Terms in this set (...)

Anatomic Position
Sagittal plane of body
Transverse plane of body
Frontal plane of body
Anterior= front
Superior= top
Proximal= closer to
Distal=farther from
Medial= closer to midline
Lateral= farther from midline
Body positions
Supine= face up
Prone= face down
Shock/Trendelenbyrg=laying down with elevated legs
Fowlers= sitting
Bones of face
Frontal bone: forehead
Parietal bone: top of head
Occipital bone: posterior portion of skull
Temporal bone: lateral bones above cheek bones
Maxillae: upper jaw
Mandible: lower jaw
Zygomatic bones: cheekbones
Nasal bone: nose
Foramen magnum: opening where the brain connects to the spinal cord
Bones of spinal column
Cervical (7)
Thoracic (12)
Lumar (5)
Sacrum (5, fused)
Coccyx (4, fused)
Bones of leg
Femur: thigh
Patella: knee cap
Tibia: medial (shin)
Fibula: lateral
Elements of upper airway
Larynx: voice box
Epiglottis: valve that protects the opening of the trachea
Ends at cricoid cartilage
Anaerobic respiration
inadequate oxygen supply, so the body triages oxygen to send it to the most important parts of the body (heart and brain). Byproduct is lactic acid
Pleura of lungs
Pleura: two thin layers with fluid between them that allow frictionless movement

Visceral pleura: outer later
Parietal pleura: inside layer
Movement of breathing in
diaphragm and intercostal muscles contract, thoracic cavity expands, pressure in chest decreases, air rushes in
Movement of breathing out
diaphragm and intercostal muscles relax, thoracic cavity shrinks, pressure in chest increases, air rushes out
Carbon dioxide drive
primary mechanism of breathing for most people. The brain stem monitors CO2 levels, when it gets too high an increase in respiration is triggered
Hypoxic drive
backup to the CO2 drive (it's less effective than the CO2 drive). Specialized sensors in brain, aorta, and carotid arteries monitor oxygen levels, when they get too low breathing is stimulated

Prolonged exposure to oxygen in patients with hypoxic drive (usually people with end-stage COPD) can depress spontaneous ventilations
Three layer surrounding the heart
Endocardium (inside), myocardium, epicardium (outside)
Pericardium is the sac that surrounds the heart
Pulse points
Carotid (neck)
Femoral (groin)
Radial (wrist)
Brachial (below bicep)
Dorsalis pedis (foot)
Systolic vs. Diastolic
Systolic: BP during contraction of LV
Diastolic: BP between contractions
Central NS
Consists of brain and spinal cord
It is the command and control section: it receives information from PNS, makes decisions, and sends commands to PNS
Peripheral NS
Sends information to CNS and carries out commands

Two divisions:
Somatic (voluntary)
Autonomic (involuntary)
Sympathetic: fight or flight
Parasympathetic: feed and breed
Infants and Neonates
Neonate: newborn-1 month
Infant: 1 month-1 year

Neonates: 30-60 breathing, 140-160 bpm, 70 BP
Infants: 25-50 breathing, 100-140 bpm, 90 BP

Newborns typically weigh 6-8 pounds. During the first couple weeks the may lose weight and then gain it back. Their weight will typically double by 6 months, and triple by 1 year. Their head makes up about 25% of their body, so it's a significant source of heat loss. Their fontanelles (soft spots of head) are not fully formed until 18 months, if they are depressed it may be a sign of hypovolemia.
They are nose breathers and can go into respiratory distress easily, which can lead to respiratory arrest very quickly.
Toddlers: 1-3
Preschoolers: 3-6

Toddlers: 20-30 breathing., 90-140 BPM, 80-90 BP
Preschoolers: 20-25 breathing, 80-130 BPM, 90-110 BP

Separation anxiety is common, allow child to stay with caregiver when possible. Communicate with child directly, choose words carefully and don't lie.
School age (6-12)
Vitals: 15-20 breathing, 70-110 BPM, 90-120 BP

Communicate in easy to understand terms, don't talk down to them, respect their privacy
Causes of airway obstruction
tongue (most common), fluid, swelling, foreign bodies
Early indications of hypoxia
restlessness, anxiety, irritability, dyspnea (difficulty breathing), tachycardia
Late indications of hypoxia
altered/decreased LOC, severe dyspnea, cyanosis, bradycardia
Head-tilt Chin-lift
Indications: altered LOC, suspected airway obstruction, patient requires suctioning

