Exam 5 Section 1 Chapter 23, 33, 34

What are some questions to ask to determine any potential complications?

-Have you had any problems in a previous pregnancy? -Do you use drugs, drink, alcohol, or take any medications? -Do you know if there is a chance for multiple births? -Does your doctor expect any complications?

What are some questions to determine if delivery is imminent?

-How long have you been pregnant? -When are you due? -Is this your first baby? -Are you have contractions, how long? -Do you feel like you will have a bowel movement? -Have you had any spotting or bleeding? -Has your water broken? -Were any of you children delivered by cesarean?

Menstrual Cycle

1 follicle matures + reaches egg

What Apgar Score should you assign to this newborn?

1 minute to 5 minutes after birth. Numeric Value (0, 1, 2) in five areas Appearance - Pink Body 1 Pulse - Heart Rate 130 beats/min 2 Grimace/Irritation - Moves Foot Away 2 Activity or Muscle Tone - Resists Leg Straightening 2 Respirations 40 to 60 breaths/min 2 NEWBORN SCORE = 9

What are the three stages of labor?

1)Dilation of the cervix 2)Delivery of the infant 3)Delivery of the placenta

What are the guidelines for treating a pregnant trauma patient?

1)Maintain an open airway - increased risk of vomiting 2)Administer high-flow O2 - patient also supplying O2 to fetus 3)Ensure adequate ventilations - listen to lung sounds 4)Assess circulation - maintain Index of S. for internal bleeding 5)Transport considerations - call ALS for MOIs or major trauma

During delivery of the placenta, the following are considered emergency situations:

1)More than 30 minutes elapse, and the placenta has not delivered. 2)There is more than 500 mL of bleeding before the placenta. 3)There is significant bleeding after delivery of the placenta.

While the ages can vary, women typically experience menstruation from approximately ... to ... years of age.

11, 50

A child may begin to show signs of stranger anxiety as early as

12 months

An infant's fontanels should close completely by the time he or she is

18 months old

The suture of the anterior fontanelle is typically closed by__ months of age, and the suture of the posterior fontanelle is typically closed by__ months of age

18, 6

After squeezing the end of a child's finger or toe for a few seconds, blood should return to the area within:

2 seconds

By the end of pregnancy, the pregnant patient's heart rate increases up to 20%, or about __________ beats more per minute.

20

Which of the following is the MOST appropriate dose of activated charcoal for a 20-kg child?

25g

Blood pressure is usually not assessed in children younger than___years.

3

Preeclampsia or Pregnancy Inducted Hypertension

30 weeks of gestation symptoms: headache/seeing spots/swelling hands + feet = edema/anxiety/high BP

Premature Infant

36 weeks of gestation, weigh less than 5 lbs smaller, thinner than full term head larger than rest of body missing vernix, less body hair

A full-term pregnancy is from _______ to _________ weeks, counting from the first day of the last menstrual cycle.

36; 40

If the situation allows, a child should be transported in a car seat if he or she weighs less than __lb.

40

Post Term Pregnancy

42 weeks larger baby, weighing more than 10 lbs difficulty delivery mecomium aspiration, infection, still born

What is patient's blood volume during pregnancy?

50 % Heart Rate 20%

The amniotic sac contains about _________ to __________ mL of amniotic fluid, which helps to insulate and protect the floating fetus as it develops.

500; 1,000

A child may begin to show signs of separation anxiety as early as:

6 months

Febrile seizures are MOST common in children between

6 months and 6 years of age.

Capillary refill time is MOST reliable as an indicator of end-organ perfusion in children younger than:

6 years

The normal respiratory rate for a newborn should not exceed ____ breaths per minute.

60

Bacterial vaginosis is a condition that occurs when: A. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. B. numerous bacteria enter the uterus through the cervix and cause severe tissue damage. C. abnormal bacteria enter the vagina and cause damage without causing any symptoms. D. harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes.

A

EMTs treating a patient of a sexual assault may not only be dealing with medical issues, but with _____ issues as well. A. psychological B. physiological C. educational D. sociological

A

Each ovary produces an ovum in alternating months and releases it into the: A. fallopian tube. B. vagina. C. cervix. D. uterus.

A

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer: A. may be relatively painless. B. is typically not as severe. C. can be controlled in the field. D. often presents with acute pain.

A

In rare cases, _____ causes arthritis that may be accompanied with skin lesions and inflammation of the eyes and urethra. A. chlamydia B. gonorrhea C. PID D. vaginal bleeding

A

It is not uncommon for young females who experience their first menstrual period to: A. experience abdominal cramping, which may be misinterpreted. B. become so emotionally distraught that they contemplate suicide. C. have a falsely positive home pregnancy test result. D. lose up to 500 mL of blood within the first 24 hours.

A

Often the most important intervention for sexual assault patient is _____ and transport to a facility with staff specially trained to deal with this scenario. A. comforting reassurance B. excellent assessment skills C. bandaging skills D. emotional sympathy

A

The "PID Shuffle" refers to: A. a distinctive gait when the patient walks. B. rotation of the microorganisms that cause PID. C. symptoms that come and go. D. a structural that come and go.

A

When a female has reached menarche: A. she is capable of becoming pregnant. B. she can no longer produce an ovum. C. she usually requires hormone therapy. D. menstrual periods become less frequent.

A

Which of the following statements regarding rape is correct? A. Rape is a legal diagnosis, not a medical diagnosis. B. Only a licensed physician can make a diagnosis of rape. C. The EMT should try to determine if rape occurred. D. Rape causes more physical harm than emotional harm.

A

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. Your first course of action should be to: A. determine whether the patient is physically injured. B. establish the exact events of what took place. C. allow the patient to use the restroom. D. let the police question the patient before conducting a primary assessment.

A

What are the five areas of assessment for the Apgar?

A - Appearance - color of the infants skin P - Pulse - determine the beats/min G - Grimmace/irritability - newborn's response to stimuli A - Activity/muscle tone - newborns resistance to stretching R - Respiration - how air is ventilated and used for the newborn

Which of the following statement regarding a 3 month old infant is correct?

