288 terms

NREMT - Everything you need to know.

Medical Direction
Oversight of the patient-care aspects of an EMS system by the Medical Director.
lists of steps, such as assessments and interventions, to be taken in different situations. Protocols are developed by the Medical Director of an EMS system
Offline Direction
consists of standing orders issued by the medical director that allows EMTs to give certain medications or perform certain procedures without speaking to the medical director or another physician.
Online Direction
consists of orders from the on-duty physician given directly to an EMT-B in the field by radio or telephone.
Standing Orders
A policy or protocol issued by a Medical Director that authorizes EMT-Bs and others to perform particular skills in certain situations.
High Efficiency Particulate Air respirator; used for patients with suspected TB; worn by the EMT provider to prevent airborne transmission
Hepatitis B
infectious inflammation of the liver caused by the hepatitis B virus (HBV) that is transmitted sexually or by exposure to contaminated blood or body fluid
Hepatitis C
inflammation of the liver caused by the hepatitis C virus, transmitted by exposure to infected blood (rarely contracted sexually)
Infectious disease caused by the tubercle bacillus, Mycobacterium tuberculosis. Most commonly affects the respiratory system and causes inflammation and calcification of the system.
Acute Stress
short term ; fight or flight response ; effects disappear quickly after it is over
Scope of Practice
What we are allowed to do or trained to do
Standard Care
the degree of care that a reasonably prudent person should exercise under the same or similar circumstances
Duty to Act
an obligation to provide care to a patient
Good Samaritan
a person who voluntarily offers help or sympathy in times of trouble
Expressed Consent
Permission that must be obtained from every conscious, mentally competent adult before emergency treatment may be provided
Implied Consent
The consent it is presumed a patient or patient's parent or gaurdian would give if they could, such as for an unconscious patient or a parent who cannot be contacted when care is needed.
Treatment of a Minor
Must be given by legal guardian
Mentally incompetent person
Advanced Directive
a legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care; may also be called a living will or durable power of attorney for health care
Physicians orders for life sustaining treatment. May include order for DO NOT RESUSCITATE
Prehospital care report
Emergency Move
a move made when there is an immediate danger to the patient.
Urgent Move
Move used if a scne factor causes a decline in patient's condition, or if the treatment of a patient requires a move.
Non urgent move
No immediate threat to life, are carried out in such a way as to prevent injury and to avoid discomfort and pain.
bariatric stretcher
Stretcher for obese patients
scoop stretcher
this cot splits in tow or four sections, so it can be used where larger stretchers cannot fit.
basket stretcher
designed to surround and protect the patient, this stretcher is used to move a patient from one level to another to over rough terrain.
flexible stretcher
made of canvas or rubberized or other flexible material, often with wooden slats sewn into pockets and three carrying handles on each side. can be useful in restricted areas or narrow hallways
anatomical planes
1. coronal (vertical cut into front and back halves) 2. transverse (horizontal cut into upper and lower) 3. sagittal (vertical cut into left and right halves)
fowler position
a bed sitting position with the head of the bed raised to 45 degrees
semi fowler position
the head of the bed is raised 30 degrees; or the head of the bed is raised 30 degrees and the knee portion is raised 15 degrees
shock position
feet elevated 12 inches higher than head
Toward the Front
Toward the back
toward the head or above point of reference
away from the head or below point of reference
Toward the back/spine
Toward the front/ belly
Toward center of body
Away from center of body
Both sides
One side
Same side
opposite side
Near the point of reference
Far from point of reference
mid clavicular
the line through the center of the clavical
mid axillary
line drawn veritcally from the middle of the armpit to the ankle
Sole of foot
Palm of hand
quadrants of the abdomen
Describing where an abdominal organ or pain is located is made easier by dividing the abdomen into four imaginary quadrants.

