Obstetrics

Question 1

Calcium Chloride

BB blocker/ CC Bloker OD

Answer 1

Class
Electrolyte

Adult Dosage
500 mg IV/IO dilute in 50 mL normal saline bag and infuse over 10 minutes q 10 minutes prn to a total maximum of 1000 mg

EMS Contraindications
Hypersensitivity
Hypercalcemia
Patients with digitalis toxicity

Notes
Avoid extravasation due to the risk of tissue irritation / necrosis

Question 2

magnesium sulfate

Pre-Eclampsia / Eclampsia

Answer 2

Class
Antiarrhythmic

Adult Dosage
Loading dose:
5 g IV/IO diluted in 50 mL normal saline bag and infused over 20 minutes

Maintenance dose
2 g/hr diluted in 1000 mL normal saline bag and infused over 60 minutes

For recurrent or ongoing seizures:
Mandatory OLMC: 2 g IV/IO diluted in 50 mL normal saline bag and infused over 20 minutes Do not repeat dose

EMS Contraindications
Any degree of heart block
Renal failure

Notes
Administer IM injections in the lateral quad (vastus lateralis) muscle
IM administration involves multiple injections and is painful; should be reserved for patients with no vascular access
Monitor for respiratory depression
Given for antihypertensive properties, protection from arrhythmias, and to stop seizure activity

Question 3

midazolam (Versed)

Pre-Eclampsia / Eclampsia

Answer 3

Class
Benzodiazepine

EMS Indications
Recurrent or ongoing seizures or inability to establish vascular access

Adult Dosage
With OLMC (administered concurrently with magnesium sulfate):

5 mg SIVP/IO q 5 minutes prn to a total maximum of 20 mg

Or

Repeat 10 mg IM Do not repeat IM dose

EMS Contraindications
Hypersensitivity to benzodiazepines
Myasthenia gravis
Systolic BP less than 100 mmHg

Notes
May cause respiratory depression and hypotension; monitor vital signs closely post administration
Use with caution with other drugs that are sedatives / depressants

Question 4

oxytocin (Pitocin)

Post delivery

Answer 4

Class
Oxytocic

Adult Dosage
10 units IM Do not repeat dose

EMS Contraindications
Hypersensitivity
Uterine inversion
Placenta previa
Abruptio placenta

Notes
In the setting of multiple gestation births, do not administer until all fetuses have been delivered

Question 5

oxytocin (Pitocin)

Post Partum Hemorrhage

Answer 5

Class
Oxytocic

EMS Indications

Post-partum hemorrhage not responsive to fundal massage / breastfeeding with signs and symptoms of shock

Adult Dosage
10 units IM
40 units SIVP/IO diluted in 1000 mL normal saline bag; start at 150 ml/hr (6 units / hr) to control bleeding
Do not repeat dose

EMS Contraindications
Hypersensitivity
Uterine inversion
Placenta previa
Abruptio placenta

Notes
If bleeding is controlled, continue infusion and transport
If significant bleeding persists, Mandatory OLMC for further direction