Ops Flashcards
What is passive immunity, and how long does an infant have it?
An infants immune system is immature & is based on antibodies received through the placenta from his mother during pregnancy.
Passive immunity is retained throughout the first 6 months of life
What are some of the special reflexes had by infants?
Blinking, startling, rooting, sucking, swallowing, stepping, gagging, grasping
What are some significant anatomical differences between a child and an adult?
Pedi: tongues are larger, trachea smaller, neonates are obligate nose breathers, chest muscles underdeveloped, ribs more pliable (allow internal injuries), head larger, fontanelles until 18 months, skin surface larger (more potential for burns), metabolic rate faster (need more O2, except for neonates = only room O2), less blood volume (355 ml)
How long are pediatric patients obligate nose breathers? What does this mean in terms of treatment?
Neonates are obligate nose breathers until 4 weeks of age
For newborns: suction mouth before nose, b/c once nose is cleared, they will begin breathing anything from mouth & nose; be sure to keep nose clear
At what stage of development does a child begin to understand cause and effect
during the toddler stage; 2 yoa
What is menopause? At what age does this usually occur?
Menopause: permanent end of menstruation and fertility
Occurs in middle adults in their late 40s & 50s
What are some of the physiological changes associated with ageing and late adulthood?
Increased hypoxia but less able to detect it
Decreased cardiovascular function
Decreased nutrition
Increased electrolyte imbalance/toxic build up
More skin tears, wounds, and infections
Less coordination, more falls
More broken bones
What is your primary concern in dealing with a psychiatric emergency?
Determining whether it is actually a psych patient or a physical emergency
Safety! Psych pts can be unpredictable
What are some clues that the cause of a problem may be physical rather than psychological?
Sudden onset, memory loss, salivation, pupillary changes, incontinence, unusual odor.
One clue that the problem is NOT physical is hallucinations
What are the components of a mental status exam?
Orientation: x3?
Cognition: rational?
Perception: hallucinations?
Memory: short/long term?
Body language: hostile
Speech: slurred, illogical?
Skin: shock?
Posture/gait: coordinated?
General appearance: grooming?
What are the basic characteristics of anxiety? Psychosis? Depression? Bipolar disorder?
Anxiety
Painful unease & inner turmoil about things out of ones control; mental & biochemical triggers epi dump (from panic attack)
S/S: agitation, restlessness, fear, panic, hyperventilation, dizziness, carpal-pedal spasms, irregular/rapid HR, palpations, SOB/CP
Psychosis
Out of touch w/ reality: affective vs. delusional; responses out of proportion to stimuli; temporary or chronic
S/S: delusions, hallucinations, mood swings, disorganized speech, living in own world
Depression
Deep feelings of sadness, worthlessness, meaninglessness; environmental stressor; biochemical cause
S/S: periods of crying, appetite loss, sleep disorder, fatigue/despondence, anhedonia (lack of seeking pleasure), suicidal ideation
Bipolar disorder
Manic-depressive disorder; up & down phases; not just mood swings; lasts weeks or hours
S/S: manic: elated, powerful; depressive: withdrawn, suicidal; delusions, hallucinations
What is the best treatment for a panic attack?
Conscious breathing: breath in a few seconds, hold breath for a few seconds, breath out for a few seconds
What is schizophrenia? What are its signs/symptoms?
Severe psychosis; break w/ reality; debilitating distortions; NOT multiple personality disorder
S/S: hallucinations, delusions, poor hygiene, disorganized, social withdrawal, catatonic
What is agitated delirium? What type of drug is usually associated with it? What kind of patient positioning is usually associated with it?
Aka excited delirium
Neurocognitive disorder: neurons impaired; affects memory, personality, reasoning; pt initially resist/violent, has unusual strength, endurance, tolerance of pain, is agitated, hostile, frenzied behavior, and has unusual speech
Drug use: uppers (stimulants such as amphetamines, cocaine, and other CNS stimulants.)
What is PTSD? What are its s/s?
Persistent mental/emotional stress following physical or psychological trauma
S/S: flashbacks, sleep disturbances, nightmares, depression, early aging, physical pain, anger/anxiety
PTSD pts turn to alcohol/drugs
What are extrapyramidal symptoms? What causes these symptoms?
