Texas EMS Magazine, Volume 19, Number 1, January/February 1998 Page: 40
60 p. : col. ill.View a full description of this periodical.
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ducatioHn
References:
Paramedic Emergency Care
Bryan E. Bledsoe
Robert S. Porter
Bruce R. Shade
Principles Of Anatomy And
Physiology, sixth edition
Gerald J. Tortora
Nicolas P. Anagnostakos
The Merck Manual, sixteenth
edition
Multiplecontributors
Foundations of Maternal Newborn
Nursing
T.M. Gorrie
E.S. Stone
S.S. Murray
Emergency Medicine
A Comprehensive Study Guide
American College of Emergency
Physiciansis needed to keep the alveoli from col-
lapsing on expiration. The premature
infant should be transported to a facil-
ity with a neonatal intensive care unit.
The infant born to a drug-depen-
dent mother may require aggressive
resuscitation attempts with ACLS.
Care of the Mother
Patients in labor should be given
high-concentration oxygen to maxi-
mize oxygen delivery to the fetus. Af-
ter the secondary exam is completed,
a large bore IV of Lactated Ringer's is
indicated to facilitate fluid administra-
tion. LR should be given at 100 to 200
ml/hr as a maintenance infusion for
exertion and anticipated blood loss.
Perineal lacerations are treated
with bandages and direct pressure.
Do not pack the vagina. When lacera-
tion bleeding stops, place a clean ban-
dage over the original bandage and
dressing to reassess for postpartum
hemorrhaging. Frequent checks for
postpartum hemorrhage are needed.
A Pitocin (oxytocin) drip should
be considered if postpartum hemor-INDICATOR DESCRIPTION VALUE 1 MINUTES 5 MINUTES
Heart Rate >100 2
<100 1
Absent 0
Respiratory strong cry 2
Effort weak cry 1
Absent 0
Muscle Active motion 2
Tone Some flexion 1
Flaccid 0
Reflex Vigorous cry 2
Some motion 1
No response 0
Color Fully pink 2
Body: pink/ Ext: blue 1
Blue; pale 0
TOTAL SCORErhage continues. A drip is preferable
over intramuscular injection. Ten
units of Pitocin should be mixed in
1000ml of Lactated Ringer's and run
at a rate necessary to sustain uterine
contraction. Two to four ml/min is the
recommended initial rate. Since the
adverse effects of Pitocin include hy-
pertension and dysrhythmias, the pa-
tient's blood pressure and ECG
should be monitored.
Do not attempt to deliver the pla-
centa by pulling on the umbilical cord.
If the placenta delivers spontaneously,
transport it to the hospital so it can be
examined for completeness. Placental
fragments left in the uterus can cause
hemorrhage and infection.
Finally, be gentle with mom. She's
tired and sore.
Conclusion
During labor and delivery it is im-
portant to remember that you have
two patients who need careful and ap-
propriate care to make the birthing ex-
perience a positive event. The role of
the EMS professional changes in this
situation from the person who
begins the repair process after
trauma to the one who minimiz-
TES es trauma as it is happening.
Birthing can be accomplished
with a minimum of skills and
equipment by being confident and
emotionally supportive. Confi-
dence is based on knowledge,
and emotional support is based
on a genuine concern for the
well-being of your patients.-Paramedic Dan Edwards
works for MedStar in Tarrant
County.40 Texas EMS Magazine January/February 1998
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Texas. Department of State Health Services. Texas EMS Magazine, Volume 19, Number 1, January/February 1998, periodical, January 1998; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1507967/m1/40/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.