USPE1 Flashcards
dif/ from a PEDI vs adult airway) PEDI:
Adult:
= Large tongue, Floppy omega epiglottis, cricoid narrowest point
= glottis narrowest point, firm epiglottis
1 Killer 3rd trimester
Placenta Abruptio
Sudden Infant Death syndrome (SIDS)
SUID is a broad category that can include identifiable causes such as suffocation, choking, or strangulation as well as SIDS.
Normal Pedi Urine output:
1-2ml/kg/Hr urine output
Menstrual Phase) average blood vol & duration
What is the bleeding from:
Egg is implanted @
= ~50mLs & lasts ~ 3-5 days
= endometrium lining shedding
= Corpus lutium
2 Ways to stimulate baby to start respiratory drive
Wax on baby & Foot tapping
Full-term pregnancy:
Premature (preterm):
Postmature:
Hermaphrodites:
= 38-42 Weeks (40 average)
= Any birth before 37 weeks.
= Any birth after 43 weeks.
= Born w/ both sex organs; PC “Intersex”
How many Wks to auscultate Fetal heart tones:
How to find for heart tones:
= 20 weeks
= gently palpate, find firm head & butt
3 general approaches to tocolysis) 2nd approach:
B/c oxytocin & ADH are secreted from the same area:
= admin/ 1L IV fluid bolus; increases intravascular fluid vol, thus inhibiting ADH secretion from posterior pituitary
= inhibition of ADH secretion also inhibits oxytocin release, often causing cessation of uterine contractions
3 general approaches to tocolysis) if previous failed) 3rd:
= mag-Sulfate or a beta-agonist, such as terbutaline or ritodrine, can be admin/ed to stop labor by inhibiting uterine smooth muscle contraction
Secretory phase)
vascularity increases in anticipation of implantation of fertilized
PT complains of dyspareunia. You quickly recognize this as:
pain during intercourse
A patient complains of lower abdominal pain that occurs during sexual intercourse. You recognize this patient is complaining of:
Dyspareunia
A surge of what horomone causes the rupture of the mature egg from the ovary.
LH
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
“Tilt Test” is considered positive when:
= PT’s SBP Drops 20 mmHg or more
A very common infection of the female reproductive tract that is caused by either a virus, bacterium, or fungus is known as:
Pelvic Inflammatory Disease
Abnormal Delivery Situations
Breech Presentation, Prolapsed Cord, Limb Presentation, Occiput Posterior Position, Multiple Births, Cephalopelvic Disproportion, Precipitous Delivery, Shoulder Dystocia, Meconium Staining
Abortion classifications) incomplete abortion:
= Abortion in which some but not all fetal tissue has been passed. associated with a high incidence of infection.
Abortion classifications) Potential) Threatened abortion:
= unexplained vaginal bleeding during 1st half of pregnancy in which the cervix is slightly open & fetus remains alive in uterus (some cases the fetus still can be saved)
Abortion classifications) Potential) Inevitable abortion:
= bleeding w/ severe cramping & cervical dilation but the fetus hasn’t yet passed from uterus & cannot be saved
Abortion classifications) spontaneous abortion:
commonly called what & generally result of:
Most spontaneous abortions occur:
Common occurrences:
= Naturally occurring expulsion of the fetus prior to viability
= miscarriage; generally from chromosomal abnormalities
= before week 12 of pregnancy.
= Many occur w/in 2Wks after conception & mistaken for menstrual periods
Abortion classifications) elective abortion:
Most elective abortions are performed during:
2nd-trimester elective abortions:
3rd-trimester elective abortions
Elective abortions in 1st & 2nd trimesters:
= termination is desired & requested by mom
= the 1st trimester (less complication chances)
= Some clinics perform although higher complication rate
= are generally illegal in this country.
= have been legal in the US since 1973.
Uterine inversion) Rx step 1
NEVER EVER:
Step 2:
Step 3:
Uterus Replacement technique:
If this single attempt is unsuccessful:
1= place supine & begin oxygen (if hypoxic). Do not attempt = attempt to detach placenta or pull on the cord
2= Initiate 2 big-bore IVs of NS & begin fluid resuscitation
3=Make 1 attempt to replace uterus technique
= w/ palms, push fundus of inverted uterus toward vagina
= cover uterus w/ towels moist w/ NS & transport ASAP
Aortocaval compression) Pregnant Cardiac arrest:
= In the pregnant PT, the large gravid uterus can compress the aorta & vena cava when PT supine. To facilitate optimal CPR, the uterus must be manually moved off to allow adequate blood return to the heart. Placing PT other than supine position (tilted 30 degrees left) can compromise CPR.
-B/c of this, its now recommended that all pregnant PT in cardiac arrest w/ ~20Wks gestational or greater receive manual lateral uterine displacement (LUD). If difficult to assess, (morbidly obese) LUD should be provided if possible technically feasible.
3 general approaches to tocolysis) 1st approach
= sedate PT, often w/ narcotics or barbiturates, thus allowing her to rest. Often, after a period of rest, the contractions stop on their own
The puerperium is
the time period surrounding the birth of the fetus.
Assessing contractions)1 Place hand @:
2 Time Contractions:
3 It is important to note:
4 During & between contractions monitor:
1= 1 hand on fundus of uterus.
2= from beginning of 1 contraction until beginning of the next.
3= whether the uterus relaxes completely between contractions.
4= fetal heart tones; Occasional bradycardia occurs during contractions, but the HR should increase to a normal rate after the contraction ends (If baby doesn’t deliver after 20Mins of contractions every 2-3Mins, transport immediately)
Fetal HR failing to return to normal between contractions:
A drop in the fetal HR <90BPM indicates:
= is a sign of fetal distress & transport ASAP
= fetal distress & requires prompt immediate transport w/ PT in L-Lateral Recumbent position
Abortion:
Expulsion of fetus prior to 20 weeks’ gestation
Most common cause of bleeding in 1st & 2nd trimesters
Acrocyanosis
= extremities remain dusky after delivering & drying healthy baby (Very common in 1st Hrs of life
Adults vocal cords @
Pedi Vocal cords @
C4 - 5
C2 - 3
AEIOU-TIPPS reflects major causes of AMS
Alcohol
Epilepsy
Insulin
Opiates
Uremia (Kidney Failure)
Trauma, Temp
Infection
Poisoning
Psychogenic
Shock, Stroke, Seizure
Mom) After 32 weeks and until pregnancy ends, uterus fills:
3rd trimesters anatomical change:
3rd Trimester v/s change:
Possible effects from changes:
Vascular vol/ increase accompanied by <increase in RBC Result:
1= abdominal cavity to level of lower rib margin.
2= Enlarging ABDMMN increases ABDMN P. displaces diaphragm upward
3= Reduced lung capacity, +Circ 45%, +15% CO BPM, CO +40%
4= Anemia <RBC 45% from not keeping up w/ RBC
5= anemia becomes consideration w/ aggressive fluid resuscitation for shock
Amenorrhea:
Primary Amenorrhea:
2ndary Amenorrhea :
= Absence of menstruation
= Never started periods.
= Periods stopped after being regular.
amniotic sac:
After the 20th week of gestation:
= Baby grows in w/ amniotic fluid increasing in vol/ throughout course of the pregnancy.