Contraindications: possible cervical spine injury
Jaw thrust
Indications: altered LOC, suspected cervical spine injury

Contraindications: conscious patient
Oropharyngeal airway (OPA)
Used to prevent the tongue from obstructing the airway. Failure to size/insert correctly can cause the tongue to obstruct the airway

Sizing: corner of mouth to earlobe

Inserting in adults: open airway (suction if needed), insert upside down, rotate 180 degrees while advancing

Inserting in pediatrics: manually open airway (suction if needed), depress tongue with tongue depressor, insert directly (no rotation)

Remove immediately if the patient gags
Always have suction available

Indications: unresponsive patient without a gag reflex

Contraindications: conscious patient (has a gag reflex)
Nasopharyngeal airway (NPA)
Used to prevent the tongue from obstructing the airway in patients who can't protect their airway.

Sizing: tip of nose to earlobe

Inserting: lubricate, advance gradually, rotating as necessary

Remove immediately if patient gags
Always have suction available
If resistance is met, don't force

Indications: unresponsive patient without gag reflex, decreased LOC but with gag reflex (couldn't use OPA)

Contraindications: conscious patient who can protect their airway, sever head injury or facial trauma, resistance to insertion, under 1 year old
Aspiration (matter entering into lungs) increases risk of death
Suctioning increases the risk of hypoxia so don't exceed 15 seconds for adults, 10 seconds for pediatrics, and 5 seconds for infants
Suction on the way out of the mouth

Recovery position= Position patient to lay on their side. Reduces the risk of aspiration

Indications: secretions (blood, vomit, mucus, etc) in the airway that could be aspirated, obstruct the airway, or interfere with ventilations/insertion of devices

Contraindications: substances too large to suction (these should be removed manually)
Supplemental oxygen
Goal: to maintain SaO2 level of at least 94%. Not needed if there are no signs of respiratory distress or if SaO2 s above 94%

Indications: cardiac arrest, receiving artificial ventilation, suspected hypoxia, signs of shock, SaO2 below 94%, medical condition/traumatic injury that may benefit, altered LOC

Contraindications: unsafe environment
Non Rebreather mask (NRB)
Usually the preferred method of oxygen administration
Flow rate: 10 to 15 lpm, up to 90% oxygen delivered

Simple face mask is a NVB but without oxygen
Nasal cannula
Low flow oxygen administration
Flow rate: 1 to 6 lpm, 24 to 44% oxygen

Indications: patient won't tolerate BVM or patient is on long term oxygen therapy via nasal cannula

Caution: prolonged use can dry out and irritate nasal passage
Bag valve mask device
Positive pressure ventilation
Single rescuer: not recommended because it's hard to hold mask, make seal, and pump bag all at once. Use CE grip
Two rescuer: one person controls the mask and seal while the other uses both hands to squeeze the bag

Indications: inadequate spontaneous breathing ;leading to respiratory distress or failure (consider for patients breathing less than 8 or more than 24), use for patients with OPA or NPA. OFten unresponsive but not always

Complications: Increase intrathoracic pressure (reduces circulatory efficiency), Gastric distention (increases risk of vomiting), Risk of hyperventilation (too fast or too deep)

Need correct rate (1 breath every 5 or 6 seconds for adults, 1 breath every 3 to 5 seconds for infants and children), and 1 breath every 1 to 1 ½ seconds for newborns
Breathing in pediatrics
Anatomical and physiological differences mean that hypoxia can develop much faster. Airway and respiratory problems are the primary cause for circulatory collapse.

Signs of respiratory failure:
Altered LOC
Head bobbing, grunting
Seesaw breathing
Six rights of drug administration:
Right patient
Right drug
Right route
Right amount
Right time
Right documentation
Drugs that EMS carry (need medical direction to administer):
Oral glucose
Activated charcoal
EPI pens
Drugs that EMS doesn't carry but can administer
Oxygen drug information
for hypoxia, 15 lpm via NRB mask
Oral glucose drug information
Increases blood glucose levels, for hypoglycemia

Dose is half a tube to one tube via oral

Side effects are nausea and vomiting

Contraindications are decreased LOC, inability to swallow, expired, lack of medical direction
Aspirin drug information
Anti-inflammatory/platelet aggregate/pyretic. Used for chest pain.