A 3 month old infant can distinguish a parent from a stranger

Because cardiac arrest in neonates is nearly always the result of ventilation compromise, a compression to ventilation ratio of what should be used?

A compression to ventilation ratio of 3:1 should be used, which yields 120 actions per minute (90 compressions & 30 vents)

Which of the following statements regarding a decreased level of consciousness in the elderly patient is correct?

A decresed level of consciousness is not a normal part of the aging process

A 16-year-old female complains of vaginal bleeding and abdominal cramping that began several hours ago. During your assessment interview, you should: A) inquire about the possibility of pregnancy in private, if possible. B) avoid asking questions that she will feel uncomfortable answering. C) recall that patients in this age group prefer not to be treated as adults. D) obtain the majority of your information from one of her parents.

A) inquire about the possibility of pregnancy in private, if possible.

Signs of an upper airway obstruction in an infant or child include all of the following, EXCEPT: A.wheezing B.stridorous breathing C.a cough that resembles the bark of a seal D.a weak cough

A.wheezing

Abuse

ABC's, control bleeding, immobilize injuries, treat for shock with oxygen, keep patient warm.

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes:

Administrating blow by oxygen and transporting the child with her mother

When should you begin resuscitation efforts on an infant?

After 10-15 seconds, many infants require some form of stimulation that will encourage them to breath air.

What should you do to help control bleeding in mother who has just given birth?

After delivery massage the mother's abdomen in a firm, circular motion. The uterus will contract and become firmer.

Proper management for infant needing ventilatory assistance

Apgar Score

Any bleeding from the vagina in a pregnant woman should be treated how?

As a serious sign and should be treated in the hospital promptly.

How should you manage the umbilical cord situation?

As soon as head is delivered, stop pushing. Nuchal Cord when cord is wrapped around baby's neck. Place 2 clamps 2" apart. Cut between two clamps.

Physical Exam

Assess major body systems Fetal Movement Contractions? Delivery Imminent: Check Vagina for Crowing but protect patient's privacy

Delivery at Home

At home, place towels on floor put patient on floor, elevate hips support head, neck, shoulders with blankets

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: A. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. B. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. C. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. D. assist her ventilations with a bag-mask device, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

B

As a woman approaches menopause: A. she usually experiences abdominal cramping without vaginal bleeding. B. her menstrual periods may become irregular and vary in severity. C. her risk of developing PID lowers significantly. D. she cannot become pregnant because of fluctuating hormone levels.

B

If a patient with vaginal bleeding present with a rapid pulse and pale or cool skin, you should: A. attempt to locate the source of bleeding and correct it. B. place the patient in a supine position with her legs elevated. C. consider this to be a normal sign in a menstruating woman. D. inquire about recent problems with urination.

B

Painful urination associated with burning and a yellowish discharge is assocated with: A. chlamydia. B. gonorrhea. C. endometriosis. D. syphilis.

B

Potentially life-threatening consequences of PID include: A. bacterial vaginosis and chlamydia. B. ovarian abscess and ectopic pregnancy. C. ovarian cysts and gonorrhea. D. uterine rupture with severe bleeding.

B

The onset of menstruation usually occurs between the ages of: A. 8 and 10 years. B. 11 and 16 years. C. 16 and 18 years. D. 17 and 20 years.

B

When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she: A. has obtained a complete set of vital signs. B. has gathered patient history information. C. ascertains if the patient was ever pregnant. D. has formed a general impression of the patient.

B

Which of the following conditions does NOT typically present with vaginal discharge? A. PID B. genital herpes C. chlamydia D. gonorrhea

B

Which of the following statements is FALSE regarding assessment and treatment of a woman who was the victim of sexual assault? A. You may be called to testify in court regarding the incident B. You should question the victim thoroughly about the assaulter in case the police missed any details C. The patient should be given the option of being treated by a female responder D. The patient should be discouraged from urinating or changing her clothes prior to examination at the hospital

B

You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings would increase your index of suspicion for PID? A. a history of ectopic pregnancy B. a shuffling gait when walking C. bright red blood in the urine D. vaginal passage of blood clots

B

How much of an increase in blood volume does a pregnancy bring?

Blood volume may eventually increase as much as 50% by the end of pregnancy.

Breech Delivery

Body part delivered first. Greater risk for trauma. Mother needs to deliver 10 minutes after buttocks shows. Need ALS. Make a "V" with gloved fingers + put inside vagina to keep walls of vagina from compressing airway.

How can you prevent the perineum from tearing?

By applying pressure to the baby's head to allow the tissues to stretch and to prevent a precipitous birth. An episiotomy may be performed by the physician (incision to the perineum).

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: A. refraining from placing any dressings into the vagina. B. treating external lacerations with moist, sterile compresses. C. carefully removing any foreign bodies from the vagina. D. supplemental oxygen and lower extremity elevation.

C

If a woman with vaginal bleeding reports syncope, the EMT must assume that she: A. is pregnant. B. has an infection. C. is in shock. D. has an ectopic pregnancy.

C

In anticipation of receiving a fertilized ovum, the lining of the uterine wall: A. sheds and is expelled externally. B. diverts blood flow to the vagina. C. becomes engorged with blood. D. thins and begins to separate.

C

Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should: A. advise her that she cannot clean herself up because this will destroy evidence. B. perform a limited hands-on assessment to detect life-threatening injuries. C. provide emotional support and visually assess her for obvious trauma. D. ask her if there is anyone you can contact, such as a friend or relative.

C

Left untreated, _____ can lead to premature birth or low birth weight in pregnant women. A. chlamydia B. gonorrhea C. bacterial vaginosis D. vaginal bleeding

C

When taking a history on a patient experiencing a gynecologic emergency, you should consider asking all of the following EXCEPT: A. Are you taking birth control? B. When was your last menstrual period? C. How many sexual partners have you has in the past? D. Do you have any history of sexually transmitted diseases?

