EMS 81 Final Part 1 PDF

Pathophysiology of Bleeding Related to Pregnancy Abruptio placenta (cont’d) Patient will report: Sudden onset of severe abdominal pain No longer feeling the fetus moving Vaginal bleeding with dark red blood Breech Presentations If buttocks are...

Pathophysiology of Bleeding Related to Pregnancy Abruptio placenta (cont’d) Patient will report: Sudden onset of severe abdominal pain No longer feeling the fetus moving Vaginal bleeding with dark red blood Breech Presentations If buttocks are presenting and delivery is imminent: Position the woman with buttocks at edge of bed or stretcher, legs flexed. Allow newborn’s buttocks and trunk to deliver spontaneously. Once the legs are clear, support the body. Lower the newborn slightly. Shoulder Dystocia Difficulty in delivering the shoulders. If the shoulders cannot clear the birth canal, the fetus cannot breathe. A major concern for the newborn is brachial nerve plexus damage. Shoulder Dystocia McRoberts maneuver Hyperflex the woman’s legs tightly to the abdomen. You may need to apply pressure to the lower abdomen and gently pull on the fetus’s head. Nuchal Cord The umbilical cord becomes wrapped around the newborn’s neck during delivery. Slip a finder under the cord and gently attempt to slip it over the shoulder and head. If unsuccessful, cut the cord. Prolapsed Umbilical Cord The cord emerges before the fetus. Shuts off the oxygenated blood supply from the placenta Leads to fetal asphyxia © Jones & Bartlett Learning. Prolapsed Umbilical Cord Keep the woman supine with hips elevated. Administer 100% supplemental oxygen. Have the woman pant with each contraction. Gently push the presenting part back up the vagina until it no longer presses on the cord. Postpartum Hemorrhage Can be either early or late hemorrhage. Early: bleeding within 24 hours of delivery Late: bleeding occurring from 24 hours to 6 weeks after delivery Blood loss exceeds 500 mL during first 24 hours after birth. Pathophysiology and Assessment Considerations Pregnant patients will have different signs or responses to trauma. It may be more difficult to interpret tachycardia. Signs of hypovolemia may be hidden. The patient has a higher chance of bleeding to death in case of pelvic fractures. A respiratory rate less than 20 breaths/min is not adequate. Arrival of the Newborn If delivery in ambulance: Use blankets. Confirm ABCs. Place newborn on mother’s chest. Suction mouth, then nose. Keep newborn at level of mother. © Jones & Bartlett Learning. The Apgar Score Helps record condition at birth If score is less than 7, redo every 5 minutes until 20 minutes after birth. Postpartum Hemorrhage Continue uterine massage. Encourage the woman to breastfeed. Notify the receiving facility of status. Transport immediately. Add a large-bore IV line en route. Do not pack dressings into the vagina. Algorithm for Neonatal Resuscitation If the newborn’s pulse rate is apneic or less than 100 beats/min, begin PPV. Begin chest compressions if the newborn’s pulse rate is less than 60 beats/min. If ventilation and chest compression do not improve the bradycardia, administer epinephrine preferably via IV line. Pathophysiology and Assessment Considerations First trimester The uterus is well protected and rarely damaged from trauma. Second and third trimesters The uterus extends into the abdomen and becomes more vulnerable to trauma. Pathophysiology of Bleeding Related to Pregnancy Abruptio placenta (cont’d) Physical examination may reveal: Signs of shock Tender abdomen and rigid uterus Absent fetal heart sounds Pathophysiology of Bleeding Related to Pregnancy Placenta previa (cont’d) Painless vaginal bleeding with bright red blood. Uterus is soft and nontender. Pathophysiology of Bleeding Related to Pregnancy Ectopic pregnancy The ovum implants somewhere besides uterus. The patient usually presents with: Severe abdominal pain Hypovolemic shock Should be considered for all female patients of child-bearing age with severe lower abdominal pain. Treat for shock and provide rapid transport. Pathophysiology of Bleeding Related to Pregnancy Third-trimester bleeding Greatest danger of hemorrhage A large volume of blood is present. Compensatory mechanisms function as a result of pregnancy.