Dose is 160 to 325 mg via oral.

Side effects are nausea/vomiting, stomach pain, bleeding, allergic reaction

Contraindications: allergy, decreased LOC, inability to swallow, recent bleeding, pediatric, expired medicine or no medical direction.
Activated charcoal drug information
Adsorbent drug that binds to drugs and chemicals to prevent the body from absorbing them.

Dose is 1 g per kg body weight via oral.

Side effects are nausea/vomiting and dark stool

Contraindications: decreased LOC, inability to swallow, ingest acids, expired charcoal or no medical direction.
EPI pen drug information
vasoconstriction, increased heart rate, and bronchodilation. Used for anaphylactic shock

Dose is one injection via IM. Side effects are tachycardia, hypertension, increased oxygen demand, restlessness

Contraindications are allergy or lack of medical direction
MDI/SVN drug information
MDI is meter dose inhaler
SVN is small volume nebulizers
For respiratory distress (bronchodilator)

Dose is one or two inhalations via inhaled

Side effects are tachycardia, hypertension, increased oxygen demand, restlessness)

Contraindications allergy, unable to follow directions, expired, not prescribed to patients, lack of medical direction.
Nitroglycerin drug information
vasodilator, decreased oxygen demand, increased oxygen supply. Used for chest pain, suspected infarction.

Dose is 0.4 mg sublingual via spray or tablet.

Side effects are tachycardia, hypotension, headache, burning under the tongue, and nausea/vomiting).

Contraindications are expired, not prescribed, hypotension, recent use of viagra/cialis/levitra, head injury, or lack of medical direction.
Patient Assessment steps
Can change order depending on priority of patient

Scene Size up
Primary Assessment
Patient History
Secondary Assessment
Scene size up
Begins as soon as the call is received

Make sure scene is safe
Take standard precautions (PPE)
Determine number of patients and if more resources are needed
Determine Mechanism of injury or nature of illness
Primary Assessment
Purpose is to identify and treat immediate and threatening injuries. If c-spine is needed then do it immediately

General impression (age, sex, level of distress, overall appearance)
Position patient
Determine LOC (conscious and alert, conscious and altered, unconscious)
AVPU (awake and alert, responsive to voice, responsive to pain, unresponsive)
If conscious and alert, determine if they know their name, where they are, what year/month it is, and if they can describe the MOI/NOI

Manual maneuvers as needed (head tilt chin lift, jaw thrust)
Suction as needed
Mechanical airway adjunct as needed (OPA, NPA)

Assess rate, quality, and auscultate
Provide supplemental oxygen and artificial ventilations as needed
Manage life threatening breathing conditions (flail chest and sucking chest wound)

Assess pulse, initiate CPR as needed (should be done immediately for unconscious patients)
Assess and control life threatening bleeding using direct pressure
Check skin color and capillary refill time

Rapid head to toe scan (Used to identify any remaining life threats, shouldn't take longer than 90 seconds. Inspection, palpation, and auscultation as needed)

Transport priority (Determine if they should be transported rapidly or if care can be continued on scene)
History Taking
SAMPLE history
*Signs and symptoms
***Onset (when did these symptoms begin?)
***Provocation (does anything make them better/worse?)
***Quality (how would you describe the pain?)
***Radiation (does the pain go anywhere?)
***Severity (1-10 scale)
***Time (when did they start?)
*Past pertinent history
*Last oral intake
*Events leading to incident (anything unusual)
Secondary Assessment
This shouldn't delay patient transport

Obtain baseline vitals and the reassess as needed

Head to toe inspection for unresponsive patients, multisystem trauma, and high priority patients. Use a focused exam if the patient is alert and the injury has been isolated

Head and neck
Monitor patient's LOC, airway, breathing, and circulatory status

Obtain vitals as needed and reassess interventions
When to take vitals
Take baseline set, then take other sets in order to see trends

Stable patient: take every 15 minutes
Unstable patient: take every 5 minutes
Three causes of shock
Heart problems
Blood vessel problems
Blood volume problems
Body compensation for shock
The body will try to protect itself from shock for as long as possible by initiating tachycardia, vasoconstriction, and increases respiratory rate. Falling blood pressure is a late sign of shock and means the body's compensations are failing
Cardiogenic Shock
Due to a pump problem because the heart can't pump effectively which causes a fluid buildup (edema) and hypotension.