C

Whenever possible, a female sexual assault victim should be: A. thoroughly assessed, even if no signs of injury exist. B. encouraged to take a shower and change her clothes. C. given the option of being treated by a female EMT. D. asked to provide a brief description of the perpetrator.

C

Which of the following clinical presentations is MOST consistent with PID? A. left lower quadrant pain, referred pain to the left shoulder, and fever B. upper abdominal cramping, severe headache, and heavy vaginal bleeding C. lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge D. pain around the umbilicus, low-grade fever, and generalized weakness

C

Which of the following statements regarding gonorrhea is correct? A. Mild infections with gonorrhea cause abdominal pain, vomiting, and fever. B. Symptoms of gonorrhea usually appear within 3 months after being infected. C. Painful urination is a common symptom of gonorrhea in men and women. D. Most men who are infected with gonorrhea do not experience symptoms.

C

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The second course of action involves the psychological care of the patient. You should avoid: A. making attempts to get a female EMT to examine the patient. B. examination of the vaginal canal, even if active bleeding is taking place. C. attempting to gather information to assist the police. D. granting the patient's wishes for refusing care and transport.

C

Your _____ is the best tool to gain the patient's confidence to seek medical help. A. professionalism B. content knowledge C. compassion D. empathy

C

Common causes of seizures in children include all of the following, EXCEPT: A.infection B.electrolyte imbalances C.hyperglycemia D.poisonings or ingestion

C.hyperglycemia

What anatomic + physiologic changes occur during pregnancy? How will they affect your assessment of the patient?

Changes occur in respiratory, cardiovascular, musculoskeletal, gastrointestinal systems.

Which of the following statements regarding a pediatric patient's anatomy is correct? (Needs options)

Children have a larger, rounder occiput compared to adults

Which of the following conditions would most likely lead to pelvic inflammatory disease if left untreated?

Chlamydia

Patient Position

Clothing pushed up to waist, remove underwear Pillow under hips to elevate 2' to 4' Support head, neck, back with pillows Each team members has a job caring for mom/other member care for baby

If the newborn's cardiac arrest is believed to be of cardiac origin, what do you use?

Consider a higher ratio, 15:2 compressions vs. ventilations.

Labor

Contractions of uterus Bloody Show/Rupture of Amniotic Sac/Water Breaking Uterine contractions last about 30 to 60 seconds.

Infant Bag Mask

Cover infant's nose + mouth. Ventilate high flow oxygen at rate of 40 to 60 breaths.

What do you do for excessive bleeding?

Cover vagina with sterile pad. Change pads often + keep for hospital.

During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse is rapid and weak. You should: A. perform a rapid secondary assessment. B. perform a visual assessment of her vaginal area. C. assess her blood pressure and elevate her legs. D. assist her ventilations with a bag-mask device.

D

PID typically does NOT affect the: A. ovaries. B. uterus. C. fallopian tubes. D. urinary bladder.

D

Possible causes of vaginal bleeding include all of the following EXCEPT: A. ectopic pregnancy. B. cervical polyps. C. vaginal trauma. D. peptic ulcer.

D

Rape is considered to be a _____ diagnosis, not a medical diagnosis. A. psychological B surgical C. sociological D. legal

D

The most common presenting sign of PID is: A. vaginal discharge. B. fever. C. nausea and vomiting. D. lower abdominal pain.

D

The onset of menstruation is called menarche and usually occurs in women who are: A. between 25 and 35 years of age. B. between 12 and 14 years of age. C. between 45 and 50 years of age. D. between 11 and 16 years of age.

D

The physical examination of a sexual assault victim should be: A. deferred until the patient can be evaluated by a physician. B. as detailed as possible so all injuries can be documented. C. performed in the presence of at least two police officers. D. limited to a brief survey for life-threatening injuries.

D

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to: A. determine the underlying cause of her problem. B. ask questions related to her gynecologic history. C. keep assessment and treatment to a minimum. D. maintain her ABCs and transport without delay.

D

When documenting a call in which a female was sexually assaulted, you should: A. only use quotation marks when recording any statements made by witnesses. B. translate the patient's words or statements using proper medical C. record your opinion only if you have reasonable proof to justify the statement. D. keep the report concise and record only what the patient stated in her own words.

D

When performing a physical exam on a victim of sexual assault, you should: A. expose and evaluate the patient's vaginal area regardless of whether there is bleeding. B. allow multiple people to observe the examination in case you have to testify. C. limit your examination to a brief survey for life-threatening injuries. D. place the patient's clothes into a paper bag.

D

Which of the following conditions would MOST likely lead to PID if left untreated? A. genital herpes B. ovarian cysts C. ectopic pregnancy D. chlamydia

D

Which of the following statements regarding pelvic inflammatory disease (PID) is correct? A. The most common presenting symptom of PID is generalized upper abdominal pain. B. PID most commonly affects women who have had an ectopic pregnancy in the past. C. The most severe cases of PID occur in women who are not sexually active. D. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.

D

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The patient tells you that she would really like to be transported to the hospital but refuses a physical examination. You should: A. explain to her that she cannot be transported without a physical exam. B. have the police take the patient into custody in order to legally force a physical exam. C. explain to her that this is a criminal case and that she must be examined. D. follow your system's refusal of treatment policy and respect the patient's wishes without judgement.

D

All of the following are normal findings in an infant or child, EXCEPT: A.quiet breathing B.belly breathing C.fear or anxiety D.head bobbing

D.head bobbing

Which of the following is NOT a known risk factor of SIDS? A.mother younger than 20 years B.mother smoked during pregnancy C.low birth weight D.putting a baby to sleep on his or her back

D.putting a baby to sleep on his or her back

Second Stage of Labor Spontaneous Birth - Infant is Born

Deliver baby at scene or transport to hospital Fetus moves to birth canal Contractions are closer + last longer Pressure on rectum/mom thinks she needs a bowel movement.