*Right upper quadrant (RUQ)
*Left upper quadrant (LUQ)
*Right lower quadrant (RLQ)
*Left lower quadrant (LLQ)
the 33 bones of the spinal column
Vertebrosternal = 'True ribs" -ribs 1-7 attach directly to the sternum through their costal cartilage. Vertebrochondral = "False ribs" =ribs 8-10 costal cartilage articulate indirectly with the sternumb by joing the costal cartilages of ribs above. Vertebral Ribs = "Floating ribs" ribs 11 and 12 no anterior attachment.
upper airway
(Nose, mouth, pharynx, larynx)FUNCTION:Conducts air to lower airway Protects lower airways *Warms, filters & humidifies air
lower airway
trachea, bronchi, bronchioles, and aveoli (gasses travel through the structers to and from the blood)
cricoid cartilage
the ring-shaped structure that forms the lower portion of the larynx
muscular partition that separates the thoracic cavity from the abdominal cavity and aids in respiration by moving up and down
phrenic nerve
stimulates the diaphragm
The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.
hypo perfusion
Also known as shock (decreased blood flow through an organ, as in hypovolemic shock; if prolonged, it may result in permanent cellular dysfunction and death.)
large part of the brain that controls the senses and thinking
the "little brain" attached to the rear of the brainstem; its functions include processing sensory input and coordinating movement output and balance
brain stem
the part of the brain continuous with the spinal cord and comprising the medulla oblongata and pons and midbrain and parts of the hypothalamus
adrenaline; activates a sympathetic nervous system by making the heart beat faster, stopping digestion, enlarging pupils, sending sugar into the bloodstream, preparing a blood clot faster
A neurotransmitter from nerve endings and a hormone from the adrenal gland. It is release in times of stress and is involved in hunger regulation, blood glucose regulation and other body processes.
alpha1 and Alpha2
Alpha1 vessels constrict and release sweat
Alpha2 try's to regulate alpha1
beta 1
increases HR, inotrophy (forced contraction of heart) increases electrical impulse in heart
beta 2
relaxes smooth muscle such as bronchioles and some vessels
pulse pressure
difference between systolic and diastolic pressure no more than 25%
..., the bodily process of inhalation and exhalation
pulmonary ventilation
..., Movement of air into and out of the lungs
internal respiration
..., exchange of gases between the blood and the cells of the body
external respiration
..., exchange of gases between the lungs and the blood
cellular respiration
..., process that releases energy by breaking down glucose and other food molecules in the presence of oxygen
..., the fork at the lower end of the trachea where the two mainstem bronchi branch.
..., smallest branches of the bronchi
..., membrane surrounding the lungs
visceral pleura
..., inner layer of pleura that surrounds each lung
parietal pleura
..., pleura that lines the inner chest walls and covers the diaphragm
pleural space
..., the small potential space between the parietal and visceral layers of the pleura
intercostal muscles
..., Muscles which move the rib cage during breathing
signs of mild hypoxia
Pale cool clammy skin ( early)
Elevation of blood pressure
Disorientation and confusion ( from high carbon dioxide levels)
signs of severe hypoxia
Tachycardia may lead to dysrhythmias and eventually bradycardia
Loss of coordination
sleepy appearance
Head bobbing
Slow reaction time
Altered mental status
..., difficult or labored respiration
..., A bluish discoloration of the skin and mucous membranes
patent airway
..., An airway that is open and clear of obstructions.
snoring sounds
..., airway blocked, open patients airway promt transport
..., A breathing sound similarto the cawing of a crow; may indicate that muscles around the larynx are in spasm.
..., indicates presence of fluid in the upper airway, need for suctioning
..., a whistling sound when breathing (usually heard on inspiration) upper airway
..., Mask used for a patient with TB
tonsil tip
... Rigid suction
french tip
...Soft suction
..., -curved plastic device used to establish an airway in a patient by displacing the tongue from the posterior wall of the oropharynx
-used in unconscious patients who do not have a gag reflex
..., flexible airway inserted through the patients nose
..., Movements in which the skin pulls in around the ribs during inspiration.
respiratory failure
..., a condition in which the level of oxygen in the blood becomes dangerously low or the level of carbon dioxide becomes dangerously high
respiratory arrest
..., When breathing completely stops.
agonal respiration
..., Shallow, slow or infrequent breathing
..., fast breathing, an abnormally rapid rate of respiration, usually >20 breaths per minute
..., slow respiratory rate, usually below 10 respirations per minute
methods of artifical ventilation
...Mouth to mask
Two person bag valve
One person bag valve
cricoid pressure
..., Pressure on the trachea, prevents air from entering the esophagus/stomach and vomiting
..., flow-restricted, oxygen-powered ventilation device: a device that uses oxygen under pressure to deliver artifical ventilations. Its trigger is placed so that the rescuer can operate it while still using both hands to maintain a seal on the face mask. Has automatic flow restriction to prevent overdelivery of oxygen to the patient.