Signs and symptoms: hypotensions, chest pain, respiratory distress, pulmonary edema, altered LOC
Obstructive Shock
Due to a pump problem caused by a mechanical obstruction of the heart
Two types of obstructive shock
Cardiac Tamponade= Accumulation of fluid in pericardial sac which compresses the heart. Signs and symptoms are JVD, narrowing pulse pressure, hypotension. Can lead to circulatory collapse

Tension pneumothorax= When air enters the chest cavity due to lung injury or a sucking chest wound. Signs and symptoms are JVD, respiratory distress, absent/diminished lung sounds, poor compliance during artificial ventilation, tracheal deviation to unaffected side. Causes progressive collapse of the lung tissue.
Distributive shock
Blood vessel problem due to widespread vasodilation
Four types of distributive shock
Anaphylactic= Due to a severe allergic reaction, Signs and symptoms are hives/swelling/itching/flushed skin, weak pulse, hypotension, severe dyspnea, wheezing, respiratory failure

Neurogenic= Caused by spinal cord damage typically in the cervical region. It interferes with the normal pathway between the central and peripheral NS, which affects compensation mechanisms. Signs and symptoms are hypotension, warm skin (because the nervous system cannot stimulate peripheral NS), non tachycardic, paralysis, respiratory paralysis

Septic shock= Due to severe infection. Causes vessels to not constrict well, so the body doesn't compensate well. Signs and symptoms are fever/chills/weakness, altered LOC, increased respirations, tachycardia, hypotensions, pale/cool skin, weak peripheral pulses

Psychogenic= Pseudo-shock caused by vasodilation that leads to fainting. Not dangerous, doesn't affect the brain
Hypovolemic shock
Due to a fluid problem, like loss of blood or dehydration.

Signs and symptoms are trauma, bleeding, altered LOC, nausea/vomiting/diarrhea, tachycardia, pale/cool skin, weak peripheral pulse, hypotension
Early S/S of shock
Altered LOC
Pale/cool skin'
Weak peripheral pulses
Increased respirations
Late S/S of shock
Falling BP
Irregular breathing
Mottling or cyanosis
Absent peripheral pulses
Managing shock
Control bleeding, place patient in shock position if possible, prevent loss of body heat, rapid transport
Depth of compressions: at least 2 inches for adults/children, 1 ½ inch for infants

Maximum 10 second interruption of chest compressions

Ratio for adults is 30:2 and 15:2 for children

No pause in compressions for someone with advanced airway

Avoid hyperventilation

Use AED if patient is pulseless. Don't use if unsafe environment
Cystic fibrosis
genetic disorder, thick mucus production with chronic lung infections, often causes death
inflammation of pharynx, larynx, and trachea, highly infections and usually occurs in children. Often presents with barking cough and stridor
Pulmonary embolism
blockage of pulmonary artery means compromised blood flow to lungs, provide high flow oxygen
Acute coronary syndrome
caused by poor blood supply
Angina pectoris
Chest pain due to a lack of oxygen supply to the heart. It is usually caused by atherosclerosis in the coronary arteries. Typically happens during exercise, lasts around 10 minutes, doesn't cause permanent damage
Acute myocardial infarction
From lack of blood flow to heart
pain usually doesn't go away within a few minutes, can cause pain at any time not just during exertion. Can lead to sudden cardiac arrest
Congestive heart failure
occurs when the ventricles are unable to keep up with the flow of blood. Can have left or right ventricular failure, left failure typically leads to right failure

LSHF causes fluid to back up into lungs, presents with pulmonary edema and respiratory distress

RSHF causes fluid to back up into body, presents with pedal edema and JVD
Risk factors for heart disease and stroke
Nonmodifiable: RASH (race, age, sex, heredity)

Modifiable: SHEDS (smoking, hypertension, exercise, diet, diabetes)
Two type of stroke
Ischemic stroke (Blood flow to brain is stopped due to blockage like atherosclerosis)

Hemorrhagic stroke (caused by swelling in the brain)
S/S of stroke
S/S: severe headache, slurred speech, facial droop, drooling, unilateral numbness/weakness/paralysis, altered LOC, vision problems
Stroke scale
Facial droop
Arm drift
Slurred speech/unable to speak
Transient Ischemic Attack (TIA aka mini stroke)
S/S correct within 24 hours and leave no permanent brain damage. Typically a warning sign of impending stroke
Types of seizures
Generalized(grand mal, unresponsive and full-body convulsions)

