of her side
What is the cause and findings of Ruptured Uterus?
Cause:
- Uterus tears as it enlarges during pregnancy possibly release fetus into abdominal cavity
Findings:
- Vaginal bleeding
- Tearing, sever abdominal pain
- Sings of hypovolemic shock
- Cessation of uterine contractions
- Ability to palpate the infant in the abdominal cavity
What is the cause and findings of Ectopic Pregnancy?
Cause:
- Fertilized egg implants somewhere other then the uterus
- symptoms occur within 4-8 weeks of conception
Predisposing factors:
- Previous ectopic pregnancies
- Pelvic inflammatory disease
- Adhesions from surgery
- Tubal surgery
- Intrauterine device use
assessment findings:
- vaginal bleeding
- poorly localized pain that becomes sudden and sharp
- abdominal pain that radiates to shoulder
- Bloating
- Signs of shock
- Discoloration around navel
What is the cause and findings of Preeclampsia?
Causes:
- Multisystem disorder not well understood
- Characterized by High blood pressure and swelling in extremities
Findings:
- abdominal pain
- History of hypotension
- Sudden weight gain
- Altered mental status
- Blurred vision
- Excessive swelling in the face, fingers, legs or feet
- Severe headache
- Elevated blood pressure
What is the treatment of Preeclampsia?
- ABC’s
- Transport on her side
- Be prepared to suction or to ventilate patient if needed
What is the cause and S/S of Supine Hypotensive Syndrome?
Causes:
- Complication late in pregnancy due to weight of fetus compressing the inferior vena cava when patient is lying supine
S/S:
- Dizziness of light headiness
- Decrease in blood pressure
- Tachycardia
- Pale, cool, clammy skin
What is the treatment of Supine Hypotensive Syndrome?
Transport patient either seated, on her side, or elevate her right hip if lying supine
When cutting the umbilical cord , it should be cut ____inches from the infant.
6 inches
What signs indicate delivery is going to happen within a few minutes?
- Crowning
- Contractions, every 2 minutes apart or less
- Urge to defecate
- Strong urge to push
List the 10 types of Abnormal Deliveries:
- Prolapsed cord
- Breech/Limb presentation
- Multiple Births
- Meconium Staining
- Premature Birth
- Post-Term Pregnancy
- Precipitous Delivery
- Shoulder Dystocia
- Pre-Term Labor
- Premature Rupture of membranes
What is the treatment of Prolapsed Cord?
- ABC’s and O2 prn
- Place PT in “Knee-chest” or supine position with hips elevated
- Insert Gloved hand into vaginal canal to remove pressure on the cord (It should be pulsating)
- Keep cord moist with wet to dry dressing
- Immediate transport
What is the Explanation and treatment of Breech/Limb Presentation?
- When arm/leg or buttock is first instead of head through birth canal
Findings:
- Buttocks or arm/leg presentation
- Position mother in “Knee-chest” position, pelvis elevated
- Insert gloved hand into vaginal canal to create space for respirations if the head cannot be delivered
- Immediate transport
- Avoid field delivery and mother not to push
What is the treatment of Multiple Births??
- ABC’s and O2 prn
- Same guidelines as normal birth, except if additional infant has delivered within 10 minutes immediately
- consider requesting back, to assist with additional patient(s)
What is the Explanation and findings of Meconium Staining?
- Fecal material in the amniotic fluid
- indicates fetal stress (hypoxic event) during gestation or delivery
Findings:
- Greenish to brownish amniotic fluid
What is the treatment of Meconium Staining?
- ABC’s and O2 prn
- Suction if meconium is present in infant’s airway or if infant is depressed prior to drying to stimulation
What is the Explanation and findings of Premature Birth?
Explanation:
- Delivery of an infant before 37th week of gestation or
- Neonate weighing less then 5 pounds
What is the treatment of Premature Birth?
Treatment:
- ABC’s and O2 prn
- Keep infant Warm
What is the Explanation and findings of Post-Term Pregnancy?
Explanation:
- Gestation extend past 42 weeks
- potential for decline in suitable environment for fetus
Findings:
- Increased risk of hypoxic incident
- difficult delivery
- meconium staining
What is the treatment of Post-Term Pregnancy?
Provide same care as normal delivery
What is the Explanation and findings of Precipitous Delivery?
Explanation:
- Birth of fetus in less then 3 hours
Findings:
- Increased risk of trauma to the fetus and mother
What is the treatment of Precipitous Delivery?
Provide same care as normal delivery
What is the Explanation and findings of Shoulder Dystocia?
Explanation:
- Fetal shoulders are larger then head caused a “Turtle sign” presentation
- upper shoulder cannot pass through pelvic opening
Findings:
- Common with post term gestation and gestational diabetic mothers
What is the treatment of Shoulder Dystocia?
- Place mother in McRobert’s Position
- Attempt normal delivery
Define Pre-Term labor:
Explanation:
- Onset of labor prior to 37th week of gestation