= the volume varies from 500 to 1,000 mL
Dysmenorrhea:
= Pain/”Severe discomfort” during menstruation & commonly goes w/ PMS
Anuria
No urination
APGAR Scoring) Scoring
A
P
G
A
R
5 parameters; Scored bad 0 to 2 Normal/healthy
Appearance (skin color)
Pulse rate) Normal 100-180
Grimace (irritability)
Activity (muscle tone)
Respiratory effort) Normal 30-60
Appendicitis:
= Common GI emergencies
= If untreated, can lead to peritonitis or shock
= Rebound Tenderness Pain at McBurning’s Point (2/3 from umbilicus)
Fetal Circulation) As soon as a baby takes its 1st breath:
Ductus arteriosus:
Ductus venosus:
Forman Ovale:
= lungs inflate, greatly decreasing pulmonic vascular resistance to blood flow
= closes, diverting blood to the lungs
= closes, stopping blood flow from placenta
= closes stopping blood flow through atriums (now fossis ovalis)
Auscultation technique w/ Pedis
Using Bell & Armpit to Armpit
Bacterial Meningitis
Viral Meningitis
Most Lethal
Most common/viral
Begins @ day 15 & ends @ 8Wks
Embryonic stage
B/c CO increases up to 30% during pregnancy, PTs who have serious preexisting heart disease may develop:
Congestive heart failure
Belly breathing
Normal w/ todlers but not adolescents
Kirinick’s sign:
+ sign indicates:
= bend knee to chest but cant outflex legs
= Meningitis
Braxton-Hicks Contractions:
False labor:
= Painless, irregular contractions.
= increased intensity and frequency; no cervical changes.
Fetal Circulation) 1 umbilical vein connects directly to:
2 Blood then travels through:
3 Blood enters R-atrium & passes through & into:
4 Blood exits R-ventricle & travels through & into:
5 The foramen ovale allows:
6 Once in pulmonic artery, blood enters & connects w/:
7 The ductus arteriosus causes blood to:
8 Once in the aorta, blood flow is:
9 Deoxygenated blood w/ waste products exits fetus:
1= Inferior Vena-Cava by ductus venosus
2= the inferior vena cava to the heart
3= the tricuspid valve into the R-ventricle
4= the pulmonic valve into the pulmonary artery
5= mixing oxygenated blood in the R-atrium, leaving the L-ventricle bound for aorta bypassing the lungs &
At this time, the blood is still oxygenated
6= Ductus arteriosus, which connects the pulmonary artery with the aorta.
7= bypass the uninflated lungs.
8= basically the same as in extrauterine life
9= after passage through the liver via the umbilical arteries
Breech Presentation:
Risks:
Increased potential for:
Delivering:
If head does not deliver:
= Buttocks or both feet present first
= Increased risk for delivery trauma to mother,
= cord prolapse, cord compression, anoxic insult for infant
= Hold her legs flexed, As infant delivers, DONT PULL LEGS,
Allow entire body to be delivered w/ contractions
= place gloved hand in vagina w/ palm toward infant’s face
Bright red hemorrhage without pain in a female that is in her third trimester most likely describes:
Placenta Previa
Broselow Tape Purpose
Rapid pediatric weight & dose estimation based on height.
Bacterial tracheitis:
seen w/:
S/S:
= bacterial infection of subglottic region
= after Croup, 1-5Yrs
= High fever, phlem, horse if talking, Stridor
Bronchiolitis:
= viral infection of bronchioles, most commonly respiratory syncytial virus (RSV) affecting lining of the bronchioles
Bronchiolitis sound:
Occurs commonly:
AKA:
= expiratory wheezing
= in winter <2Yrs
= “Baby asthma”
Brudzinkis sign:
+ sign indicates:
= Supine & flex head feet kick up
= Meningitis
BRUE)
ALTE)
= Brief resolved unexplained event
= Apparent Life threatening event
Infants who are not breathing, cyanotic, and unresponsive sometimes resume breathing and color with stimulation
Classic presentation is characterized by: Distinct change in muscle tone, Change in color, Choking or gagging/apnea , 50% underlying cardiac
Bronchiolitis) Mild Treatment:
Moderate:
Severe:
= Nebulized Albuterol & Atrovent, & Steroids: Dexamethasone & Solu Medrol
= CPAP/ SVN Epi & Mag Sulfate
= Epi 1:1 IM & ET Intubation
by 32 weeks until delivery A&P changes:
The displacement reduces:
= Baby displaces all surrounding organs
= lung capacity, Tidal Vol,
Cardiac arrest common etiologies
1st most common Cardiac myopathy from sick)
Prolonged QT syndrome
Commotion cordis
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
Uterine Rupture:
= Actual tearing, or rupture, of uterus; occurs with onset of labor or blunt abdominal trauma.
Rare occurrence; extremely high maternal and fetal mortality rate.
Choanal Atresia
Congenital blockage of nasal passage, causes respiratory distress when mouth is closed
Causes of Neonatal Bradycardia
Hypoxia, acidosis, hypothermia; primary treatment is ventilation before considering meds
Causes of Neonatal Hypoglycemia
Prematurity, diabetic mother, sepsis, hypothermia, birth stress
Changes in the body with pregnancy) -O2 consumption
-blood volume:
-Cardiac Output:
-Heart Rate:
-Blood Pressure:
-GI System:
-Urinary System:
-Musculoskeletal System:
= 20% increase O2 consumption
= 45% increase in blood volume
= Cardiac Output Increases by 1 to 1.5 L/min
= 30% increase Heart Rate 15-25% increase
= BP decreases slightly
= Peristalsis is slowed in GI (Digestion)
= Urinary System GFR Increases nearly 50%
= Joints loosen Musculoskeletal System
Cephalopelvic Disproportion:
Causes:
Delivering:
What can occur:
= Infant’s head too big to pass through maternal pelvis easily; oversized fetus.
= Diabetes, multiparity, postmaturity.
= Fetal abnormalities may make vaginal delivery impossible
=Fetal demise or uterine rupture may occur
Classifications of Abortion:
= complete, incomplete, Threatened, inevitable, spontaneous, Missed, criminal, habitual, & Elective
Abortion classifications) complete abortion:
= An abortion in which all uterine contents, including the fetus and placenta, have been expelled.
Cleft Palate & Lip
Failure of structures to close during fetal development, can cause feeding & airway issues
Common Causes of Neonatal Seizures
Hypoxia, hypoglycemia, infection, intracranial hemorrhage, congenital abnormalities
Common issue/injury w/ PPV on Pedis
= Barotrauma; Too much squeeze & too slow
Ruptured Ovarian Cyst:
= Cysts are fluid-filled pockets. When they develop in the ovary, they can rupture & be source of pain
Corpus lutium
on the ovary where the egg was implanted & keep secreting estrogen & progesterone to keep secreting
Corpus albican)
“Scar” b/c not fertilized) has fluid in it Common spot for ovarian cysts
Abortion classifications) criminal abortion
= Intentional termination of pregnancy under any condition not allowed by law. Usually attempt to destroy a fetus by a person who is not licensed or permitted to do so & often attempted by amateurs & rarely aseptic
Croup is characterized by
S/S:
Rx:
Notes:
= subglottic edema} laryngotracheobronchitis
= Bark Stridor, ~6Mns-4Yrs, No drooling,
= SVN Epi, Albuterol, RaceEpi
= decrease truck temp b/c cool air helps subglottic edema
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
Croup vs Epiglottitis) Temp
Usually occurs @:
Common age:
=(C)Low fever101-2 (E)High fever 102-4
=(C)Before bed (E) in Morning/middle of night
=(C)6Mns - 4Yrs (E) 3Yrs - 7Yrs
Croup/(Laryngotracheobronchitis) Rx
SVN Albuterol (or Epis) & Steroids: Dexamethasone & Solu Medrol, CPAP
Cystitis
= UTI) Urinary Tract Infection
Decrease pulmonic defects:
= Tetralogy of Fallot (TOF),
dextro-Transposition of the Great Arteries (d-TGA), Levo-Transposition of the Great Arteries (l-TGA)
Detachment of the placenta from the uterine wall during pregnancy is called:
Abruptio placentae
Dextrose Pediatric Dosing
- Neonate (<2 months): D10W, 5-10 mL/kg IV
- Infant (2 months-2 years): D25W, 2-4 mL/kg IV
- Child (>2 years): D50W, 1-2 mL/kg IV
Diagphram herniation takes place most often in
he posterolateral segments of the diaphragm, and most commonly (90 percent) on the left side. The defect is caused by the failure of the pleuroperitoneal canal (foramen of Bochdalek) to close completely
Diaphragmatic Hernia Considerations
Do not bag-mask ventilate, intubate early, position baby with head elevated
Drop in fetal HR < 90BPM indicates
fetal distress = immediate transport
DUB:
= Dysfunctional Uterine bleeding
During pregnancy, maternal O2 demands increase so:
To compensate, the body makes changes:
= progesterone causes a decrease in airway resistance
= 20% increase in o2 consumption & 40% increase in tidal vol/, slight increase in RR, diaphragm is pushed up by the enlarging uterus, resulting in flaring of the rib margins to maintain intrathoracic volume.