..., abnormal crackling sound made during inspiration
..., lower-pitched sounds like snoring or rattling, secretions in larger airways (pneumonia, bronchitis, aspiration)
paradoxus pulsus
blood pressure declines as one inhales and increases as one exhales
capillary refill
..., tested by pressing the nail tip briefly and watching for color change. A normal finding is the pink tone returns immediately when pressure is released. An abnormal finding is slow (greater than 2 seconds) return of pink tonewith respiratory or cardiovascular diseases that cause hypoxia.
Penetrating truma
Made a cut through
Blunt force trauma
No cut but internal problem
Too much carbon dioxide
Flexion posturing
(Formerly known as decorticate posturing). Client flexes one or both arms on the chest and may extend the legs stiffly. Indicates nonfunctioning cortex. Lesions of cerebral hemispheres or internal structures of brain cause this posturing.
Extension posturing
A posture in which the pt arches the back and extends the arms straight out parallel to the body. A sign of serious head injury
closed off
difficult or labored respiration
inadequate perfusion also known as shock
Secondary assessment
after immediate life- or limb-threatening injuries/illnesses have been identified, this more thorough evaluation is performed to identify more subtle, yet still important, injuries
Physical exam, Baseline vitals, History
Three major steps in secondary assessments
Cerebrospinal fluid
clear liquid produced in the ventricles of the brain
Jugular vein distention
the visible bulging of the jugular vein when the Pt is in semi-fowlers position or full fowlers position. this is indicative of inadaquate blood movement through the heart and/or lungs
Tension pneumothorax
a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels
Pericardial tamponade
filling of the pericardial sac with fluid, which in turn limits the filling and function of the heart.
material expelled from the lungs by coughing
What is PMS
motor function
MOI falls
Adults 20 feet
children/infants more than 10 feet or 2or3 times their height
Glasgow coma scale
Used for head trauma- Score 3-15, based on Eye opening, Verbal response and Motor response.
less than 13
Rapid transport (what's the number on the GCS)
Brain herniation
Increasing intracranial pressure related to the presence of lg pocket of blood (hematoma)
contains majority of liver, gallbladder, small portion of pancreas, right kidney, small intestines, and colon.
left lobe of liver
body of pancreas
L kidney and
contains parts of the small and large intestines, left ovary, left fallopian tube, left ureter
contains parts of the small and large intestines, right ovary, right fallopian tube, appendix, right ureter
beneath the tongue
breathing in
into the muscle
Right date, right patient, right drug, right dose, right route
the 5 rights
Inadequate tissue perfusion
Also know as hypoperfusion
Types of shock
Hypovolemic shock
shock caused by severe blood or fluid loss
Distributive shock
less distribution of blood to areas = venous pooling, most common in general anesthesia and spinal cord injuries and septic shock (bacterial infection where toxins in blood). cause: general anesthesia and spinal cord injuries and septic shock
Cardiogenic shock
shock that results from failure of the heart in its pumping action.
Obstructive shock
mechanical obstruction or compressing that prevents blood from reaching the heart
Tension pneumonthorax
A type of pneumothorax in which air can enter the pleural space but cannot escape via the route of entry. This leads to increased pressure in the pleural space, resulting in lung collapse. The increase in pressure also compresses the heart and vena cavae, which impairs circulation.
Pericardial tamponade
filling of the pericardial sac with fluid, which in turn limits the filling and function of the heart.
Stages of shock
1. Compensatory Shock 2. Decompensatory Shock 3. Irreversible Stage
If patient been in cardiac arrest for more than 5 min and no CPR has been done what do you do
Provide 2 min of CPR before ard
aed shock then pulse check?
