review sheet

• Fundus


  Top of uterus
• Umbilical vein


  Carries oxygenated blood from placenta to fetus
• Umbilical arteries


  Carry deoxygenated blood from fetus to placenta
• Preeclampsia


  Pregnancy induced hypertension
• Signs of preeclampsia

  • Can occur after 20 weeks; headaches, visual anomalies (spots), swelling of hands and feet, sense of anxiety
• Treating ecclampsia

  Lie on LEFT side, oxygen, watch for vomiting
• Placenta abruption (abruptio)


  Placenta pulls away from wall of uterus
• Placenta abruption


  • Baby may not survive, mom can hemorrhage, a lot of pain, less visible bleeding
• Placenta previa


  Placenta not on top where it's supposed to be; towards bottom
• Placenta previa

  • Can cause bleeding, heavier visible bleeding, almost no pain
• Precipitous labor


  Really fast labor
• Vernix caseosa


  White, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy
• Normal blood loss in pregnancy is 500 mL's
• Scope of practice


  Operating in accordance with legal duties and ethical standards
• When asked to provide information to a media representative regarding a high-profile patient, you should not provide any info, violates HIPAA
• Primary assessment


  1. Treat ABC's first

  2. Treat lower fracture once ABC's are secured
• Objectives of primary assessment

  • Identify and rectify life threats
  • Ensure airway, breathing, circulation are secure
  • Stop anything that is going to kill the patient right now if not addressed
• Systolic blood pressure


  Pressure against arterial walls when the ventricles contract
• Diastolic blood pressure


  Pressure against the arterial walls when the ventricles relax
• Physical exam on an adult patient is usually conducted cephalad to caudal (head-to-toe)
• Normal pediatric capillary refill time is less than 2 seconds
• Symptom


  What the patient describes to be happening to them; things they are experiencing; more subjective
• Sign


  Definitive measurements of body function; objective; e.g. blood pressure, pulse, respirations, etc
• The structure that prevents foreign matter from entering the airway is the epiglottis
• Oxygen flow rate via nasal cannula

  1. 1-6 lpm
• Providing PPV

  1. Ventilate infant at 40-60 breaths/minute just enough for chest rise

  2. Ventilate child every 3-5 seconds, each breath is given over 1 second and should cause visible chest rise

  3. Ventilate adult every 5-6 seconds, each breath is given over 1 second and should cause visible chest rise
• Airway obstruction management


  1. Conscious infant - 5 chest thrusts alternating with 5 back-blows; DO NOT use abdominal thrusts/Heimlich maneuvers

  2. Conscious child - abdominal thrusts just above the naval

  3. Conscious adult - abdominal thrusts just above the naval
• Airway management with suspected spinal injury

  Do not perform head-tilt chin lift; instead, use jaw thrust
• Compression to ventilation ratio in 1 rescuer

  • Infant CPR - 30:2
  • Child CPR - 30:2
  • Adult CPR - 30:2
• Managing an OPA insertion when patient starts to gag

  Remove the OPA, suction their nose and mouth, insert an NPA
• A tall, thin patient experiences a sharp pain in his chest and progressive dyspnea following a severe coughing fit, with diminished lung sounds on his right side. You suspect spontaneous pneumothorax
• For a patient on home O2 via nasal cannula, not in respiratory distress, with a pulse oximetry reading of 94%, the proper O2 device to transport her with is a nasal cannula
• O2 concentration delivered by a nonrebreather mask at 12-15 lpm


  Approximately 90%
• Open wounds of the neck are problematic because the vessels in the neck are extremely vascular and there is also a risk of air embolism
• MOST cases of external bleeding can be controlled by direct pressure
• Signs of compensated shock

  • Agitation, anxiety, restlessness, feeling of impending doom, weak and rapid (thready) pulse, clammy (pale, cool, moist) skin, pallor, with cyanosis about the lips, shallow and rapid breathing, nausea or vomiting, capillary refill longer than 2 seconds in infants and children, marked thirst, narrowing pulse pressure
• Signs of decompensated shock

  • Failing blood pressure (systolic bp of 90mm Hg or lower in an adult), declining mental status, altered level of consciousness, labored or irregular breathing, ashen and mottled or cyanotic skin, thready or absent peripheral pulses; dull eyes, dilated pupils, poor urinary output
• Characteristics of bleeding types


  • Arterial - bright red, spurting blood; Capillary - slow
• Perfusion


  Passage of bodily fluids, such as blood, through the circulatory or lymphatic system to an organ or tissue
• Signs of anaphylaxis

  • Skin - flushed, itching, or burning, especially over the face and upper part of the chest; urticaria (hives), edema, pallor, cyanosis
  • Circulatory system - dilated peripheral blood vessels, increased vessel permeability, drop in blood pressure, weak and barely palpable pulse
  • Respiratory system - sneezing or itching in the nasal passages, stridor, upper airway obstruction, tightness in the chest, with a persistent dry cough, wheezing and dyspnea (difficulty breathing), secretions of fluid and mucus into bronchial passages, alveoli, and lung tissue, causing coughing; constriction of bronchi; difficulty drawing air into the lungs; forced expiration, requiring exertion and accompanied by wheezing, cessation of breathing
  • Other - abdominal cramping, nausea, vomiting, altered mental status, dizziness, fainting and coma