Associated w/ taking/changing psych meds; caused by dopamine block
S/S: AMS, elevated temperature, muscle rigidity, abnormal contraction of head, eyes, neck, limbs; tremors, hypersensitivity to lights & noise, involuntary movements of tongue, jaw, limbs
What are some signs/symptoms of a potentially violent patient?
Pacing, fists/teeth clenched, staring or looking away, aggressive posture, shouting or cursing, throwing objects, in general: any change in behavior
What are some of the signs that a patient may be a suicide risk?
History of mental illness (depression, bipolar, schizophrenia), history of suicide attempts, isolation, loss of loved on, divorce/widow, pt giving away belongings, alcohol or drug abuse
How do the genders differ with regard to suicide and attempted suicide?
Females make 3 times as many attempts as males
Males are four times more likely to succeed on the first try
What are some techniques you might use in dealing with a psychiatric emergency?
Safety first!
Establish rapport: calm, reassure, listen, support, stabilize
Approach slowly, no quick movements
Be honest, no playing along
Ask before touching
Restrain only if necessary; work to convince
Never leave pt alone, never turn back on pt
Limit interruptions
Avoid questions or comments that may come off as threatening
When and how should an EMT work to physically restrain a patient?
Restrain only if danger to self/others
Obtain assistance from PD
Act quickly while talking
Do NOT restrain prone, only supine
Use humane/soft restraints only
No release once applied
Have 1 rescuer per extremity
What diagnostic tool should be used on all patients with AMS?
Mental status exam: observe appearance, speech, skin, posture, orientation, memory, awareness, body language, judgement
History
Physical exam
What occurs during menstruation? How long is the menstrual cycle?
Lasts from 24 to 35 days
First day begins w/ menstruation: sloughing of endometrial tissue that was preparing for implantation of the fertilized ovum. When menstruation is over, estrogen levels increase & begin to prepare endometrium for implantation of fertilized ovum.
On the 14th day, ovulation occurs & the mature ovum is released from the ovary, which descends through fallopian tube w/in next 5-7 days.
If fertilized: implants itself in endometrial lining of uterus.
If not fertilized: discharged w/ outer layer of endometrial tissue during menstruation which occurs 14 days after ovulation
What are the meanings of “gravida” and “para”?
Gravida: times pregnant
Para: # of birth events after 20 weeks gestation (twins count as 1)
Ex: GII PI means 2 pregnancies, 1 live birth (so about to have another)
What are the three stages of labor, and what happens during each one?
First Stage: Dilation
Begins w/ dilation/effacement (thinning) of cervix
Cause contractions & bloody show
Contractions 10-20 mins apart; lasts 8-10 hours for first time mother
Braxton hicks contractions
Ends w/ full dilation at 10 cm
Second stage: Expulsion/Delivery
Full dilation/effacement through birth
Head drops down
Contractions > 60 seconds & < 2 mins apart (half on, half off)
Mom feels need to defecate
Bulging of perineum
Crowning
Coached pushing
Neonate born
Third stage: Placenta
Afterbirth
From delivery of baby to delivery of placenta
Usually 10-20 minutes
Less severe contractions
Cord lengthens
Dont wait to transport
What marks the onset of each stage of labor?
First stage: when dilation begins & contractions are 10-20 minutes apart
Second stage: when contractions are greater than 60 seconds and < 2 mins apart; dilation to 10 cm
Third stage: delivery of baby, cord lengthens
What is a spontaneous abortion? Is this very common?
Miscarriage: termination prior to 20 weeks (usually during 1st trimester); cause is usually genetic; spontaneous abortion occurs in 15-20% of all recognized pregnancies
What is supine hypotensive syndrome? What is its treatment?
Weight of fetus compresses inferior vena cava, resulting in: decreased preload, CO, BP; lightheadedness/syncope
Treatment: position pt sitting upright, on side or supine w/ right hip elevated
What is the treatment for supine hypotensive treatment if you must perform CPR?