No aed shock then 2min CPR then pulse check
completely erratic rhythm with no identifiable waves; fatal
Ventricular tachycardia (an increased ventricular heart rate).
the absence of a heartbeat
pulseless electrical activity. Heart is doing something but not pumping
Stop ambulance when using aed
True and shut off engine
Can I aed on 1-8 year olds
Yes but prefer to use less electrical dose
If u can't it is ok
How many shocks can I give
2-3 with CPR in-between
Common diseases from wheezing
Chronic bronchitis
Common diseases from rhonchi
Chronic bronchitis
Common diseases from crackles
Pulmonary edema
difficult or labored respiration
absence of breathing
deficient amount of oxygen in tissue cells
Respiratory Distress
Indicates that a patient is breathing but is having trouble doing so. May lead to respiratory arrest.
Respiratory Failure
The reduction of breathing to the point where oxygen intake is not sufficient to support life
Respiratory arrest
When breathing completely stops.
chronic obstructive pulmonary disease; chronic bronchitis - bronchiole lining inflamed, excess mucus formed; emphysema - walls of alveoli break down; HYPOXIC DRIVE (not in asthma)
obstructive pulmonary disease characterized by overexpansion of the alveoli with air, with destructive changes in their walls resulting in loss of lung elasticity and gas exchange
Chronic bronchitis
obstructive pulmonary disease characterized by excessive production of mucus and chronic inflammatory changes in the bronchi, resulting in a cough with expectoration for at least 3 months of the year for more than 2 consecutive years.
acute inflammation and infection of alveoli, which fill with pus or products of the inflammatory reaction
Pulmonary embolism
blockage of the pulmonary artery by foreign matter or by a blood clot
Acute pulmonary edema
occurs when an excessive amount of fluid collects in the spaces between the alveoli and capillaries, disturbs normal gas exchange
Acute infectious disease characterized by a cough that has a "whoop" sound; also called whooping cough
Sinoartrial node
located in the upper portion of the "R" atrium. Has its own rhythm. Sets the basic pace for the cardiac rate.
Atrioventricular node
located in the lower wall of the right atrium; delays impulses from the SA node to allow the atria to completely empty before the ventricles contract
Pulmonary arteries
carry deoxygenated blood out of the right ventricle and into the lungs
Pulmonary veins
deliver oxygen rich blood from the lungs to the left atrium
Coronary arteries
the two arteries that supply blood to the heart muscle
a blood clot formed within a blood vessel and remaining attached to its place of origin
the most common form of CVD; a disease characterized by plaques along the inner walls of the arteries.
Acute coronary syndrome
sudden symptoms of insufficient blood supply to the heart, sudden symptoms of insufficient blood supply to the heart indicating unstable angina or myocardial infarction
Angina pectoris
chest pain caused by a temporary loss of oxygenated blood to heart muscle often caused by narrowing of the coronary arteries
How long does angina pain last
2-15 min
acute myocardial infarction (heart attack)
Aortic aneurysm
congenital or developed weakness in wall of lower lumbar region (aorta), balloons out, anterior abdominal wall pulses, untreatable if ruptures
Aortic Dissection
damage may result in fatal bleeding, dissection is a condition where the inner layer of the wall of the aorta begins to tear; patient may complain of pain in the chest, abdomen or back will exhibit signs of shock
Congestive Heart Failure failure of the heart to pump blood away from the heart causing accumulation of fluid in the tissues and lungs
Cardiac arrest
The heart and breathing stop suddenly and without warning
Neurological deficit
any deficiency in the nervous system's functioning, typically exhibited as a motor, sensory, or cognitive deficit
A medical injury to brain that is not related to truma
Ischemic stroke
the most common kind of stroke
Hemorrhagic stroke
stroke caused by the rupture of a blood vessel in the brain
Thrombotic stroke
type of stroke caused by a blood clot blocking an artery in the brain
Embolic stroke
a type of ischemic stroke that causes a clot to travel to the brain, mostly from the left side of the heart
transient ischemic attack; temporary interference with the blood supply to the brain
sudden, transient disturbances in brain function resulting from abnormal firing of nerve impulses (may or may not be associated with convulsion)
chronic brain disorder characterized by recurrent seizure activity
Status epilepticus
a condition in which there are continuing attacks of epilepsy without intervals of consciousness
Grand mal
generalized tonic-clonic (it is sudden cry, fall, rigidity, followed by muscle jerking; shallow, irregular breathing; possible loss of bladder or bowel control; usually lasts seconds to minutes, followed by some confusion, a period of sleep (postical lethargy), and then return to full consciousness.