Stages of Labor

Dilation of Cervix Delivery of Infant Delivery of Placenta

With regard to the legal implications of child abuse

EMT-Bs must report all suspected cases of child abuse

.... pregnancy and spontaneous abortion are two conditions that can cause vaginal bleeding in women who do not appear to be pregnant and may not even realize that they are pregnant.

Ectopic

Causes of vaginal bleeding include which of the following?

Ectopic pregnancy Vaginal trauma Spontaneous abortion

Post Partum Complications

Excessive bleeding 500 mL Massage Uterus Muscles of Uterus Contracting treatment:shock position, oxygen, vital signs, transport

T/F A woman who is having her first baby is called a multigravida.

F

T/F After delivery of the head, suction the nose first.

F

T/F Crowning occurs when the baby's head obstructs the birth canal, preventing normal delivery.

F

T/F Labor begins with the rupture of the amniotic sac and ends with the delivery of the baby's head.

F

T/F Most premature infants have vernix on their skin when delivered.

F

T/F Once labor has begun, it can be slowed by holding the patient's legs together.

F

T/F The placenta and cord should be properly disposed of in a biohazard container after delivery.

F

T/F The umbilical cord may be gently pulled to aid in delivery of the placenta.

F

Which of the following factors is associated with the lowest risk of meningitis?

Female gender

Where does fertilization of the egg usually occur?

Fertilization, when a sperm and egg meet, usually occurs when the egg is inside the fallopian tube.

Meconium or Green Fluid

Fetal Stool indicates newborn distress or fetus aspiration or secretion of fluids

Dilation of Cervix

Fetus enters birth canal Cervix is dilated Longest stage of labor usually lasting 16 hours

Cephalic Presentation

Fetus positioned head first in birth canal

Which of the following infections, when left untreated, may lead to infection of the blood and brain?

Gonorrhea

Normal Delivery Management

Has Patient delivered before? Does she feel like she has to move her bowels? Infants head is pressing on rectum, delivery is about to occur. Check for crowning where infant's head can be seen in vagina. Do not touch vagina without partner present. Your job is to help, guide, support. Use standard precautions.

As soon as the infant is born, you should?

He or she needs to be dried off and wrapped immediately in a blanket or towel and placed on one side.

Lightening

Head of fetus moves descends into pelvis. Sensation of uterus moving

What are the signs and symptoms of preeclampsia?

Headache, seeing spots, swelling in the hands and feet (edema), anxiety, and high blood pressure.

What immediate treatment is indicated for this newborn?

Heart rate 80 beats/min cyanosis, hypoxemic needs supplemental oxygen Infant remains cyanosis up to 24 hours after birth Palpate brachial pulse. 12 pulsations, 6 seconds = 120 beats/min Ventilate newborn 40 to 60 breaths/min for 30 seconds keep warm, transport

SAMPLE History

History of Medical Problems/Medications Focus on prenatal care + complications Due date, frequency of contractions, previous deliveries Water broken?

Which of the following statements regarding spinal injuries in pediatric patients is correct?

If the cervical spine is injured, it is most likely to be an injury to the ligaments because of rapid movement of the head

In cases of sexual assault, it is important to ensure that you do which of the following?

Immediately write down your observations of the scene before assessing the patient. Call for a female EMT or ALS care provider. Discuss with law enforcement any suspicions that you may have about the perpetrator.

Communication + Documentation

Imminent Delivery/notify hospital Rapid Transport Information: Number of Weeks Gestation, Due Date, Complications, thorough documentation Complete two patient care reports Obstetrics + Regular

Pregnant women have an increased amount of overall what?

Increased amount of overall blood volume and an approximate 20% increase in their heart rate by the third trimester.

Cardiovascular Changes During Pregnancy

Increased blood volume Preparing for blood loss during child birth Blood Volume passes through uterus every 8 to 11 minutes/increase of 50% during pregnancy Red Blood Cells increases = pregnant women need to take iron Blood Clotting factors change to prepare for childbirth. Heart Rate increases 20% or 20 beats per min.

Respiratory Changes During Pregnancy

Increased respiratory rate decreased minute volume (amount of gas inhaled) Increased demand for oxygen

Fetal Demise

Infant who died in mother's womb before labor Labor will proceed as normal Infection will present foul odor Stage of Decomposition:Skin blisters, skin slogging, dark discoloration, head soft

What question is a sign that delivery is imminent?

Is this your first baby?

The umbilical vein carries?

It carries oxygenated blood from the woman to the heart of the fetus.

What is the placental barrier?

It consists of two layers of cells, keeping the circulation of the woman and fetus separated but allowing nutrients, oxygen, waste, carbon dioxide, and many toxins and most medications to pass between the fetus and woman.

How much fluid is contained in the amniotic sac?

It contains about 500-1000 mL, which helps insulate and protect the fetus.

The female reproductive system includes which organs?

It includes the fallopian tubes, uterus, cervix, vagina, and the breasts.

What is placenta previa?

It is a condition in which the placenta develops over and covers the cervix.

What is fetal alcohol syndrome?

It is a condition of infants who are born to women who consume alcohol during pregnancy; characterized by growth and physical problems, mental retardation, and a variety of congenital abnormalities.

What is preeclampsia/pregnancy-induced hypertension?

It is a condition of late pregnancy that involves headache, visual changes, and swelling of the hands and feet.

What is meconium?

It is a dark green material in the amniotic fluid that can indicate distress or disease in the newborn; the meconium can be aspirated into the infant's lungs during delivery; aka infant's first bowel movement.

What is breech presentation?

It is a delivery in which the buttocks come out first.

What is vertex presentation?

It is a delivery in which the head comes out first.

What is limb presentation?

It is a delivery in which the presenting part is a single arm, leg, or foot.

What is spina bifida?

It is a developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly even outside of the body, usually at the lower third off the spine in the lumbar area.

What is an ectopic pregnancy?

It is a pregnancy that develops outside the uterus, typically in a fallopian tube.

What is an abruption placenta?

It is a premature separation of the placenta from the wall of the uterus.

What is the Apgar score?

It is a scoring system for assessing the status of a newborn that assigns a number value to each of the five areas of assessment.

