EMS “Live” In-Station Continuing Education - UTSW Obstetrics WEB VERSION.pdfEMS “Live”...

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EMS “Live” In-Station Continuing Education CE Provider: University of Texas Southwestern Medical Center at Dallas

Department of Emergency Medicine Course Title: Obstetrical and Newborn Care Course Approval Number: UTSW – 4M2016

TDH – 101606 Date: April 2016 National Registry Content Area and Hours:

4.0 hours: Flexible: Obstetrics and Pediatrics

TDH Content Area and Hours:

2.0 hours: Medical 2.0 hours: Special Considerations

Skills Proficiency Verification:

None

Class Location: __________________________________________________________ Instructor Name: __________________________________________________________ Student Name: __________________________________________________________

In order to accrue the CE hours required for recertification, the student must attend and participate in the live CE

component represented by this module and complete the required skill demonstrations. This form shall serve as a written record of the participant's successful completion of the EMS educational activity as outlined in the Texas Administrative Code, Title 25, Part 1, Chapter 157, Subchapter C and as outlined in CECBEMS Standards and Requirements for Organization Accreditation.

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Obstetrical and Newborn Care

Cognitive Objectives: Upon successful completion of this course, the student will be able to:

• Assess and provide care to an obstetric patient • Provide care to a newborn • Provide care to a mother immediately following delivery of a newborn

Psychomotor Objectives:

• No psychomotor objectives listed for this CE module Affective Objectives:

• No affective objectives listed for this CE module This continuing education activity is approved by the University of Texas Southwestern Medical Center at Dallas, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS). You have participated in a continuing education program that has received CECBEMS approval for continuing education credit. If you have any comments regarding the quality of this program and/or your satisfaction with it, please contact CECBEMS at: CECBEMS -5111 Mill Run Road -Dallas, Texas 75244 - (972) 387-2862 [email protected]. CECBEMS is an organization established to develop and implement policies to standardize the review and approval of EMS continuing education activities. The cosponsoring organizations of CECBEMS are the National Association of Emergency Medical Technicians, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians, the National Association of State Emergency Medical Services Directors, the National Council of State Emergency Medical Services Training Coordinators, and the National Registry of Emergency Medical Technicians, and the National Association of EMS Educators.

Kenneth Navarro

CE Program Coordinator Gil Salazar, MD

CE Program Medical Director

For ECG practice or review, visit www.ecglibrary.com. To access the latest version of the protocols, for patient care alerts or updates on new medications, visit www.biotel.ws. References and bibliographies for all CE modules are on file and available upon request. To comment on this module, good or bad, e-mail [email protected]

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Obstetrical and Newborn Care

Introduction Under normal conditions, the arrival of a child is a joyous occasion welcomed by all involved.

Giving birth in the prehospital environment is less than ideal, but in most cases is still a happy event.

This section will focus on the care of the obstetrical patient before, during, and after childbirth, along

with care of the newborn and some abnormal delivery emergencies.

Anatomy and Physiology Review

Exercise 1: Name the structure that usually receives the egg once it is released from the ovary.

Answer:

Exercise 2: Label the following structures.

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Exercise 3: How many days does it take for the egg to reach the uterus after being released from the ovary?

Answer:

Exercise 4: Match the anatomical term with the appropriate definition

Anatomical Term Definition

Cervix A Bag that surrounds the fetus

Vagina B Produce eggs and hormones

Corpus C Conception usually occurs here

Ovaries D Transfers oxygen to baby’s blood

Placenta E Connects the placenta to the fetus

Mucus plug F Seals the cervix during pregnancy

Amniotic sac G Part of the uterus that opens to the vagina

Umbilical cord H Part of the uterus that holds the developing baby

Fallopian tubes I Fibrous muscular tube also known as the birth canal

Placental barrier J Prevents some substances from reaching baby’s blood

Exercise 5: You are caring for a 26 year-old female complaining of lower abdominal pain. Her reproductive history is G4-P2-AB1.

How many times has she been pregnant?

How many babies does she have?

How many miscarriages has she had?

Is she pregnant now?

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Exercise 6: Match the event with the appropriate pregnancy trimester

Event Pregnancy Trimester

Leg cramps begin A First Trimester

Heart rate highest B Second Trimester

Blood pressure lowest C Third Trimester

Very little uterine enlargement

All essential fetal body parts form

First sensation of fetal movement

Change in maternal center of gravity

Mother experiences nausea/vomiting

Mother experiences breast tenderness

Period of well-being with few symptoms

Elevated diaphragm causes shortness of breath

Increased maternal blood volume (physiologic anemia)

Exercise 7: What do these obstetrical abbreviations mean?

Estimated Date of Confinement

Last Menstrual Period

Bag of Water

Fetal Heart Tones

Rupture of Membranes

Exercise 8: How did the term represented by the abbreviation EDC come to be?

Answer:

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Exercise 9: You completed supine spinal immobilization on a third trimester primigravida woman. She appeared normal before the immobilization but now is pale, diaphoretic, cool to the touch, tachycardic, and hypotensive. How can you explain this?

Answer:

Exercise 10: The blood pressure in non-pregnant humans typically begins to drop at about 15% loss of blood volume. How much blood loss is required to produce hypotension in a near-term female? Why?

Answer:

Exercise 11: Will maternal compensatory mechanisms keep blood and oxygen flowing to the fetus at the expense of her own organs? What are the implications of that answer?