Simple partial seizures
begins in one area can move, patient aware and conscious, expreience change in taste/smell cause nausea
Complex partial seizure
impairment of consciousness for a few min or less; usually has rhythmic movements of face or extremities
Petit mal
milder form with loss of consciousness for a few seconds. Common in children. May disappear by late adolescence
Febrile seizure
convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body.
a sudden, and generally temporary, loss of consciousness and postural tone, due to inadequate flow of oxygenated blood to the brain (fainting)
Glucose and sodium bring what with them?
Storage form of glucose
a hormone secreted by the pancreas
Normal glucose
Glucose after meal
Glucose after 8-10hr of no food
Hypoglycemia symptoms
hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin
Hyperglycemia symptoms
lots of eating, peeing, drinking. blurred vision, fatigue, weight loss
Type 1
this type of diabetes mellitus is an autoimmune situation. The pancreas produces and releases NO insulin, so no glucose transport.
Type 2
Diabetes mellitus initially begins with INSULIN RESISTANCE, where the cells are not able to use the insulin properly and pancreas loses its ability to produce adequate quantities of insulin.
Where do I put epipen when done
Sharp object container
Acute abdomen
sudden, sever abdominal pain that is less than 24 hours in duration
Double-layered membrane surrounding the abdominal organs
Soild organs
Spleen liver pacreas kidneys
Hollow organs
-stomach, small intestine, colon, bladder, gallbladder
Visceral pain
Pain is less severe and poorly localized because of lack of pain receptors on the organ pain is generalized
Parietal pain
More severe pain and more localized
a neural structure lying below the thalamus; directs eating, drinking, body temperature; helps govern the endocrine system via the pituitary gland, and is linked to emotion
Body heat lost to surrounding air, which becomes warmer then rises and is then replaced by cool air and then repeat the cycle
Body heat is lost to the atmosphere or nearby objects without physically touching them
Body heat is lost through direct physical touch of other objects
5 Stages of hypothermia
Apathy and decreased muscle function
Decreased level of responsiveness
Decreased vital signs
Heat cramp
muscle pain or spasm due largely to the loss of salt from the body from sweating, or inadequate intake of salt
Heat exhaustion
Occurs when the body's cooling mechanism have been expended
Skin is normal to cool in temp
Pale or Gregory in color
And sweaty
Heat stroke
The failure of the heat-regulating ability of an individual under heat stress.
Skin will be hot and red possibly not sweating
What temp and humidity are bad for the body to regulate temp
90 degrees and 75 humidity
Low velocity injuries
A knife or other impailed object in the body exerts damage to the immediate area of impact and it's underlying structures. The length of the object used is important
Medium and high velocity injuries
Med/High velocity projectiles are from pellets or bullets. The damage caused, depends on the Trajectory and the dissipation of energy. Dissipation of energy is affected by Drag,Profile,Cavitation, & Fragmentation.
Primary phase injuries
Are due to the pressure wave of the blast. Injuries primarly effect the gas-containing organs, such as the lungs, stomach, intestines, inner ears and sinuses. Death may occur from this stage w/o any sign of external injury
Is the cavity that is formed by a pressure way
Secondary phase injuires
Are due to flying debris propelled by the blast
They are usually lacerations fracture burns
Tertiary phase injuries
Are due to being throw and then landing on the ground similar to being ejected out of a car
A loss of 15% of blood volume is
Significant and can lead to shock
When can I apply a splint on scene
To extremity fractures only if the patient is stable and there is no life threat
bleeding from the nose
Good indicator of internal blood loss
Weak pulse the into fast pulse
Also no radial pulse body brings blood to core
Narrow pulse pressure indicates
Significant loss of blood
Factors that may increase bleeding
Low body temp clotting less effective
Medication anticlotting like aspirin
Intravenous fluids
Removal of bandages
an outer layer of cells designed to provide protection
second layer of skin, holding blood vessels, nerve endings, sweat glands, and hair follicles
tissue layer beneath the dermis; contains adipose tissue, a connective tissue that includes fat-storing cells and blood vessels
Superficial burn
a burn that involves only the epidermis, the outer layer of the skin. It is characterized by reddening of the skin and perhaps some swelling. An example is a sunburn. Also called a first-degree burn.