What is lightening?

It is a sensation felt by a pregnant patient when the fetus positions itself for delivery.

What is prolapse of the umbilical cord?

It is a situation in which the umbilical cord comes out of the vagina before the infant.

What is a bloody show?

It is a small amount of blood at the vagina that appears at the beginning of labor and may include a plug of pink-tinged mucus that is discharged when the cervix begins to dilate.

What is a multigravida?

It is a woman who has experienced previous pregnancies.

What is a primigravida?

It is a woman who is experiencing her first pregnancy.

What is the length of the vagina?

It is about 8-12 cm in length (begins at the cervix & ends as an external opening)

In terms of litigation where does obstetrics fall?

It is among the most litigated specialties in medicine; therefore, scrupulous documentation is essential.

What is a nucal cord?

It is an umbilical cord that is wrapped around the infant's neck.

What is gestational diabetes?

It is diabetes that develops during pregnancy in women who did not have diabetes before pregnancy.

What is supine hypotensive syndrome?

It is low blood pressure resulting from compression of the inferior vena cava by the weight of the pregnant uterus when the mother is supine. (Prevent by transporting patient on her left side).

What is eclampsia?

It is seizures (convulsions) resulting from severe hypertension in a pregnant woman.

What is crowning?

It is the appearance of the infant's head at the vaginal opending during labor.

What is the umbilical cord?

It is the conduit connecting mother to infant via the placenta; contains two arteries and one vein.

What is the fetus?

It is the developing, unborn infant inside the uterus. (Grows for approximately 9 months/40 weeks)

What is the fundus?

It is the dome-shaped top of the uterus.

What is an embryo?

It is the fertilized egg that is the early stages of the fetus.

What is the amniotic sac?

It is the fluid-filled, baglike membrane in which the fetus develops.

What is the leading cause of maternal death in the first trimester of pregnancy?

It is the internal hemorrhage into the abdomen following rupture of an ectopic pregnancy.

What is the cervix?

It is the narrowest portion of the uterus that opens into the vagina.

What is miscarriage?

It is the passage of the fetus and placenta before 20 weeks; spontaneous abortion.

What is presentation?

It is the position in which an infant is born; the part of the infant that appears first.

What is the placenta?

It is the tissue attached to the uterine wall that nourishes the fetus through the umbilical cord.

What is the birth canal?

It is the vagina and cervix?

What is the endometrium?

It is when the lining of the inside of the uterus, begins to thicken and prepare for the potential fertilized egg to implant.

When does ovulation occur?

It occurs approximately 2 weeks prior to menstruation.

What happens if the egg is not fertilized within 36-48 hours after it has been released from the follicle?

It will simply die. Eventually, the lining that has thickened inside the uterus will be shed...It occurs around the 28th day of woman's cycle.

Musculoskeletal Changes During Pregnancy

Joints more loose Change in body's gravity/more prone to fall

What is involved in the routine post delivery care of a newborn?

Keep baby warm, adequate breathing. respiratory/heart rate/skin color "DO WHAT PROBABLY SEEMS SIMPLE" dry warming positioning suctioning stimulation

When you should place your gloved finger in a patient's vagina?

Keep vagina walls from compressing the infant's airway during breech or to push infant's head away from the cord when the cord is prolapse.

Seat Belt Position for Pregnancy

Lap under abdomen + over hip bone Shoulder between the breasts

Premature Rupture of Amniotic Sac

Months before due date Patient put on bed rest/doctor care

What are gestational diabetes + preeclampsia? How can they affect this delivery?

Obese Women Resolves on its own Increased production of the hormones progesterone + estrogen Pre-eclampsia - hypertension of hands/feet/face + protein in urine, seeing spots, headache Damages mother's liver Eclampsia - seizures

Chief Complaint

Obstetric History expected due date, complications, prenatal care. Feel anything different in fetus? How long contractions occurring + lasting? Is water broken? Does patient feel like they need a bowel movement?

Guidelines for Treating Pregnant Trauma Patient

Open Airway High Flow Oxygen Adequate Ventilation Assess Circulation Transport

Delivery

Partner at patient's head to comfort her apply oxygen patient grip someone's hand/nausea/vomit clear airway assess for crowning time contractions to determine frequency duration of contraction: feel abdomen contraction = uterus tightens contraction ends = uterus relaxes take quick short breaths/rest breath deeply through mouth

Deliver at Scene

Patient's home roomy, warm, comfortable, private or transport to hospital give oxygen Last 2 trimesters transport on (L) side Spinal Immobilization, put blankets under (R) side to elevate to prevent Supine Hypotensive Syndrome Rapid transport

Patient complaints of pain during intercourse, lower abdominal discomfort, and nausea may be indicative of which of the following?

Pelvic inflammatory disease

crowning

Perineum (pelvis) will bulge, top of infant's head should begin to appear at vaginal opening

Preventing Supine Hypotensive Syndrome in Pregnancy Patient

Place blanket under (R) side of backboard

Delivery of Placenta

Placenta is attached to umbilical cord coming out of vagina. can be 30 minutes after birth size: 7' diameter 1" thick surface rough/divided into two lobes wrap placenta in towel + place in plastic bag to be examined placenta inside mother will cause infection + bleeding put napkin by vagina, rub abdomen in kneading motion

Third Stage of Labor Delivery of Placenta

Placenta must completely separate from uterine wall. Contractions continue. Takes 30 minutes. Standard Precautions for fluids.

Circulation

Pregnancy has increased blood volume, increased heart rate, changes in blood clotting Assess skin color, temperature, moisture Check pulse too fast or too slow Control bleeding, give oxygen, keep patient warm

Is there time to transport this patient or should you prepare for delivery?

Prepare for imminent delivery Standard Precautions, OB Kit. Provide reassurance, give oxygen, view of vagina to see crowning, contractions Uterus/Abdomen will be firm during contraction + relaxed when not contracting. Take short breaths in between contractions.

How will you determine if delivery is imminent or if there is enough time to transport a pregnant patient?