Dysmenorrhea:
Painful menstruation due to uterine contractions or conditions like endometriosis.
Endometrium is stimulated to build/prep by:
If fertilization does not occur, the lining:
myometrial fibers contract for:
= Estrogen & Progesterone
= degenerates & sloughs off (menses) ‘period’
= helps control post-birth bleeding & to maximize the sloughing of the endometrium
Dysuria:
Hesitancy:
= pain during urination
= trouble starting & stopping pee stream
Eclampsia:
= Most serious manifestation of hypertensive disorders of pregnancy Generalized tonic-clonic seizure activity
Menarche:
of eggs @ Birth:
of eggs @ Menarche:
immature follicles/ova “eggs” are called:
= 1st menstruation, needs 16% body fat, ages 10-14 but now days 8-12
= 3 mil
= 30K
= Primordial Follicle
Ectopic pregnancy:
Why is it dangerous:
= fertilized egg implants outside uterus (most commonly in the fallopian tube)
= can rupture by ~8 Wks, causing severe bleeding & leading cause of maternal death in 1st trimester
endometriosis:
Cavital-pneumial pneumothorax:
= abnormal growth of endometrial cells make tissue outside the uterus, often causing pelvic pain, heavy periods, & infertility.
= pneumothorax from endometriosis growth on lungs
Primordial Menstrual Site:
What is LH & its job:
It comes from where:
= Ovarian follicles that house immature eggs.
= luteinizing hormone triggers the follicle to release its egg & stimulate fimbriae activity to guide the egg into the fallopian tube.
= Anterior portion of the Pituitary Gland
Endometritis:
Complications of endometritis include:
Commonly reported S/Ss:
= Uterine lining infection often mimics PID & can be quite serious if not quickly treated w/ appropriate antibiotics.
= sterility, sepsis, or even death. Can occasional complication of miscarriage, childbirth, or gynecologic procedures such as D&Cs.
= mild to severe lower ABDMN pain; a bloody, foul-smelling discharge; fever (101-104°F)
onset of symptoms is usually 48-72HRs after the gynecologic procedure or miscarriage.
Epiglottitis is characterized by:
S/S:
Rx:
Notes:
= inflammation of epiglottis & supraglottic tissues
= Drooling, ~3-7Yrs old
= Keep kid calm
= 1 intubation attempt,
Epiglottitis) Treatment:
place PT in position of comfort, Humified O2, therapy (mask or blow by)– Nothing in child’s mouth
(Intubation as a last resort)
Key steps for delivering baby) 1 Cover:
2 Coach Mom:
3 As the baby’s head crowns:
3.1 Checking umbilical cord isn’t around the baby’s neck?
4 Procedure for delivering the baby’s shoulders?
5 How to clamp & cut the umbilical cord after delivery?
1= Prep/ PPE; gloves, gown, face shield or goggles
2= push w/ contractions & Breathe inbetween
3= Control head w/ gentle pressure, Support head as emerges & turns, (Tear amniotic sac open if head enclosed)
3.1= Slide finger along head & neck to check for cord
4= Guide head downward for upper shoulder delivery & upward for lower shoulder delivery (Support as emerges)
5= Delay clamping 30Secs after delivery, Clamp cord 4in. (10 cm) from navel; place 2nd clamp 2in (5 cm) from 1st &
Cut cord between clamps
Estrogen & progesterone role:
= from ovaries, make endo engorge & +blood vessels (stop secretions when menstruations start)
Etiology of Pediatric Arrest
Respiratory Failure
Hypotensive shock
Cardiopulmonary Failure
Asphyxial Arrest (lack of perfusion & oxygen)
Infant to 1 year)ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
3.5–4.0
Uncuffed
9.5–11.0 cm (~2 - 3cm past cords)
1 straight
External genitalia fn & aka:
= Protect, pleasure, propriate & Vulva/Pundium
febrile seizures result from
Most commonly between ages of
= a sudden increase in body temperature.
= 6Mns & 6Yrs often, guardians report a recent onset of fever or cold symptoms.
vulva, or pudendum refers to:
Diamond-shaped, area of muscular tissues separating vagina & anus:
= The female external genitalia
= perineum
Fetal Circulation) Fetus receives its oxygen & nutrients from:
while in the uterus, the fetus does not need to use:
B/c of this, the fetal circulation shunts blood around:
The infant receives blood from
The umbilical vein connects directly to:
= its mother through the placenta
= its respiratory system or its gastrointestinal tract
= the lungs and gastrointestinal tract.
= the placenta by means of the umbilical vein
= the inferior vena cava by a specialized structure called the ductus venosus.
8Wks until delivery marks what stage
Fetal stage
fluid replacement after perfusion rule:
4 2 1rule/ formula :
=back to normovolemia Used for every hr after to maintain
= [A] 4ml/kg 1st 10kg
[B]2m/Kg 2nd 10kg
[C]1ml/kG after per hour Used for every Hr after to maintain
Following ovulation, the site from where the egg was ejected out into the ABDMN cavity turns into:
Corpus Luteum
From what time is a baby classified as an ‘infant’?
From time of birth until 1 year.
Gastric in distention prob/ w/ Pedis
increasing intrathoracic vol = decreasing BP
(Pressure on R-atrium kills Preload & afterload)
Straddle injury:
common form of blunt trauma) to genitals commonly from a bike seat
Gestational Diabetes rx:
BGL < 70 mg/dL: Start IV NS & Admin/ 50-100 mL 50% dextrose intravenously
Gestational Diabetes:
Rx:
= Diabetes from Carry w/ BGL < 70 mg/dL
= Administer 50-100 mL 50% dextrose
Gravidity:
Parity:
= # of times woman has been pregnant
= # of pregnancies carried to full term
Grunting
heard when an infant attempts to keep the alveoli open by building back pressure during expiration
Gurgling
Is coarse, abnormal bubbling sound heard in the airway during inspiration or expiration; can indicate an open chest wound or a foreign body in the airway
Gynecology deals w/
Obstetrics focuses on:
= health & diseases of women’s sex organs.
= care of women throughout pregnancy.
Abortion classifications) habitual abortion
= Spontaneous abortions that occur in 3 or more consecutive pregnancies.
HANDTEVY System Purpose
Pediatric resuscitation tool for dose calculations & equipment sizing.
Head bobbing
Is observed when the head lifts and tilts back as the child inhales and then moves forward while exhaling
Heart defect categories
1 Increase pulmonary blood flow
2 Decrease pulmonary blood flow
3 Obstruct blood flow
Heart defect categories:
dextro-Transposition of the Great Arteries (d-TGA)
= Decrease pulmonary blood flow
= 1st trimester: TPMA now TAMP
Systems flip flopped
Block Blood flow defects:
= Coarctation of the Aorta,
Pulmonary & Aortic Stenosis
Truncus Arteriosus,
Hypoplastic Left Heart Syndrome
Heart defect categories”
Levo-Transposition of the Great Arteries (l-TGA)
= Decrease pulmonary blood flow
L&RV on wrong side
Heart defect categories
Coarctation of the Aorta:
= Block blood flow
= Narrowinfg of aorta Commonly ductus arterioous most common site, Increased after load & LVF,
Heart defect categories
Pulmonary Stenosis
= Block blood flow
Pulmonary Stenosis: less oxygenation & bad compliance
Heart defect categories:
Truncus Arteriosus :
=Block blood flow
= Aorta & pulmonic artery become one
< blood to aourta >pulmonic
Heart defect categories
Hypoplastic Left Heart Syndrome:
=Block blood flow
= No area for Preload from too much tissue
Heart defect categories
=Block blood flow, Decreased & Increased Pulmonic Flow,
function of the cervix during pregnancy:
= Forms a mucus plug to block pathogens from reaching the fetus & supports the uterus during gestation
How do hormonal changes affect PMS:
How do hormonal changes affect PMDD:
= physical & emotional symptoms like bloating, fatigue, & irritability before a period
= severe form of PMS w/ extreme mood swings/ depression
How do you properly immobilize a pediatric trauma patient?