Absences (petit mal, does not interact with the environment and no convulsions)

Partial Simple: no change in LOC, possible twitching and sensory changes

Partial Complex: altered LOC, isolated twitching and sensory changes

Status epilepticus (prolonged or recurrent seizures without patient regaining consciousness)
Phases of seizures
Aura (warning)
Postictal (recovery)
Syncope (fainting caused by temporary lack of blood flow to brain. PT regains consciousness as soon as blood flows back to brain)
How insulin and glucagon work
Insulin is needed to move glucose out of the bloodstream and into cells to provide energy. Insulin causes blood glucose levels to drop. Without insulin, cells starve. The brain cannot use other forms of energy. Glucagon works opposite of insulin.

Cycle: eat food, insulin is released, blood glucose levels rise, glucagon is released, blood glucose level maintained.
Normal Blood glucose levels
80-120 mg/DL but 120-140 after eating
Type 1 Diabetes
Genetic, must take insulin

Risk of insulin shock (severe hypoglycemia caused by unexpected drop in blood glucose from not eating with insulin or insulin overdose- leads to confusion, violence, or unconsciousness)

Risk of Diabetic Ketoacidosis (high blood glucose, body uses other fuel source which causes buildup of byproducts like ketones and acidosis. Acidosis causes threat to brain)
Three P's (classic symptoms of diabetes):
Polyuria: excessive peeing
Polydipsia: excessive thirst
Polyphagia: excessive hunger
Risk factors for diabetes
1. Fatty deposits in blood vessels increase risk of stroke

2. Chronically high blood glucose can damage arteries
How to treat a toxicology patient
Avoid exposure to toxins, remove patient from source of toxin before treating, decontaminate if needed, consider activated charcoal
Abdominal pain
Primary concern is hemorrhagic shock. Hollow organs can spill their contents when injured, solid organs bleed.

Two types:
Visceral= dull, diffuse pain pain that is difficult to localize, often associated with nausea and vomiting. Most likely not severe, but may indicate organ damage

Parietal= severe, localized pain that is sharp.
Inflammation of appendix, can lead to septic shock
inflammation of gallbladder, often due to gallstones. S/S increased pain at night and after eating fatty foods. Pain radiates to shoulder
small pouches along the wall of the intestine fill with feces and become infected. Causes lower GI bleeding
infection associated with diarrhea, nausea, and vomiting. Usually due to contaminated water/food. Can lead to hypovolemic shock
Esophageal varices
weakening of the blood vessels that line the esophagus. Associated with alcoholism
causes upper GI bleeding
Abdominal aortic aneurysm
weakening of the aorta and abdominal wall, could rupture and cause rapid, fatal bleeding
Pelvic inflammatory disease
Sexually transmitted from vagina to womb (uterus), fallopian tubes, or ovaries. S/S is pelvic pain and fever
how to stop epistaxis (nosebleed)
can be stopped by holding nose closed for about ten minutes, swallowing blood may lead to nausea
What is bleeding or CSF a sign of?
Possible skull injury
Compartment syndrome
Caused by the compression of veins/arteries/nerves, can lead to death of tissue. S/S is severe pain
How to treat Evisceration
cover with moist sterile dressing then cover with occlusive dressing
When to remove impaled object
There is an airway obstruction or if it makes it so that CPR cannot be done
Five basic interventions for external bleeding:
Direct pressure
High flow oxygen
PRevent heat loss
Shock position
High priority transport
Five Factors of Burn severity
Depth of burn

Amount of body surface burned (palm of patient's hand is 1%)

Burns to critical areas (respiratory tract, hands, face, feet, genitals)

Associated with trauma of pre existing medical condition

Age (under 5 or over 55 are greater risk)
Severe Burns
Burns that cause respiratory compromise
Full thickness circumferential burns
Partial thickness burns covering more than 30% of body
Burns associated with trauma
Full thickness burns to critical areas or that cover more than 10% of body
To patient under 5 or over 55
Thermal burns
stop it with sterile burn sheet then replace with dry sterile dressing when no longer hot to the touch. Take off jewelry because extreme swelling is likely
Electrical burns
do not try to remove them. These patients are at high risk for cardiac and respiratory failure
Chemical burns
assess scene safety, do not risk your exposure. If safe, remove contaminated jewelry/clothing, brush any dry chemicals off, irrigate patient
Life threatening musculoskeletal injuries
Pelvic fracture and femur fracture because they can cause severe bleeding