Primigravida - 1st time delivery labor longer Multigravida - 2nd time delivery labor shorter Woman's urge to move her bowels means infant is coming.

Vital Signs

Pulse Oximetry, Skin, Blood Pressure Pulse, Respirations Tachycardia (fast hb) + Hypotension(low bp) = Hemorrhage or compression of vena cava Hypertension (high bp) indicates serious problems

Primary Assessment

Rapid Scan for ABC's. Chief Complaint: Baby is Coming. Vaginal Bleeding/Seizures/Evaluate 1st/Then assess impact on fetus AVPU: Alert, Verbal, Pain, Unresponsive

Reassessment

Repeat Primary Assessment ABC's + vaginal bleeding Vital Signs Hypoperfusion or decreased blood flow Interventions/Treatments

Teenage Pregnancy

Respect privacy/do assessment away from parents.

Which of the following drugs is commonly referred to as "roofies"?

Rohypnol

Scene Size Up

Safety Standard Precautions: gloves, eye protection gown, mask Remain calm + professional. Get additional resources.

Bruising to the _______ is LEAST suggestive of child abuse.

Shins

Signs of severe dehydration in an infant include all of the following, EXCEPT

Slowed level of activity

Cultural Value Consideration

Some cultures may not allow a male to examine a female patient. Some cultures view pregnancy as achieving status in family unit others consider it a drop in self esteem. Respect + honor requests. Your responsibility is to provide care + transport. Patient can refuse treatment.

Apgar Score

Standard Scoring System used to assess the status of newborn. Calculated 1 to 5 minutes after birth. Appearance Pulse Grimace or Irritability Activity or Muscle Tone Respirations

Neonatal Assessment + Resuscitation

Standard precautions Newborn breaths spontaneously 15 to 30 seconds after birth. Heart Rate 120 beats/min. Flick soles of baby's feet to stimulate breathing Not breathing after 15 sec/begin CPR.

Gastrointestinal Changes During Pregnancy

Stomach moves upward for pregnancy Pregnant Trauma results in vomiting/aspiration secretion into stomach Manage airway

Why is it important to suction the newborn's mouth before the nose?

Suction mouth 1st then nose. Infants are Obligate Nose Breathers, suctioning nostrils will stimulate a gasping response making infant aspirate amniotic fluid. More fluid can be retrieved from mouth.

Delivery of Infant

Support bony parts of head with hands. Suction mouth first then nose. Upper shoulder appears, guide head down slight. Support head + upper body + lower shoulder delivers Handle infant firmly but gently. keep neck in neutral position, maintain airway. keep at level of vagina until umbilical cord is cut. Place umbilical cord clamps 2' to 4' apart + cut. Allow placenta to deliver itself. Do not pull on cord to speed up.

T/F A limb presentation occurs when the baby's arm, leg, or foot is emerging from the vagina first.

T

T/F Abuse during the pregnancy increases the chance of miscarriage, premature delivery, and low birth weight.

T

T/F Delivery of the buttocks before the baby's head is called a breach delivery.

T

T/F Excessive bleeding after birth is usually caused by the muscles of the uterus not fully contracting.

T

T/F If called to deliver an infant who may have died in the uterus, you could notice skin blisters and dark discoloration to the infant.

T

T/F Massaging the abdomen after delivery helps to control bleeding.

T

T/F Multiple births may have more than one placenta.

T

T/F Pregnant teenagers may not know that they are pregnant.

T

T/F The small mucous plug from the cervix that is discharged from the vagina, often at the beginning of labor, is called a bloody show.

T

During gynecologic emergencies, in addition to the standard Sample questions, the EMT should attempt to determine which of the following?

The amount of time since of the patient's last menstrual cycle The possibility that the patient may be pregnant If the patient is sexually active

cervix

The lower third, or neck, of the uterus; it is the narrowest portion of the uterus and opens into the vagina.

uterus

The muscular organ where the fetus grows, also called the womb; responsible for contractions during labor.

vagina

The outermost cavity of a woman's reproductive tract that connects the uterus with the vulva or the external female genitalia, the lower part of the birth canal.

ovaries

The primary female reproductive organs that produce sex hormones and an ovum, or egg, that, if fertilized, will develop into a fetus.

What systems are involved in changes dealing with pregnancy?

The primary systems are the respiratory, cardiovascular, and musculoskeletal systems.

As the pregnancy continues what happens to the respiratory system?

The respiratory rate increases, with decreasing minute volumes. The pregnancy also increases the patient's overall demand for oxygen as the metabolic demands increase.

During the menstrual cycle how many follicles are successful at maturing and able to release an egg?

There will only be one follicle (out of 10 to 20 that attempt the process each month)

What are Braxton-Hicks contractions?

They are preterm or false labor contractions.

Which of the following statements regarding use of the pneumatic antishock garment (PASG) in children is MOST correct?

They are rarely used in treating children with traumatic shock.

The umbilical arteries carry?

They carry deoxygenated blood from the heart of the fetus to the woman.

Pregnant Patient in Cardiac Arrest

To save the infant, you have to save mom. CPR, transport, call hospital Hospital may do emergency cesarean section

20 Weeks of Gestation

Top of uterus grown to belly button aid in assessment of pregnant woman's abdomen

What do you do for trauma with a pregnant woman?

Treat woman first because she affects fetus.

Multiple Gestation

Twins. Baby B born 45 min after Baby A.

Prolapse of Umbilical Cord

Umbilical Cord comes out first before infant Cuts off circulation to infant depriving him of oxygen Early labor when amniotic sac ruptures Trendelenburg Position (supine, feet elevated)

If chest compressions are required for an infant, which technique should be used?

Use either the hand-encircling technique or the two-finger technique.

.... can cause significant blood loss and lead to hypovolemia

Vaginal bleeding

Primigravida

Woman experiencing 1st pregnancy

Multigravida

Woman who has experienced pregnancy

During the physical examination of a pregnant patient what should you focus on?

You should focus on the contractions and possible delivery.