Answer:

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Exercise 12: When caring for a pregnant woman with a medical or traumatic emergency, what action (on your part) will provide the fetus with the best opportunity for survival?

Answer:

Exercise 13: What is the danger of using a vasopressor like dopamine as a first-line agent for raising a gravid female’s blood pressure?

Answer:

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Exercise 14: Match the event with the appropriate stage of labor.

Event Stages of Labor

Urge to push A First Stage

Cervix dilates B Second Stage

Baby is expelled C Third Stage

Placenta is delivered

Expulsion of mucus plug

Cervix is completely dilated

Amniotic sac frequently ruptures

Usually less than one hour in duration

Lasts for many hours in first pregnancies

Contraction increase in intensity but not duration

Averages about an hour and a-half in first pregnancies

Exercise 15: Sequentially order your actions during a normal out-of hospital delivery.

Prep

Elevate the buttocks with pillows or blankets

Place the mother on her back with her knees’ widely separated

If time permits, don clean gloves, a mask, gown, and eye protection

Delivery of Baby

Deliver shoulders

Suction the baby’s mouth

Suction the baby’s nasal passages

Deliver the infant’s body delivers rapidly

Encourage mother NOT to push as the head emerges

Have the mother take slow deep breaths through her mouth

Place the palm of one hand gently over the advancing head of the fetus

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Exercise 16: What term is used to describe an umbilical cord wrapped around a baby’s neck?

Answer:

Exercise 17: What should you do if the umbilical cord is wrapped around the infant’s neck when the head delivers?

Answer:

Exercise 18: What should you do if that doesn’t work?

Answer:

Exercise 19: Sequentially order your actions during a normal out-of hospital delivery

After Delivery

Clamp the umbilicus

Cut the cord between the two clamps

Suction the baby’s mouth and nose again

Support the infant at the level of the vagina

Wrap the infant in a clean, dry, warm blanket

Examine the cut ends of the cord for bleeding

Wipe the blood and mucus from the baby’s face

Place the baby on its side to facilitate draining of the airway

Exercise 20: Which shoulder is usually the first to deliver?

Answer:

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Exercise 21: Name two presentations that demand immediate transport even though the baby has not delivered.

Answer:

Exercise 22: What stimulus causes the baby to take his or her first breath?

Answer:

Exercise 23: Will a prolapsed cord always be visible hanging out of the vagina?

Answer:

Exercise 24: What is the danger of using your trauma shears to cut the umbilical cord?

Answer:

Exercise 25: After clamping and cutting the umbilical cord, you notice that the end attached to the baby is still oozing blood. What should you do?

Answer:

Exercise 26: What are three basic steps that you must take to prevent the deterioration of the infant once delivery is complete?

Exercise 27: What is the medical term that describes a newborn with a pink trunk and blue hands and feet?

Answer:

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Exercise 28: What is the highest and lowest possible APGAR score for a newborn?

Highest Lowest

Exercise 29: Fill in the APGAR information

Score 0 Score 1 Score 2

Exercise 30: What is the leading cause of death for gravid females?

Answer:

Exercise 31: What is the leading cause of traumatic death for the fetus?

Answer:

Exercise 32: What is the most common complication of pregnancy?

Answer:

Exercise 33: Who is more likely to have this complication?

Women under the age of 20 years Women over the age of 20 years

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Exercise 34: Who is more likely to die from this complication?

Caucasian women African American women

Exercise 35: Correctly Identify the obstetrical emergency.

Spontaneous termination of pregnancy before the 20th gestational week

Hypertensive disorder developing after 20th week gestation that results in

significant loss of protein in urine

Hypertonic disorder in pregnancy characterized by the appearance of clonic-

tonic seizures

Pregnancy that develops outside of the uterus, typically in the Fallopian tube

Separation of the normally located placenta after the 20th week of gestation

and prior to birth

Implantation of the placenta over or near the cervix

Exercise 36: Which of the above obstetrical emergencies can occur during the post partum period?

Answer:

Exercise 37: What is the most common cause of maternal death associated with the obstetrical emergency identified in exercise 35?

Answer:

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Exercise 38: What is the drug of choice for the management of eclamptic seizure within the BioTel system?

Answer:

Exercise 39: What is the definitive treatment for eclampsia?

Answer:

Exercise 40: Who is more likely to die from eclampsia?

Caucasian teenagers Minority teenagers

Exercise 41: Which increases the likelihood of an ectopic pregnancy?

Pregnancy between the ages of 25-34 years

Use of fertility drugs

Use of oral contraceptives

Use of intrauterine devices (IUD)

Prior tubal infection

Structural abnormalities of the fallopian tubes

Uterine anomalies

Exercise 42: What is the primary cause for non-traumatic abruptio placenta?

Answer:

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Exercise 43: Which are risk factors for the development of non-traumatic abruptio placentae?

Alcohol use

Cocaine use

Multiple gestation

Previous abortion

Cigarette smoking

Advanced maternal age

First pregnancy following a cesarean delivery

Exercise 44: Who is more likely to develop placenta previa?

Women over age 30 years Women under age 30 years

Exercise 45: Which are risk factors for the development of placenta previa?

Alcohol use

Cocaine use

Multiple gestation

Previous abortion

Cigarette smoking

Advanced maternal age

First pregnancy following a cesarean delivery

EMS “Live” In-Station Continuing Education - UTSW Obstetrics WEB VERSION.pdfEMS “Live”...

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