Partial thickness burn
a burn in which the first layer of skin (epidermis) is burned through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering, and a mottled appearence. (Also called second-degree burn).
Full thickness burn
a burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white. Also called a third-degree burn.
Rule of nines
A system that assigns percentages to sections of the body, allowing calculation of the amount of skin surface involved in the burn are, a method of estimating the extent of a burn. For an adult, each of the following surfaces represents 9% of the body surface: the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining 1% is assigned to the genital region. For an infant or child the percentages are modified so that 18% is assigned to the head, 14% to each lower extremity.
the cup-shaped hollow in the hipbone into which the head of the femur fits to form a ball-and-socket joint
What are two critical fractures
Femur and pelvis
Subdural hematoma
pertaining to below the dura mater, tumor of blood
Epidural hematoma
temporoparietal skull fracture; tear middle meningeal artery
Secondary assessment for trauma major injury
Rapid trauma assessment
Secondary assessment for trauma minor injury
Focused on injury
Then detailed exam in the back of truck
Secondary assessment for medical unresponsive
Rapid trauma assessment
Secondary assessment for medical responsive
Focused on injury
Glasgow scale
This is an assessment tool used to determine consciousness in clients. The Score of 15 reveals a fully oriented person. 3 is deep coma., Used for head trauma- Score 3-15, based on Eye opening, Verbal response and Motor response.
Rhyme for glasgow
Evm 456
Eye 4
Verbal 5
Motor 6
Hollow organ in abdominal
Urinary bladder
Internal urethra
Fallopian tubes
Solid organs in abdominal
Examples of hypovelemic shock
loos whole blood
Non hemmorrhgagic
Fluid loss and burns
a transparent membrane that lines the abdominal cavity in mammals and covers most of the viscera
Abruptio placentae
a disorder of pregnancy in which the placenta prematurely separates from the wall of the uterus
Examples if distributive shock
Infection that causes the vessels to dilate
Spinal cord injury cause vessels to dilate
Body wide vessel dilation
Example of obstructive shock
Pulmonary edema
Blood can't move forward

Pericardial tamponade
Tension pneumothorax
Both put pressure on Herat and can't fill appropriately
Example of cardiogenic shock
Heart attack
Congenital heart failure
Abnormal rhythm
Beta blockers
Bloody show
the pink-tinged secretions that follow the loss of the mucous plug b/c of exposed cervical capillaries. this is a sign that labor will begin within 24-48 hours.
Umbilical cord blood vessels
Unique cause they do opposite
Veins bring oxygen blood
Arteries bring deoxygenated blood
Red blood cell
White blood cell
blood cell that functions in defending the body against infections and cancer cells; also called a leukocyte
occurring or existing before birth
What should I do with someone had a spontaneous abortio.
Transport because there is lots of blood that may be lost
Placenta previa
pregnancy in which the placenta is implanted in the lower part of the uterus (instead of the upper part)
What is a sign of placenta previa
Bleeding but no pain
Ruptured uterus sign
Searing or tearing feeling in abdomen
Ectopic pregnancy
pregnancy resulting from gestation elsewhere than in the uterus
a toxic condition characterized by convulsions and possibly coma during or immediately after pregnancy
abnormal state of pregnancy characterized by hypertension and fluid retention and albuminuria
Supine hypertensive syndrome
Pressure on the vena cava by baby when mother is in supine position
the number of the pregnancy that a woman is in
(obstetrics) the number of live-born children a woman has delivered
Three stages of labor
1) dilation 2) expulsion 3) placenta
Dilation stage
first stage of labor; the uterine muscle contracts strongly to expel the fetus; the fetus presses on the cervix and causes it to dilate or expand
Expulsion stage
When the baby is expelled from its mother's body
Placenta stage
placenta is expelled-afterbirth
the general region between the anus and the genital organs
Nuchal cord
Umbilical cord around the neck; assess by as soon s the head is out of the vagina, run index finger around the neck; if unable to stretch over the babies head, clamp cord 2" apart and cut, then deliver as normal.