Place a folded towel or padding under the shoulders to align the head with the body due to larger occiput.
How does fundal height relate to pregnancy:
Soonest to use reliably:
= Top of Uterus down to Top of Pubic bone w/ cloth measuring tape; each cm = 1Wk (top of uterus when feeling dip down STOP)
= After 20 weeks, it corresponds roughly to gestational age in weeks (EX: 25 cm ≈ 25 weeks).
How to clamp & cut the umbilical cord after delivery:
What to do immediately after the baby is delivered:
= Delay clamping 30Secs after delivery, Clamp cord 4in. (10 cm) from navel; place 2nd clamp 2in (5 cm) from 1st &
Cut cord between clamps
= Dry baby; cover w/ warm, dry blankets or towels.
Position baby on side.
Record time of birth.
How to insert a OPA
Pull out/move tongue w/ OPA or depressor & OPA’s Tongue down tongue
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth to 1yr)
= ETCO2 target should be 35 mmHg
hypoglycemic with PEDIs trick:
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= Lots of sick kids hypoglycemic so use bone marrow for BGL
= <45BGL neonate 2
= <60BGL infant
PEDI Ventilation may be impaired by:
Chest Injuries-most 3 prevalent:
Chest Injuries- least 3 prevalent:
Most likely to impede initial stabilization
= Tension pneumothorax, Open pneumothorax, Hemothorax, Flail chest
= Open/closed pneumo, Tension & hemo/ pneumo/
= hemothorax, Flail chest, Cardiac Tamponade (ra
= Open & tension pneumo
Increase pulmonic blood flow (decreased peripheral systemic flow)
=ASD,
VSD,
Patent forman ovale,
Patent Ductus Arteriosus (PDA)
Infant possible SVT rate
Children possible SVT rate
SVT vs TC
> 220
180
get Hx, if sudden & random onset then SVT
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
Key Differences in Pediatric Airway Anatomy
- Larger tongue relative to mouth
- Floppy, U-shaped epiglottis
- More anterior & superior larynx
- Narrowest airway @ cricoid cartilage
Key Steps in Pediatric Primary Assessment (ABCDE)
- Airway: Position in neutral sniffing, remove obstructions
- Breathing: Assess rate, effort, SpO₂
- Circulation: HR, pulses, perfusion
- Disability: AVPU/GCS, pupil response
- Exposure: Full assessment, prevent heat loss
Labias &t heir function:
2 distinct sets of labia:
What can cause injury to the labia:
= Structures that protect the vagina & urethra
= Labia majora (lateral) & labia minora (medial)
= Trauma to vulvar area EX: SA, childbirth, or bicycle riding.
Labor Stage 1:
= (Dilation) Begins w/ onset of true labor contractions
Ends w/ complete dilation (10cm) & effacement of cervix
Labor Stage 3:
(Placental) Begins immediately after birth of infant & Ends w/ delivery of placenta w/in 5-20Mins, Continued vaginal discharge (lochia); blood, mucus, placental tissue
Labor Stage 2:
= (Expulsion) Begins w/ complete dilation of cervix & Ends w/ delivery of fetus (50-60Mins) Contractions very strong, every 2Mins, lasting for 60-75Secs
Labor:
Puerperium:
Stages of labor:
= Process by which delivery occurs
= Time period surrounding birth of fetus
= Dilation, Expulsion, Placental
layers of the uterus in order from the most interior to the outer layer:
Endometrium, Myometrium, Perimetrium
leiomyomas or myomas, uterine fibroids:
benign (not cancerous) growths/“tumors” that develop from the muscle layer of the uterus.
Limb Presentation:
Possible causes:
Absolute:
= a Limb protruding from the vagina
Preterm birth, multiple gestation.
= Cesarean section necessary &NEVER EVER should you attempt field delivery
Lochia
Vaginal Discharge of blood, mucus, & placental tissue after delivering
Manual LUD can be accomplished:
The clinician must be careful not to:
= either side of PT, using 1 or both hands to move the uterus UPward & LEFTward off the maternal blood vessels
= inadvertently push down, which would actually increase compression of the vena cava.
Maternal Narcotic Use & Neonates
Causes neonatal abstinence syndrome (NAS) with tremors, irritability, poor feeding
McRobert’s Maneuver
Used w/:
= mother drop butt off end of bed; flex thighs upward to facilitate delivery & Apply firm pressure w/ open hand immediately above pubic symphysis
= Shoulder Dystocia
Meconium Staining:
Indicative of:
Causes:
Normally:
Healthy meconium described as:
Unhealthy Meconium described as:
As a general rule:
= Fetus passes feces into amniotic fluid
= fetal hypoxic incident.
= Prolonged labor, term, post-term, lowbirth-weight infants.
May occur prior to delivery or during labor
= amniotic fluid is clear or possibly light straw colored
= the color varies from a light yellowish-green to light green
= dark green, sometimes described as “pea soup.” As a rule, = more thicker & darker, higher risk of fetal morbidity
Meconium-Stained Amniotic Fluid
Can cause aspiration syndrome; suctioning indicated if neonate is non-vigorous
Meningitis:
S/S:
Presentation:
Muscle Tone/Activity:
infection of the meninges Caused by infection by bacteria, viruses, fungi, or parasites
=Kids/ w/ non-blanchable rash, Fever, AMS, Changes can range from mild H/A to inability to interact appropriately, bulding fontanelles
= small, pinpoint, cherry-red spots or a larger purple/black rash.
= Brudzinski’s & Kirinick’s sign, Nuncal rigity
Menopause:
= estrogen secretion & Ovarian Fn ends (45-55Yrs)
(end of reproductive life AKA “climacteric” derived from Greek meaning “critical time of life”)
Menorrhagia:
= Excessive menstrual bleeding; more than their average
Period of time from ovulation to menstruation (LFH egg burst) always 14 days
= Mensuration
Menstrual Phase:
Proliferative Phase:
Secretory Phase:
= Endometrium sheds (~50 mLs) Lasts 3-5 days
= Endometrium thickens w/ estrogen; ovulation occurs at Day 14.
= Progesterone from corpus luteum prepares endometrium for implantation.
Abortion classifications) Missed abortion
= fetal death occurs but is not expelled; posing potential threat to woman’s life if fetus is retained beyond 6Wks
Moro reflex/“startle reflex,” reflex
When startled, babies throw their arms wide, spreading their fingers and then grabbing instinctively with the arms and fingers. The reflex should be brisk and symmetrical. An asymmetric Moro reflex (in which one arm does not respond exactly like the other) can imply a paralysis or weakness on one side of the body.
Pedi 1st most & 2nd most common arrest rhythm
1 Asystole #2 PEA
most common cause of postpartum hemorrhage is
= uterine atony, or lack of uterine muscle tone. occur most frequently in multigravida & most common following multiple births or births of large infants
Most common cause of vaginal bleeding in 1st & 2nd trimesters
Abortions
Most common type of meningitis:
Most Lethal type of meningitis:
= Viral
= Bacterial
Mottling
“Blonching Blues” seen in sick pedis
Multiple Births) Suspect if:
Delivering:
= ABDMN remains large after delivery of 1 baby & labor continues
= Normal delivery guidelines Usually, 1 twin presents vertex & other breech.
Nasal flaring
Occurs from widening of the nostrils; seen primarily on inspiration
Per NREMT GPA Abortion:
= pregnancy that ended before 20 weeks’ gestation
Neonatal Airway Management
Position airway, suction only if obstruction present, intubate if necessary
Neonatal Bag-Valve-Mask (BVM) Considerations
Use appropriately sized mask, ensure good seal, avoid excessive pressure to prevent barotrauma
Neonatal Care) 1. Baby Handling:
2. Maintenance
3. Vitals
4. Common indicators for Baby resuscitation:
4.1 Baby Resuscitation
1= Newborns slippery; require both hands to support head and torso.