When your patient is pregnant, you have two patients to care for, who is the focus?

Your focus is on the assessment and the management of the woman.

An infant delivered before _________ weeks is considered premature. a. 36 b. 37 c. 38 d. 39

a

During delivery, after the head has been delivered and the shoulder appears: a. guide the head down slightly to deliver the shoulder b. apply a nasal cannula to the infant c. guide the head up slightly, to deliver the shoulder d. pull gently

a

The Apgar score should be calculated at ___________ minutes after birth. a. 1 and 5 b. 3 and 7 c. 2 and 10 d. 4 and 8

a

The second stage of labor begins when the cervix is fully dilated and ends when: a. the infant is born b. the water breaks c. the placenta is delivered d. the uterus stops contracting

a

When giving chest compressions to an infant: a. use the hands-encircling technique or the two-finger technique b. press the palm of your had over the sternum, compressing 1" to 1 1/2" deep c. compress at a rate of 60 to 80 times a minute d. compress the sternum one quarter the depth of the chest

a

Which of the following is not a stage of labor? a. rupture of amniotic fluid b. expulsion of the baby c. delivery of the placenta d. dilation of the cervix

a

Which of the following is not performed when caring for a mother with a prolapsed cord? a. clamp and cut the cord b. provide high-flow oxygen and rapid transport c. use your fingers to physically hold the infant's head off the cord d. position the mother to keep the weight of the infant off the cord

a

Which of the following would not be a typical question to ask when taking a history on a woman in labor? a. are you having a boy or a girl? b. when is your due date? c. did your physician mention the possibility of any complications? d. is this your first pregnancy?

a

You arrive at the scene of a home delivery. Upon entering the scene, the father appears upset and hands you a limp baby. The child has a weak cry, is completely cyanotic, and has a pulse of 70 beats/min. Respirations are slow. Determine the Apgar score. a. 3 b. 9 c. 2 d. 7

a

You cannot successfully deliver a _________ presentation in the field. a. limb b. breech c. vertex d. cephalic

a

___________ is heralded by the onset of convulsions, or seizures, resulting from severe hypertension in the pregnant woman. a. eclampsia b. placenta previa c. placenta abruptio d. supine hypotensive syndrome

a

The EMT-B should be MOST concerned when a child presents with fever and

a rash

When questioning the parent of a child who ingested a poisonous substance, which of the following questions would be of LEAST pertinence? a) Why did your child ingest the poison? b) What time did the ingestion occur? c) Do you know what substance was ingested? d) Have you noticed any signs or symptoms?

a) Why did your child ingest the poison?

A patient with pelvic inflammatory disease will typically complain of ...

abdominal pain associated with menstruation

Passage of the fetus and placenta before 20 weeks is called ___________.

abortion

An infant with severe dehydration would be expected to present with:

absent urine output

When caring for a child with suspected meningitis, it is MOST important for the EMT-B to

adhere to BSI precautions

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should:

administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

You are dispatched to a residence for a child with respiratory distress. The patient, an 18 month old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes:

administering blow-by oxygen and transporting the child with her mother.

Submersion injuries in the adolescent age group are MOST commonly associated with

alcohol

During the attempted resuscitation of an infant with suspected SIDS

allow the family to observe if they wish

placental barrier

allows nutrients, oxygen, waste, carbon dioxide, toxins, medications between fetus + pregnant woman.

Patient is 38 weeks pregnant. Water broke

amniotic sac ruptures

The primary mechanism that a child's body uses to compensate for decreased perfusion is

an increase in heart rate

Which of the following children would benefit the LEAST from a nonrebreathing mask?

an unresponsive 5 year old male with shallow respirations

The components of the PAT are

appearance, work of breathing, and skin circulation

Perineal Tearing

apply gentle pressure to infant's head wile gently stretching the perineum.

What is a limb presentation?

arm, leg, or foot first

The umbilical cord contains two _________ and one _________.

arteries; vein

You respond to a skate park where a 10-year-old male fell from his skateboard and struck his head on the ground; he was not wearing a helmet. He is responsive to painful stimuli only and has a large hematoma to the back of his head. After your partner stabilizes his head and opens his airway, you assess his breathing and determine that it is slow and irregular. His pulse is slow and bounding. You should:

assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler

at the hands or feet

A 2 year old female has experienced a seizure. when you arrive at the scene, that child is conscious, crying, and clinging to her mother. Her skin is hot and moist. The mother tells you that the seizure lasted approximately 5 minutes. She further tells you that her daughter has no history of seizures, but has had a recent ear infection. You should:

attempt cooling measures, offer oxygen, and transport

When caring for an ill 5-year-old male, you should

avoid separating him from his parents or caregivers when possible.

After delivery, if the infant does not begin breathing after _______ seconds, you should begin resuscitation efforts. a. 5-10 b. 10-15 c. 15-20 d. 20-25

b

Ovulation occurs approximately _________ before menstruation. a. 1 week b. 2 weeks c. 3 weeks d. 4 weeks

b

The "P" in Apgar stands for: a. perfusion b. pulse c. pupils d. position

b

The difference between preeclampsia and eclampsia is the onset of: a. seeing spots b. seizures c. swelling in the hands and feet d. headaches

b

The first stage of labor begins with the onset of contractions and ends when: a. the infant is born b. the cervix is fully dilated c. the water breaks d. the placenta is delivered

b

When cutting the umbilical cord: a. place the clamps 7" to 10" apart b. place the clamps 2" to 4" apart c. tie the cord with shoelaces if you don't have any clamps d. tie the cord with string if you don't have any clamps

b

When handling a delivery involving a drug- or alcohol-addicted mother, your first concern should be for: a. the mother's airway b. your personal safety c. the infant's airway d. the need for CPR for the infant

b

Which of the following is not considered a possible effect to the fetus when the mother is a known substance abuser? a. low birth weight b. spina bifida c. prematurity d. severe respiratory depression

b

Which of the following refers to greenish or foul-smelling amniotic fluid? a. nuchal rigidity b. meconium staining c. placenta previa d. bloody show