Amputations (need to control bleeding; wrap amputated part in sterile dressing and place in plastic bag and keep cool)
How to splint
Assess PMS (pulse, motor, sensation) before and after splinting
Immobilize above and below injury
Attempt to realign with distal pulse with gentle traction
Contraindication for traction splint is femur fracture
When the brain is shaken inside of the skull

S/S: altered LOC that gradually changes, brief loss of consciousness, nausea, repetitive questioning, vision problems)
Cerebral contusion
Traumatic brain injury that bruises the brain. Can cause a decline in mental functioning in the long term, emergency concern is brain herniation (when brain squeezes past sutures in the skull)

S/S: signs of concussion + decreased mental status, changes in vitals, obvious behavioral abnormalities
Spinal Injury S/S
Pain, motor/sensory deficits (weak/absent grasps, inability to feel, paralysis)

A severed spinal cord will cause paralysis below the level of injury and loss of bladder/bowel control. High risk for respiratory paralysis if above C5
Helmets in spinal injuries
Football helmets allow access to airway, but some motorcycle helmets may not. Only remove helmet if you cannot access airway or if it does not allow for spinal immobilization
Pediatrics with spinal injuries
Pad behind shoulders prior to immobilization (helps maintain neutral position because their head is bigger than their body).
Don't use car seat that has been involved in an accident.
Foreign objects in eye
Non-penetrating objects on the sclera can be removed with irrigation, leave objects in other parts to be removed by physician. Need to consult medical direction for irrigating eyes
Orbital fracture
Usually from significant MOI, consider that there might be spinal trauma as well. S/S are double vision, deformity around orbit, loss of sensation, inability to move eye upward
Impaled object in eye
Do not remove, stabilize it in place, keep both eyes closed to make sure impaled object doesn't move
Chemical burn of eye
Immediate and continuous irrigation
Loss of tooth
Control bleeding to reduce swelling and chance of vomiting.
Rinse tooth with saline and transport in saline soaked gauze
Injuries to neck
Secure airway, control life threatening bleeding, apply occlusive dressing to large and open injuries to reduce risk of air embolism
S/S cold skin, pale/cyanotic, shivering (ceases with extreme hypothermia), loss of coordination due to stiffening muscles, difficulty speaking, altered LOC. Bradycardia, bradypnea, and hypotension

To treat: Remove patient from cold environment, remove wet clothing to prevent further heat loss (don't want to rewarm too quickly)
Frost nip
Body Part is cold but not yet frozen.

S/S is pale/cold skin, with loss of sensation in affected area.

Example is Trench Foot (feet exposed to cold for too long)
Frost bite
When the tissue freeze, frequently leads to permanent damage.

S/S hard/frozen tissue, possible blistering and mottling

To treat: Remove patient from cold, remove wet clothing, protect affected area from further injury, remove jewelry, bandage and splint affected area, keep patient immobile. Do not rub affected area and do not apply direct heat unless told to do so
Heat cramps
Typically occur from prolonged exertion likely caused by electrolyte imbalance.

To treat: Rest, rehydrate, and restore electrolytes
Heat stroke
Caused by a combination of heat exposure and hypovolemia

S/S dizziness/weakness, nausea/vomiting, headache, possible muscle cramps, thirst, tachycardia
Heat exhaustion
Uncommon, but extremely dangerous. Body loses its ability to regulate body heat, which means body temperature can climb rapidly.

S/S similar to heat stroke but with altered LOC and hot and dry/wet skin as well as seizures.

To treat: Move patient to cooler environment, take rapid cooling measures (remove clothing, cool patient with wet towels/cold packs applied to groin/neck/armpits, rapid transport, prepare for vomit and seizures.
Changes in woman's body during pregnancy
Uterus requires more blood. It also becomes enlarged and displaces other organs

Respiratory rate doesn't change very much, but oxygen demand increases significantly. During third trimester, the uterus displaces the diaphragm. They are at greater risk of developing hypoxia

Cardiac workload increases, which means faster heart rate. S/S of shock are masked during pregnancy.