2= Keep warm, Routine suctioning not recommended, Drying & tactile stimulation will stimulate respirations, crying, activity.
3= RR 30-60PM HR 100-180BPM, APGAR Scoring: 0-10
4= Prematurity, pregnancy & delivery complications, maternal hx probs, inadequate prenatal care.
4.1=Assist ventilations using Pedi-BVM, Assess HR w/ stethoscope, start compressions if HR < 60BPM & not responding to ventilations & Transport to NICU
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
Neonatal Diarrhea Risks
Can cause severe dehydration & electrolyte imbalances, especially in breastfed infants
Neonatal Fever Considerations
> 100.4°F (38.0°C) is concerning; workup for sepsis if present
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
Neonatal Hypoglycemia Treatment
Dextrose 10% (D10) at 5-10 mL/kg IV bolus
Neonatal Hypotension Causes
Sepsis, blood loss, adrenal insufficiency, heart defects
Neonatal Hypothermia Treatment
Skin-to-skin contact, radiant warmer, warm IV fluids, prevent heat loss
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
Neonatal IO Access Indications
Needed if IV access is not possible & urgent meds/fluids required
Neonatal Jaundice
Common due to immature liver; treat severe cases with phototherapy or exchange transfusion
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
Neonatal Sepsis Signs
Lethargy, poor feeding, hypothermia, tachypnea, jaundice, bradycardia or tachycardia
Neonatal Hypovolemia Shock Signs
Pale, cool skin, poor capillary refill, weak pulses, lethargy
Neonatal Shock Treatment
Fluid resuscitation (10 mL/kg bolus NS or LR), treat underlying cause
Neonatal Vomiting Red Flags
Bilious (green) emesis suggests obstruction, dark blood indicates possible GI bleed
Newborn APGAR Score Components
Appearance, Pulse, Grimace, Activity, Respiration (scored 0-2 each, total 10)
Newborn Care Priorities Post-Delivery
Maintain warmth, clear airway, stimulate breathing, assess APGAR, early breastfeeding
Newborn Oxygenation Guidelines
Start with room air for resuscitation unless preterm or persistent cyanosis
Nulligravida:
Nullipara:
Grand multiparity:
= Woman has not been pregnant
= Woman has yet to deliver her 1st child
= Woman has delivered at least 7 babies
Antepartum:
Postpartum:
= Time interval prior to delivery of fetus
= Time interval after delivery of fetus
Obtaining OB Hx:
= vaginal bleeding or spotting major concern
= Color, amount, duration; events leading up to bleeding
Count number of sanitary pads or tampons used
If passing clots or tissue, save for evaluation
Determine whether patient thinks membranes have ruptured – When patient in active labor, assess whether mother feels need to push or has urge to move her bowels.
Occiput Posterior Position:
Baby Presentation:
Delivering complications:
Possible necessities:
= Infant descends facing forward; passage through pelvis delayed
= Presenting part may be face or brow
= Fetus cannot enter pelvis for delivery; vaginal delivery impossible
= Transport immediately; forceps or cesarean delivery often required.
Pedi Oliguria:
decreased urine output] Pedi <1ml/kg/hr
On average, most females will start menstruating how many days following ovulation?
14 days
Fetal Circulation) ductus arteriosus:
Connects what w/ what:
= Once in pulmonic artery, the blood enters the structure
= connects the pulmonary artery with the aorta.
openings of the fallopian tubes fn:
Two openings: a fimbriated (fringed) end opening into ABDMN cavity near the ovaries & a minute opening into the uterus.
ovarian torsion (adnexal torsion):
When an ovary becomes twisted around the tissues (stalk) that support it, similar in nature to a testicular torsion in a male.
Ovulation occurs due to the release of what in the body?
A surge of Luteinizing Hormone
Pain that occurs in the patient’s lower abdomen during ovulation is termed:
Mittelschmerz
PAT:
Components of PAT
A:
B:
C:
D:
= Across the room visual assessment
= ABCD
= Appearance: “Activity” Mental status
= Breathing: RRQ} nasal flaring, belly breathing, mouth breathing?
= Circulation: Skin CTC
= Disability
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
Pedi intubation indications
Bad physical signs NOT MONITORS
Pedi Polyuria
> 3ml/kg
Pedi PPV BVM rate:
1 every 2-3secs ~20-30breaths /min
Pedi Resp distress:
Pedi Resp failure:
= “Huffing & Puffing Enough” to sustain life
= “failure to respirate to sustain life” >60RR
Pedi Tension Pneumo decomp:
3rd rib 2nd ICS Chest wall thickness in anterior chest varies from 1.4 – 1.6 cm (0.55 - .63 inches)
Pedi Vocal cords differences
more anterior & superficial
Pediatric Airway Differences
- Larger tongue, floppy epiglottis - Narrowest airway @ cricoid, not vocal cords - More anterior airway
Pediatric Airway Management Positioning
- Neutral sniffing position prevents airway collapse - Padding under shoulders for younger children
Pediatric Assessment Triangle (PAT) Components
- Appearance: LOC, interactiveness, muscle tone (TICLS: Tone, Interactiveness, Consolability, Look/gaze, Speech/cry)
- Work of Breathing: Visible effort, abnormal sounds
- Circulation to Skin: Color, capillary refill, mottling
Pediatric Bradycardia Treatment
- If hypoxic → Oxygen & ventilation
- If unstable → Epinephrine 0.01 mg/kg IV/IO
- Atropine (0.02 mg/kg) if vagal cause suspected
Pediatric Cardiovascular System Considerations
- Stroke volume is fixed, CO dependent on HR
-Hypotension is a late sign of shock - Bradycardia often secondary to hypoxia
Pediatric Cervical Spine Injury Considerations
- SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) is more common
- Use pediatric C-collars & padding under shoulders
Pediatric Chain of Survival
- Prevention
- Early CPR
- Early 911
- Rapid ALS
- Post-Arrest Care
Pediatric CPR Compression Depth & Rate
- Depth: 1/3 to 1/2 of chest AP diameter
- Rate: 100-120/min
- Ratios: 30:2 (1 rescuer), 15:2 (2 rescuers), 3:1 (newborns)
Pediatric GCS (Glasgow Coma Scale):
= Modified to assess eye opening, verbal response, motor response
Pediatric GCS 0-24Mns changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
Pediatric GCS 2-5Yrs changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
Pediatric GCS (Glasgow Coma Scale):
= Modified to assess eye opening, verbal response, motor response
Pediatric GCS Differences
- Modified for age
- Verbal & motor responses changed for age
Pediatric Nervous System Considerations
- Brain is larger relative to body size → higher risk for head injury
- Fontanelles remain open until ~18 months
- Spinal cord ends at L3 (vs. L1-L2 in adults)
Pediatric Respiratory Arrest Causes
- Respiratory distress → failure → arrest
- Shock (hypovolemic, distributive, cardiogenic)
- Sudden cardiac arrest (rare, often arrhythmia-based)
Pediatric Respiratory System Considerations
- Ribs are more pliable → rely more on diaphragm
- Higher oxygen demand & metabolic rate
- Less functional residual capacity (FRC)
Pediatric Shock Types & Causes
- Hypovolemic: diarrhea, Vomiting, hemorrhage
- Distributive: Sepsis, anaphylaxis
- Cardiogenic: Congenital heart defects, myocarditis
- Obstructive: Tension pneumothorax, tamponade
Pediatric Thermoregulation Considerations
- Higher surface area-to-mass ratio → heat loss easier
-Brown fat for thermogenesis
-Increased risk of hypothermia
Pediatric Vital Signs Considerations
- HR, RR higher than adults
- BP lower than adults
- Hypotension is a late shock sign
Pediatric Weight Estimation Formulas
New: (Age × 3) + 7 = kg
Old: (Age + 4) × 2 = kg
Pertussis AKA:
Absolute sign:
S/S:
= “Whooping cough” bacterial infection (<6Yrs)
= “whoop” sound after a coughing attack
= Low grade fever, Rhonchi, can be dehydrated
PID (Pelvic Inflammatory Disease):
Organs commonly involved:
More prone to:
= infection of sex organ/s, often caused by untreated STDs (EX: gonorrhea, chlamydia)
= uterus, fallopian tubes, ovaries.