Manually displace uterus to left
What is an ectopic pregnancy? What are its s/s? What threat to life does it pose?
When the egg implants anywhere its not supposed to be (ex; fallopian tube, outside wall of uterus, an ovary, cervix)
S/S: dull aching pain localized on one lower side; Kehr’s sign (shoulder pain), vaginal bleeding/spotting, signs of shock: internal bleeding; bluish discoloration around umbilicus; tender abd; decreased BP; increased pulse rate; urge to defecate;
Life-threatening emergency b/c the placenta eventually ruptures surrounding tissue; responsible for 6% of maternal mortality
What questions should you ask a pregnant patient?
Age & general condition of mother
Due date? last menstrual period?
First pregnancy?
How many previous births?
Prenatal care? Meds?
Water broken?
Fundal height?
Complications expected?
Feel need to defecate/push?
Crowning? (have to look)
Frequency of contractions?
or a woman in active labor, what three things should you assess about her contractions?
interval, duration, and intensity
What are the signs/symptoms of imminent delivery?
Contractions 2 min apart, lasting 60-90 sec
Urge to defecate/push
Abdomen extremely hard
Crowning
What are the main steps in assisting with a delivery?
Crowning-> slight pressure on head/perineum
Feces -> wipe away
Amniotic sac not broken -> pinch to rupture
Head out -> support it w/ hand
If nuchal cord present, slip over head
Suction mouth then nares of baby only if obstruction present
Vernix caseosa: white cheesy substance -> dont wipe all of it off = good bacteria for baby
Stimulate baby to breathe & keep warm (put directly on towel, loosely)
Note time of birth
Place newborn on mothers abd
Clamp cord @ 6 & 9 inches (wait 30 seconds & that pulse has stopped before clamping)
Cut cord between clamps (include father if ok w/ mom)
Do not delay transport for placenta
Do not pull on umbilical cord
In what position should you place the mother in preparation for delivery?
Supine, in the McRoberts position (knees drawn up to chest w/ legs spread apart), buttocks 2 feet from edge w/ folded blanket under buttocks
This increases the distance between the symphysis pubis & sacrum to make it easier for the fetus to pass through the pelvis during delivery
In what position should you place a patient to discourage delivery?
Knee-chest position (& instruct pt to pant, not push)
How much oxygen should be administered to a patient during childbirth?
If there are no signs of hypoxia or even if the SpO2 is 94% or greater, still apply a NC @ 2 lpm to provide additional O2 to fetus
What two things should you check immediately as soon as the head delivers?
Check for nuchal cord & obstructions; if so, slip cord over head & suction mouth before nose ONLY if obstructions present
What is preeclampsia, and what are its signs/symptoms?
Previously known as toxemia; occurs in last trimester of 12% of pregnancies; characterized by high blood pressure & protein in urine
S/S: elevated BP (usually > 140/90; severe = 160/110), AMS, sudden weight gain, N/V, edema of face, feet, lungs; HA, photophobia/blurred vision; epigastric or RUQ pain, DM, decreased urine output, crackles, respiratory distress
what is the difference between preeclampsia and eclampsia?
Eclampsia is a more severe form of preeclampsia & includes unexplained coma or new onset of generalized tonic clonic seizures in a pt w/ preeclampsia
Both have an unknown cause (possible vasospasm)
What is placenta previa? What are its s/s?
Abnormal implantation of the placenta over or near the opening of the cervix; when the fetus changes position in the uterus or the cervix begins to efface & dilate, the placenta is prematurely torn away from the lower portion of the uterine wall, resulting in bleeding which can be excessive b/c of rich blood supply
S/S: 3rd trimester vaginal bleeding that is painless; non-tender abd; bleeding can be bright or dark
What is abruptio placentae? What are its s/s?
Aka placental abruption; premature separation of the placenta from uterine wall prior to birth of baby
S/S: constant abd pain w/ or w/out vaginal bleeding; uterine contractions; hypovolemic shock; history of HTN, DM, preeclampsia, multiparity, smoking, abd trauma, cocaine use
is a ruptured uterus? What are its s/s?