Center of gravity changes, which increases chances of falls
Can develop more quickly in pregnant women. S/S may not be evident until extreme shock. May be no external bleeding.
Placenta Privia
Placenta attaches to uterus. As the cervix dilates, the placenta tears and bleeds.

Classic S/S is painless vaginal bleeding.
Abruptio Placentia
Premature separation of the placenta from uterine wall, causes bleeding. Comprises delivery of oxygen and nutrient to fetus. Fetus won't survive a complete abruption.

S/S is painful vaginal bleeding
Ectopic pregnancy
Egg implants on fallopian tube. Can lead to rupture and bleeding.

S/S is severe abdominal pain with or without bleeding.
Uterine rupture
High danger to mother and fetus. S/S is abdominal pain and vaginal bleeding
Spontaneous abortion
S/S cramping, lower abdominal pain, vaginal bleeding, passage of tissue/clots.
Pregnant women seizures
Treat as regular seizures, place patient on left side, minimize exposure to stimuli such as light
Preeclamspsia and Eclampsia
Preeclampsia S/S sudden weight gain, visual disturbances, swelling of feet/face/hands/feet, headache, hypertension

Eclampsia is when mother seizes following eclampsia
Supine hypotensive syndrome
When fetus compresses inferior venacava, causes severe drop in BP.

S/S hypertension, dizziness, altered LOC, pale skin. Do not place patient in supine position, place on side or seated
Signs of imminent delivery
Strong and frequent contractions that are less than two minutes apart
Mother feels urge to push
During delivery
Make sure cord isn't wrapped around head/neck, if it's wrapped gently remove it.
Once head clears birth canal, suction fluid from nose and mouth.
Guide one shoulder up, then once it clears guide the other down
Clamp cord and cut once it stops pulsating
Gently guide placenta, don't pull
Uterine massage and breastfeeding can help reduce risk of postpartum hemorrhage
Neonatal post birth care
Place on dry sheets after delivery
Dry baby, then replace with wet linens
Warm baby, place on mother's stomach
If baby isn't crying, attempt tactile stimulation
Assess vitals

Important: respirations, heart rate, and color
If baby isn't breathing adequately then provide oxygen, do not give more than 30 seconds.
<60 heart rate: compressions at 3:1 ratio, reassess every 30 seconds
60-100 heart rate, provide ventilations and reassess every 30 seconds
>100 heart rate assess skin color
APGAR (appearance, pulse, grimace,activity, respirations. 0-2 points for each 2 is best)
Delivery complication
Presence of fetal stool in amniotic fluid, makes a greater risk of infection and pneumonia for baby. Suction mouth and nose promptly while delivering and then again after delivery
Prolapsed cord
Delivery complication
Can cut of oxygen to baby. Instruct mother not to push, place mother in knew to chest position and push presenting part of baby away from cord. Transpor rapidly
Breech presentation
Delivery complication
Baby's butt or legs come first. Transport immediately because it poses danger for mom and baby. Uses fingers to form a V so baby can get oxygen if needed
Limb delivery
Delivery complication
Do not attempt to deliver, place mother in knee to chest position and transport immediately
Postpartum hemorrhage
Delivery complication
Uterine massage, breastfeeding, treat for shock
Anatomical/Physiological differences in pediatrics
Larger tongue
Smaller lower airway that is more easily obstructed
Obligate nose breathers
Head is much larger, significant source of heat loss, increased risk of head trauma, need to pad under shoulders for c spine, sunken fontanels are sign of hypovolemic shock, hypoxia can develop more rapidly (bradycardia is a sign of hypoxia)
More pliable ribs, decreased risk of rib fracture but increases risk of internal injury because they are less protected
Smaller lungs, increased risk of over ventilation, abdominal breathers
Hypotension usually doesn't develop in peds unless severe hypovolemia
Use glucose and oxygen faster than adults
Skin surface is larger, so they are more susceptible to hypothermia
Assessment triangle for pediatrics
Tone: movement, muscle tone, etc
Interactivity: alertness, reactivity to stimuli, interaction with environment
Consolability: can they be consoled by their parents/caregivers?
Look: can they fix their gaze or are they out of it
Speech/cry: speech in older, cry in younger

How hard are they working to breathe? Look for accessory muscle use, abnormal lung sounds, grunting, tripod positioning, head bobbing, nasal flaring

Assess skin color
Unexplained and unexpected death of someone less than one year of age
Treat as any other cardiac arrest patient, help console parents