= It leads to inflammation, scarring, & can increase the risk of ectopic pregnancy.
Most common & hypothesized every women had at least once sexual pathology:
Common problem w/ fertilization:
= PID Pelvic Inflammatory Diseases
= Inflammation of endometrium thus swelling cutting of fallopian tube & semun gets stuck
Placenta Accreta
placenta embeds itself into uterus & Wont be able to remove self from uterine wall
Percreta: embedded through all 3 metriums & attaches to organ
Placenta Previa:
= placenta dev/ before uterus so cervix dilates & tears placenta after dropping mucus plug (treat internal hemorrhage for shock & pad vagina)
Abruptio Placentae:
= VERY PAINFUL trauma (can be fall onto but or car crash) placenta rips away from uterine way, bright red hem rips away cervix, concealed no leaking,
PMS:
Physical S/S prior to period:
= premenstral syndrome caused by hormones
= Breast tenderness or engorgement, Weight gain or bloating, Excessive fatigue, Cravings for specific food, Migraine headaches, Emotional responses
Pneumonia:
= general term of lung infection (Bacterial or Viral), Often 2ndary of a infection & Leading cause of death in children
Postpartum Hemorrhage:
Causes:
Profound Hemorrhage/Shock:
= Loss of more than 500 mL of blood following delivery
= Lack of uterine muscle tone, Multigravida or following multiple births or births of large infants, Uterine Rupture: Actual tearing, or rupture, of uterus, Uterine Inversion
= Blood loss: 800 to 1,800 mL’s
Precipitous Delivery:
Complications/affects:
Baby Care:
= Occurs after < 3Hrs of labor
= Higher-than-normal incidence of fetal trauma, tearing of umbilical cord, maternal lacerations.
= Attempt to control infant’s head & kept warm
Preeclampsia:
Increase in SBP by 30 mmHg and/or diastolic increase of 15 mmHg over baseline on least two occasions at least 6 hours apart.
Preembryonic Stage:
Embryonic stage:
Fetal stage:
= First 14 days following conception
= Begins at day 15 and ends at 8 weeks
= 8 weeks until delivery
Pregnancy is broken down into 3 stages:
Preembryonic, Embryonic stage, & Fetal Stage
Pregnancy’s effect on) GI:
Urinary:
Musculoskeletal:
= Slower motility (peristalsis) → constipation hemorrhoids
= ↑ frequency due to bladder compression.
= Loosened ligaments → joint pain possiple Lordosis
Prenatal Period:
It is the time from conception until delivery of fetus
Preterm Labor:
Rx:
= True labor begins before 38th week (Potentially life threatening situation for mother & fetus)
= Stopped if possible (tocolysis) Admin IV fluid bolus; Inhibits oxytocin release, often causing cessation of uterine contractions. (Mag-Sulfate or beta-agonist may be admin/ to stop labor)
Primigravida:
Primipara:
= Woman pregnant for first time
= Woman who has given birth to 1st child
PRN Temp is most accurate for
PO PA temp will work for
= infants and toddlers
= older children
problem with children reporting SAs:
Many children wait to report or never report sexual abuse. (estimates vary across studies
about 1 in 4 girls and 1 in 13 boys experience child sexual abuse at some point in childhood.
Of these, 91 percent of child sexual abuse is perpetrated by someone the child or child’s family knows.
= Many children wait to report or never report sexual abuse. (estimates vary across studies
about 1/4 girls and 1/13 boys experience child sexual abuse at some point in childhood.
Of these, 91 percent of child sexual abuse is perpetrated by someone the child or child’s family knows.
Acquaintance rape is particularly common among adolescent victims.
Prolapsed Cord:
Risks:
= Umbilical cord precedes fetal presenting part
= Potentially shuts off fetal circulation, Serious emergency & Fetal death w/o prompt intervention
“proliferative phase” of the menstrual cycle?
The endometrium thickens and becomes engorged with blood
PT w/ preterm labor has been given corticosteroid steroids
= accelerate fetal lung maturity.
Pulmonary Cystic Fibrosis
Rx:
=Disease dysFn/Inoperation alters Na channels creates more channels thus produce mucus,
= Might have to use cuffed ETT & disable pop-off valve b/c high compliance w/ ABC Support
Febrile seizure:
when pyrogen production stops:
Fever hard to differentiate from heatstroke; neuro symptoms may present w/ either Treat:
= fever seizure with kid & cool down
= Hypothalamic thermostat will reset to normal
= for heatstroke if you are unsure which it is * If child history of febrile seizures, treat for fever.
What internal organs are part of the female reproductive system?
Ovaries, fallopian tubes, uterus, & vagina.
What is delayed cord clamping?
Waiting to cut the umbilical cord to allow extra blood transfer to baby
What is the role of external female genitalia:
What are the parts of the external genitalia:
= protect body openings & play a role in sexual function.
= vulva, mons pubis, labia majora/minora, & glands (Skene’s & Bartholin’s).
Why are women more prone to UTIs than men:
= Shorter urethra allows bacteria to travel more easily to the bladder. Infection can progress to kidneys, causing pyelonephritis
umbilical cord turn white before cutting meaning:
It is normal and means it has shunted itself closed
Respiratory Distress:
Respiratory Failure:
= Open & Maintainable , Tachypnea , Good Air Movement, Tachycardia, Pallor (pink/white cheek), Anxiety, Agitation
= Not Maintainable, Bradypnea to Apnea, Poor/Absent Air Movement, Bradycardia, Cape Cyanosis, Lethargy/Unresponsive
Retraction
Is sinking of the skin and soft tissues of the chest visible around and below the ribs and above the collarbone
Wheezing
Is low- or high-pitched sound that occurs when air passes air over mucus secretions or airway is constricted in the bronchi; heard more commonly on expiration; a l
rupture of the membranes (ROM)
amniotic sac breaks & leaks amniotic fluid out of vagina
Mom) 12-24Wks 2nd tri/ uterine changes:
= displaces most ABDMN upward; uterus rises out of pelvis & its upper border extends above the umbilicus
Secretory phase:
If fertilization does not occur:
= Uterine vascularity increases during this phase in anticipation of implantation of a fertilized egg
= Ischemic Phase) estrogen and progesterone levels fall. Vascular changes cause the endometrium to become pale and small blood vessels to rupture.
Several surgical treatments uterine fibroids are:
Hysterectomy:
Myomectomy:
Scleroses:
= removing uterus, various fibroids, & radiation
= complete surgical removal of the uterus
= surgical removal of the various fibroids
= interventional radiology procedure that blocks the blood supply to a particular fibroid, causing it to die and slough off.
Shoulder Dystocia:
Causes:
Baby presentation:
Delivering:
= Infant’s shoulders larger than head
= Diabetic & obese mothers; post-term pregnancies.