Uterine wall enlarges & becomes extremely thin during pregnancy, & can rupture spontaneously or from trauma, releasing fetus into abdominal cavity
S/S: abd trauma, previous c-section, large fetus, prolonged/difficult labor, tearing sensation or severe abd pain, fetus palpated in abd cavity
What is shoulder dystocia? What is the EMT procedure for treating this?
When fetal shoulders are larger than the fetal head so the head delivers but then it retracts b/c the shoulders are caught between the symphysis pubis & the sacrum (turtle sign)
Treatment: McRoberts position, if that doesnt work by itself, also apply suprapubic pressure; if these dont work, put pt in Gaskin maneuver (all 4s); high flow O2, transport
Under what circumstances should the EMT place a gloved hand into the vaginal canal?
Prolapsed cord & breech birth
What is meconium, and what is the EMT treatment for it?
During a difficult labor, green/yellow film presents on skin of fetus in distress which indicates release of bowel & can lead to hypoxic event for fetus. If fetus inhales meconium, it can lead to pneumonia or infection. Most often seen in breech births.
Treatment: if meconium present, but baby has good cry do not suction. Otherwise, take bulb syringe & suction mouth before nose
What is a nuchal cord, and what is the EMT treatment for it?
When the cord is wrapped around the babys neck
Treatment: use 2 fingers to slip the cord over the infants shoulders or head; if you cannot move the cord, place 2 clamps 2 to 3 inches apart & cut between the clamps; remove the cord from around the neck and ensure no blood is leaking from ends; if blood = clamp or tie & never release/remove original cord clamp or tie
What should you do if you see an intact amniotic membrane during delivery?
Use fingers to rupture the sac & then tear it away from the babys head and face as they appear
What is the proper procedure for cutting the umbilical cord?
Wait 30 seconds before cutting the cord. Place 2 clamps or ties 6 & 9 inches from baby; cut between clamps after pulse has stopped
What complications should you expect when there are two or more fetuses?
Expect breech; one or two placentas
What is a breech birth? What is the EMT treatment for breech birth?
Buttocks or both legs present
Treatment: do not attempt delivery; mom in knee-chest position; coach mom to pant, not push; O2 & rapid transport to L&D
What is the EMT treatment for a limb presentation?
One arm/leg presents; cannot manage in the field
Treatment: mom in knee-chest position; coach pant, not push; do NOT pull on limb; O2 & rapid transport to OB surgery
What is a prolapsed cord? What is the EMT treatment for this?
Umbilical cord presents before baby, & can cut the O2 supply to the baby
Treatment: cannot deliver in the field; hand in vagina to lift head off cord; mom in knee-chest position; coach: pant, dont push; high flow O2; rapid transport to OB surgery
hat can the EMT do to help control post delivery vaginal bleeding?
Oxygen therapy, fundal massage, breastfeed newborn, place pad over the area & immediate transport
What is a fundal massage? How is it done?
Massaging the uterus tones/contracts the uterus & releases oxytocin, however the mom will not like it
Place the medial edge of one hand (fingers extended) horizontally across the abdomen, just above the symphysis pubis. Cup other hand around the uterus. Use a kneading & circular motion to massage the uterus
How should you wrap the newborn to keep it warm?
Turn on heat in back of ambulance; dry baby, wrap w/ blanket & plastic wrap
What should you do to care for a newborn with no life-threatening problems?
Stimulate newborn to breath/cry by flicking soles of feet or rubbing back; place on moms abd, wrap to warm
When should a newborn be suctioned?
When there is an airway obstruction; suction mouth before nose
What are the components of the APGAR system? How is each scored?
Appearance: 0=cyanotic, 1=pink core, 2=blue extremities
Pulse: 0=no pulse; 1=under 100 bpm; 2=over 100 bpm
Grimace: 0=no reflex activity; 1=some facial grimace; 2=grimace, cough, sneeze, cry
Activity: 0=limp, no mvmt; 1=some flexion, no active mvmt; 2=actively moving
Respirations: 0=no respirations; 1=slow, irregular respirations; 2=good resp. & cry
What are the expected vital signs of a stable newborn?
HR: 100-205
RR: 40-60
BP: 60-90/30-60
