Paramedic Unit Exam: Obstetrics, Gynecology, and Pediatrics

Paramedic Unit Exam: Obstetrics, Gynecology, and Pediatrics APGAR scoring - A= appearance (color all pink, body pink and blue extremities, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cries, grimace, no response) A= activity (active motion, flaccid, limp) R= respirations (strong cry, weak cry, absent) Newborn Resuscitation (Inverted Pyramid) - • Most distressed newborns respond to relatively simple maneuvers. Drying, warming, positioning, suctioning, stimulating Oxygen Bag-Mask Ventilation Chest Compressions Intubation Medications Methods of heat loss for a newborn - evaporation convection conduction radiation Tube Size for peds - Size Depth Weight Wks 2.5 6.5-7 <1000 <28 3. 28-34 3. 34-38 3.5-4.0 >9 >3000 >38 Formula for correct tube size in pediatrics - (patient's age in years +16/4= tube size) DOPE - Displacement Obstruction Pneumothorax Equipment failure rule of nines - a method used in calculating body surface area affected by burns croup - viral infection: barking cough, slow onset; fever; nasal flaring or tracheal tugging possible. Epiglottitis - bacterial infection; characterized by: brassy cough and high temperature then pain often associated with swelling, sore throat, shallow breathing. Epiglottis is cherry red and swollen; Croup treatment - Airway maintenance with oxygen and Racemic Epi or albuterol; Steriods Epiglottitis treatment - Transport seated upright with personnel who can manage the airway; oxygen, Nebulized racemic epinephrine; intubation; Asthma treatment - establish airway, administer oxygen humidified, give albeuterol, metaproterenol, or levalbuterol Bronchiolitis treatment - treat it the same as asthma if ventilation support as necessary using Albuetrol Ventolin, Proventill; use of pulse oximeter Procedure for clearing an infant's obstructed airway - deliver 5 back blows followed by 5 chest thrusts; if infant unresponsive begin CPR Racemic Epinephrine - (Nebulized Epinephrine) Classification-sympathomimetic agonist; Promethazine Hydrochloride - (Phenergan) classification-antihistamine; indications: control and prevent nausea and vomiting. Saline Nebulized - classification: isotonic crystalloid; indication: used to loosen up thick secretions obstructing the lower airways; often used to introduce moisture to the lower airways via in-line nebulizer prior to or during suctioning of endotracheal tube when obstructed; Dosage: Adults- 3ml by nebulizer; Pediatrics=3 ml by nebulizer Diphenhydramine hydrochloride - (Benadryl) classification: antihistamine; indications: allergic reaction, anaphylaxis, dystonic reactions, chemical restraint; dosage: Adults-25-50 mg slow IV/IO or IM Pediatrics: 1 mg/kg slow IV/IO or IM max dosage 25 mg Albuterol Sulfate - Proventil, Ventolin, classification: beta 2 agonist; sympathomimetic brochodilar; dosage adult and peds >20kg: 2.505mg via handheld nebulizer; pediatric <20kg: 2.5 mg diluted in 2-3 ml of NS via handheld nebulizer Neonate resuscitation - 3:1 rule (3(compressions):1 (ventilation); 120 events per min. 90 compressions, 30 ventilations(breaths per min) When Neonate resuscitation is needed: - prematurity; pregnancy and delivery complications; maternal health problems; inadequate prenatal care; assist ventilations using pediatric bag-valve mask Breech presentations - Buttocks or both feet present first; Cesarean section often required Prolapsed cord - Umbilical cord precedes fetal presenting part; shuts off fetal circulation transfer in Knee to chest or Trendelenburg oxygen 8 to 10 L Limb presentation - when an infant's limb protrudes from the vagina before the appearance of any other body part Stage one Labor (dilation stage) - true labor contractions; ends with complete dilation and effacement of cervix. closed to 10 centimeters. Lasts 5 to 10 hours. stage 2 of labor (expulsion stage) - involves the actual delivery of the baby; Lasts 50 to 60 minutes. Contractions very strong, occurring every 2 minutes, lasting for 60 to 75 seconds. stage 3 of labor: placental stage - delivery of placenta