= Head retracts back into perineum; shoulders trapped between pubic symphysis & sacrum
= Have mother drop butt off end of bed; flex thighs upward to facilitate delivery & Apply firm pressure w/ open hand immediately above pubic symphysis (McRobert’s Maneuver)
Sick Pedi Symptoms always suspect:
They got menigitis
SIDS
Sudden Infant death Syndrome
When everything else is ruled out & found from autopsy
Signs of Neonatal Hypoxia
Cyanosis, nasal flaring, grunting, tachypnea, bradycardia
Signs of Pediatric Increased ICP
- Bulging fontanelles (if <18 months)
- Unequal pupils
- Vomiting, bradycardia, hypertension
Signs of Pediatric Respiratory Failure
- Early: Tachypnea, retractions, nasal flaring, grunting
- Late: Bradypnea, cyanosis, altered LOC
Signs of Respiratory Distress in Newborns
Nasal flaring, grunting, retractions, cyanosis, tachypnea
Simple Steps of Before & After of delivering) 1.1
1.2
2.1
2.2
3.1
3.2
4.1
4.2
4.3
1.1(Prep) OBYGN Kit Out, Set up shop, Monitors on
1.2(Cover) 1 Sheet for Poop, Cover mom & Self
2.1(Position) Butt Up, Legs bent & wide
2.2(Coach) Breath, push w/ contraction, & repeat
3.1(Head & Turn) Pressure with head & turn for shoulders
3.2(Support) Support shoulders/body
4.1(Cord) Clamp & Cut after 30secs Cut
4.2(Mom&Kid) Dry & Cover warmth for kid then mom’s tit
4.3(Placenta) Fundal massage for placenta delivery
If > 30-60 days since PT’s LMP, you should assume:
Spontaneous Abortion
Spontaneous abortion:
often called:
most commonly seen w/ & before:
Estimated % of pregnancies effected:
If the pregnancy has not yet been confirmed:
= naturally occurring termination of pregnancy
= Miscarriage
= between 8-14Wks gestation & before 12Wks
= ~10-20% of all pregnancies end in spontaneous abortion.
= the woman often assumes she is merely having a period w/ unusually heavy flow.
Stages of Labor & Delivery
1st (contractions to full dilation), 2nd (delivery of baby), 3rd (delivery of placenta)
Steeple sign:
= w/ xray has church steeple from epiglottitis
Steps for placenta delivery & postpartum mom care:
Do not pull on umbilical cord.
Deliver placenta & transport w/ mother.
Massage uterine fundus.
Encourage baby to latch on mother’s breast to stimulate uterine contractions.
Steps to prepare delivery area for field delivery) Step 1:
Step 2:
Step 3:
Step 4:
1 Equipment & facilities prepared quickly.
2 Delivery area set up out of public view.
3 PT on back w/ knees & hips flexed, butt slightly elevated
4 Drape mother w/ toweling: under buttocks, below vaginal opening, & across lower ABDMN
Stridor
(2/3 occlusion) Is abnormal, musical, high-pitched sound, more commonly heard on inspiration
Suction form:
How to estimate weight:
= 2 x ETT
= (Age x 3) + 7 = Approximate weight in kg
Sudden unexpected infant death (SUID)
Acute death during 1st Yrs of life from a cause that was unpredictable & cannot be identified before investigation.
If the cause of death cannot be identified by doctors after investigation & even after autopsy, it is then classified as sudden infant death syndrome
Heart defect categories
Tetralogy of Fallot (TOF):
=Decrease pulmonary blood flow
= 4 dif/ defects, also commonly have other defects
4: pulmonic valve stenosis, VSD, overriding aorta (over VSD), RV hypertrophy
Blue membranes/babies “Tet Spell” & pump legs into ABDMN or kid squat to increase after load pressure (hang NORepi to increase pulmonic afterload pressure)
Immediately after ovulation, the site from which the egg was released becomes the:
corpus luteum
The letter “L” in the GPAL acronym refers to:
The number of children that a patient has living
The mons pubis:
Primary fn:
= fatty tissue over pubic symphysis, the junction of pubic bones
= cushion for pubic symphysis during intercourse
The monthly development of small corpus luteum cysts rupture
a small amount of blood is spilled into the abdomen. Because blood irritates the peritoneum, it can cause abdominal pain and rebound tenderness.
The number one killer of pregnant females is:
Trauma
The ovaries secrete what hormones:
Where do most eggs get fertilized at?
Ovulation occurs due to the surge of what:
= Estrogen & progesterone
= distal third of the fallopian tube
= Luteinizing Hormone
The perineum Fn:
2 common causes for it tearing:
An episiotomy & indications:
= form slinglike structure supports internal pelvic organs & is able to stretch during childbirth.
= This area is sometimes torn as a result of sexual assault or during childbirth.
= incision of perineum facilitates birth & to prevent spontaneous tearing
The uterus has two major parts:
The upper two-thirds of the uterus:
The lower third of the uterus:
Rounded uppermost body portion of the uterus:
= the body (corpus) & the cervix (or neck)
= forms body; consists of smooth muscle layers
= is the cervix
= is the fundus, which lies above the point at which the fallopian tubes attach.
Abortion classifications) therapeutic abortion
= Termination of a pregnancy deemed necessary by a physician, usually to protect maternal health & well-being
TICLS) T
I
C
L
S
= Tone (m tone)
=Interactivity/mental status
= Consolability
= Look or Gaze “100 Yrd stare”
= Speech or Crying
Tocolysis
Process of stopping/pausing delivery/labor
Transitional Phase
- “Talking Phase of building rapport w/ Pedi (GOOD PATs)
-Toe to head exam & @ eye Lvl
mLs range in uterus
= 50mLs-1.5Ls in uterus
Baby’s Blood:
Umbilical cord veins & Arteries
= should never mix w/ Mom’s blood; Babys blood has higher oxy affinity & steal blood
= 2 arteries & 1 vein on umbilical’s cord) vein bigger than artery (smilely pic) Vein brings oxy & art deoxy}
Tubo-ovarian abscess (TOA):
Rupture of the abscess can lead to:
= pocket of pus that forms b/c an infection in a fallopian tube & ovary (adnexa) ~result of PID
= sepsis & other complications including frank peritonitis. Rqs prompt eval/ & Rx of parenteral antibiotics &, in certain situations, surgical drainage.
The fallopian tubes & AKA also called:
Fallopian tubes’ Fn:
Fertilization usually happens where:
= “uterine tubes” thin flexible tubes laterally from uterus & curve up & over each ovary
= conduct the egg from space around the ovaries into uterine cavity via peristalsis (wavelike contractions)
= in the distal third of the fallopian tube
Umbilical Cord Clamping Timing
Clamp & cut 30-45 seconds after birth, inspect for continued bleeding
Umbilical Vein Cannulation Indications
Emergency venous access in neonatal resuscitation, fluid resuscitation
Until what age is a pediatric patient classified as a ‘neonate’?
1 month.
Upper airway in Pedis:
= Anything above carina
Use of more than 2 sanity pads per hour =
significant bleeding & If passed tissue bring it
Uterine atony
Lack of necessary uterine musculature
Uterine Inversion:
Causes:
= Rare emergency; uterus turns inside out after delivery; extends through cervix.
= profound shock; Blood loss 0.8Ls-1.8Ls
Uterus 3 main jobs:
= Fucked, Fucking, Bleeding (Ovarys DONT connect to fallopian tubes)
vascular system of uterus contains how much of pregnant woman’s total blood volume
= one-sixth (16 percent) of the pregnant woman’s total blood volume.
Fetus Oxygenation
Higher oxygen affinity
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
pediatric spine w/ head/neack trauma)
Positive:
Negative:
= no hard aduld discs
Positive: no intervertebral discs so more room for m-nt
Negative: More prone to invisible disc injuries (SCIWORA)
What are common forms of contraception?
= Condoms, IUDs, birth control pills, diaphragms, spermicides, & rhythm/withdrawal methods (“pull-out game”).
What are the 2 primary functions of the ovaries?
- Secrete estrogen & progesterone in response to FSH & LH from the anterior pituitary.
- Dev/ & release eggs (ova) for reproduction.
What are the 3 parts of the Primary Assessment Triangle (PAT)?
Appearance, Work of breathing, Skin color
What are the causes of neonatal seizures?
Causes include hypoxia, hypoglycemia, sepsis, meningitis, drug withdrawal.
What are the characteristics of Pierre Robin Syndrome?
Small jaw, large tongue, cleft palate, leading to airway obstruction
Newborn def
birth till a few hours old
What are the fetal circulatory shunts?
Ductus Venosus, Foramen Ovale, Ductus Arteriosus
What are the hormones involved in ovulation:
= FSH (follicle-stimulating hormone) triggers egg maturation, & LH (luteinizing hormone) signals ovulation.
What are the maternal factors for preterm labor?
Contributory factors:
=Cardiovascular disease, Renal disease, Pregnancy-induced HTN (PIH), Diabetes, ABDMN surgery during gestation,
Uterine & cervical abnormalities, Maternal infection, Trauma to ABDMN
=Hx of preterm birth, smoking, and cocaine abuse
What are the mechanisms of heat loss in newborns?
Evaporation (fluid loss), Convection (air currents), Conduction (contact w/ cold surface), Radiation (heat transfer to surroundings)
What are the normal newborn vitals?
RR: 40-60 bpm,
HR birth: 150-180 bpm & after birth: 130-140 bpm
HR < 100 bpm = distress
What are the risk factors for ruptured ovarian cyst:
History of dyspareunia, irregular bleeding, or a delayed cycle
What are the stages of delivery?
1st (labor onset to full dilation), 2nd (delivery of neonate), 3rd (delivery of placenta)
What are the steps in newborn resuscitation?
Dry, warm, position, stimulate; if HR < 100, positive pressure ventilation (PPV); if HR < 60, CPR (3:1 compressions-to-ventilation ratio)
What blood glucose level in a newborn is considered hypoglycemia?
Less than 45 mg/dL.
What does the APGAR score assess?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes
What does the umbilical cord usually contain?
1 vein 2 arteries
What happens during menopause:
S/S:
= marks cessation of ovarian Fn, estrogen production, & menstrual cycles, ~occurring 45-55Yrs
= hot flashes, mood swings, & vaginal dryness, osteoporosis
What happens to the vital signs of a pediatric patient as they get older?
Both heart rate and ventilation rate decrease with age, but blood pressure increases.
What is a Diaphragmatic Hernia?
Abnormal opening in diaphragm, requires proper positioning and respiratory support.
Diaphragmatic Hernia happens where
Bochdalek (weak spot on LL of diaphragm)
What is common in the newborn’s skin color immediately after birth?
Cyanosis of the extremities is common, but central cyanosis is abnormal.
What is considered the most common cause of maternal death during the first trimester?
Ectopic pregnancies
What is cystitis:
If untreated, can progess to:
bladder infection
= kidneys infected (pyelonephritis), kidney damage, sepsis, dialysis
What is hypoglycemia in newborns?
BG < 40 & 45 neonates mg/dL, treated w/ D10 (5-10 mL/kg)
What is hypovolemia in newborns?
Leading cause of neonatal shock; results from dehydration, hemorrhage, third-spacing
What is Patent Ductus Arteriosus (PDA)?
Ductus arteriosus fails to close, leading to abnormal blood flow between aorta & pulmonary artery
What is Pierre Robin Syndrome?
Small jaw, large tongue, cleft palate, leading to airway obstruction.
What is the APGAR score for an infant with the following: Appearance = completely cyanotic, Pulse = below 100, Grimace = frowns when stimulated, Activity = limp, Respiration = slow, irregular?
3.
What is the APGAR Score?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes.
What is the appropriate depth for chest compressions in a child?
2 inches
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
What is the breathing assistance needed for neonates?
Most neonates breathe spontaneously; some need assistance, few require extensive resuscitation, and meds are rarely indicated.
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
What is the CPR rate for a 6-month-old infant found unconscious?
At least 100/minute; ratio 15:2; depth 1/3 to 1/2 the depth of the chest
What is the definition of a premature newborn?
An infant born before 38 weeks gestation.
Omphalocele
abdominal contents protrude through umbilicus, covered by sac;
Gastroschisis?
“Hole for gas” (intestines protrude w/o covering)
What is the difference between Primary and Secondary Apnea?
Primary: brief apnea with bradycardia, responds to stimulation; Secondary: prolonged apnea requiring resuscitation.
What is the function of the corpus luteum?
After ovulation, the corpus luteum forms at the site of the released egg & secretes progesterone & estrogen to maintain the uterine lining.
What is the function of the labia majora:
Structure & Fn of the labia minora:
= Protect the inner structures of the vulva
= Pleasure; engorge in blood & lubricate via sebaceous glands (Skene & Bartholin)
What is the function of the prostate gland in males:
The prostate gland produces a fluid that nourishes sperm & aids in its motility during ejaculation.
What is the GCS score for a 2-year-old with Eye Opening: To pain, Motor Response: Withdrawal, Verbal: Cries and Screams?
9
What is the GCS score for a 5-year-old with Eye Opening: To verbal, Motor Response: Localizes, Verbal: Inappropriate words?
12
What is the GCS score for a 7-year-old with Eye Opening: To pain, Motor Response: Extension, Verbal: Incomprehensible sounds?
6
What is the leading type of shock in newborns and all pediatric patients?
Hypovolemia.
What is the most common cause of bradycardia in the newborn?
Hypoxia.
What is the most common factor causing respiratory distress and cyanosis in the newborn?
Prematurity.
What is the most effective initial treatment for bradycardia in the newborn?
Oxygen.
What is the neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter
What is the procedure for umbilical vein cannulation?
Trim cord to 1 cm, insert 5-Fr catheter into umbilical vein, secure w/ umbilical tape
What is the rescue breathing rate for a pediatric patient?
1 breath every 2-3 seconds
Significance of Braxton Hicks contractions:
= irregular uterine contractions during pregnancy that help the uterus prepare for labor. They don’t cause cervical dilation.
What is the typical breathing assistance needed for neonates?
Most neonates breathe spontaneously, some need assistance, few require extensive resuscitation, and meds are rarely indicated.
What is the vestibule, and what does it contain?
= The area protected by the labia minora; it contains the urethral opening, vaginal orifice (introitus), & the hymen.
What is Transposition of the Great Arteries (TGA)?
Aorta & pulmonary artery switched, requiring immediate intervention
leg pumping
% of childbirths are uneventful & complicated?
= 96% are uneventful, 2% have complications
What pulse site should be used for an unconscious 18-month-old pediatric patient?
Brachial
What should a newborn’s heart rate normally be at birth?
150–180 at birth, slowing to 130–140 thereafter.
What should a normal newborn’s respiratory rate average?
40–60 breaths per minute.
What should the presence of a fever in a neonate be considered?
A sign of meningitis or another life-threatening infection until proven otherwise.
What should you do if a newborn is very limp with central cyanosis and no apparent respiratory effort?
Begin resuscitation immediately.
What sign w/ Pedis indicates immediate Rx/Venting
Grunting
What usually causes cardiac arrest in infants and children?
Respiratory failure or arrest
When does the anterior fontanelle of a pediatric patient generally close?
9-18 months
When does the posterior fontanelle of a pediatric patient generally close?
3 months
posterior fontanelle usually closes
anterior fontanelle closes
= in 2 or 3 months
= between 9 and 18 months
When maternal blood volume increases, pregnant women will often receive supplemental iron to prevent anemia. This is because:
Although both red blood cells and plasma increase, there is slightly more plasma.
Where do most deliveries of babies occur?
in the hospital
Where do most spinal injuries occur at for pediatric patients?
C2 (phrenic nerve)
Why Are Children More Prone to Head Injuries?
- Larger head-to-body ratio
- Weaker neck muscles
- Thinner skull bones
Why is postpartum pulmonary embolism a risk?
It is a risk due to a hypercoagulable state; amniotic fluid embolism is possible.
With vaginal discharges, document what:
NEVER EVER EVER PERFORM:
Document the color and character of the discharge as well as the amount and the presence or absence of clots.
= internal vaginal exam in the field (WE AINT DOCs)
Roughly, how many days does the hormone cycle for preparing the uterus to receive a fertilized egg
generally every 28 days
You are taking care of a female patient that has been involved in a serious motor vehicle accident. The patient is complaining of severe “tearing” abdominal pain and states she is eight months pregnant. Which of the following would you suspect this patient is most likely suffering from?
Abruptio Placentae
1st 14 days following conception
Preembryonic Stage
“Spontaneous abortion” used to describe:
expulsion of the fetus before 8 weeks of gestation