b

Which of the following statements is false? a. gestational diabetes will clear up in most women after delivery b. the leading cause of abruptio placenta is an ectopic pregnancy c. as pregnancy progresses, the uterus enlarges and rises out of the pelvis d. some cultures may not permit male EMTs to examine a female patient

b

You arrive on scene to assist another crew with a delivery. Upon your arrival, the crew on scene informs you that the delivery has already taken place and that you are going to be responsible for care of the infant. As you approach, you hear a very loud cry. The infant appears completely pink and moves his foot away when you flick the sole of his foot. The pulse is 120 beats/min and respirations are rapid. The infant has great muscle tone and resists your attempt to straighten the hips. Determine the Apgar score. a. 6 b. 10 c. 1 d. 8

b

You may help control bleeding by massaging the _________ after delivery of the placenta. a. perineum b. fundus c. lower back d. inner thighs

b

You should consider the possibility of a(n) ___________ in women who have missed a menstrual cycle and complain of a sudden stabbing and usually unilateral pain in the lower abdomen. a. PID b. ectopic pregnancy c. miscarriage d. placenta abruptio

b

__________ is a condition in which the placenta develops over and covers the cervix. a. eclampsia b. placenta previa c. placenta abruptio d. prolapsed cord

b

Which of the following statements regarding pediatric trauma is MOST correct? a) Children are less likely than adults to be struck by a car b) Children are more likely to experience diving-related injuries c) The child's head is less frequently injured than an adult's d) Inexperience and poor judgment are rare causes of pediatric trauma

b) Children are more likely to experience diving-related injuries.

Which of the following statements regarding sudden infant death syndrome (SIDS) is MOST correct? a) SIDS is most commonly the result of an overwhelming infection b) Most cases of SIDS occur in infants younger than 6 months of age c) The cause of death following SIDS can be established by autopsy d) Certain cases of SIDS are predictable and therefore preventable

b) Most cases of SIDS occur in infants younger than 6 months of age.

Burns in children are commonly caused by all of the following, EXCEPT: a) scalding water in a bathtub b) entrapment in a structural fire c) exposure to caustic chemicals d) hot items on a stovetop

b) entrapment in a structural fire

Common complications associated with central intravenous (IV) lines include all of the following, EXCEPT: a) clotting of the line b) rupture of a central vein c) bleeding around the line d) a local infection

b) rupture of a central vein

Left untreated, .... can lead to premature birth or low birth weight in pregnant women.

bacterial vaginosis

An 8-year-old female with a history of asthma continues to experience severe respiratory distress despite being given multiple doses of her prescribed albuterol by her mother. She is conscious, but clearly restless. Her heart rate is 130 beats/min and her respiratory rate is 30 breaths/min. She is receiving high-flow oxygen via a nonrebreathing mask. You should:

be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital.

In anticipation of receiving a fertilized ovum, the lining of the uterine wall:

becomes engorged with blood.

Death caused by shaken baby syndrome is usually the result of

bleeding in the brain

When ventilating a pediatric patient with a bag mask device, the EMT should:

block the pop off valve if needed to achieve adequate chest rise

Gestational Diabetes

blood glucose level treatment:diet/exercise/medication signs:hyperglycemia or high blood sugar or hypoglycemia low blood sugar

Pale skin in a child indicates that the

blood vessels near the skin are constricted.

There is a high potential of exposure due to ________ ________ released during the childbirth.

body fluids

Infant's heart rate is palpated in what artery?

brachial artery

The MOST ominous sign of impending cardiopulmonary arrest in infants and children is:

bradycardia

Preterm or false labor is commonly referred to as ________ _______ contractions.

braxton-hicks

What are abnormal complications during breech delivery?

buttocks first

A patient presents with a sudden onset of shortness of breath three days following a delivery. What is likely the underlying cause of this condition? a. pulmonary hypertension b. pulmonary inflammation c. pulmonary embolism d. pulmonary fibrosis

c

Fertilization usually occurs when the egg is inside the: a. ovary b. uterus c. fallopian tube d. endometrium

c

Once the infant is delivered, feel for a brachial pulse or the pulsations in the umbilical cord. If the pulse rate is below ________ beats/min, begin assisted ventilations. a. 60 b. 80 c. 100 d. 120

c

Premature separation of the placenta from the wall of the uterus is known as: a. eclampsia b. placenta previa c. abruptio placenta d. prolapsed cord

c

The third stage of labor begins with the birth of the infant and ends with the: a. release of milk from the breasts b. cessation of uterine contractions c. delivery of the placenta d. cutting of the umbilical cord

c

Which of the following is not a sign of the beginning of labor? a. bloody show b. contractions of the uterus c. crowning d. rupture of the amniotic sac

c

Which of the following is not true regarding delivery with a nuchal cord? a. gently slip the cord over the infant's head or shoulder b. clamp the cord and cut it before delivering the infant c. clamp the cord, then suction the airway before cutting the cord d. Clamp the cord and cut it, then gently unwind it from around the neck if wrapped around more than once

c

Which of the following statements regarding multiple gestations is false? a. you should consider the possibility of twins when the first infant is small and the mother's abdomen remains fairly large after the birth b. you should record the time of birth on each twin separately c. there is only one placenta with the birth of twins d. the second baby will usually be born within 45 minutes of the first

c

Which of the following statements regarding pregnancy is true? a. a patient in the third trimester is at a decreased risk for aspiration b. as the pregnancy continues, the patient will experience slower and deeper breathing c. by the 20th week of pregnancy, the uterus is at or above the belly button d. maternal blood volume increases up to 10% by the end of pregnancy

c

You assess an infant after delivery and note that the child has a loud cry and withdraws to pain. The heart rate is 94 beats/min, the extremities are cyanotic, respirations are rapid, and the infant strongly resists your attempts to straighten the knees. Determine the Apgar score. a. 2 b. 10 c. 8 d. 4

c

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. As you perform a visual exam, you note crowning. This means that: a. the baby is making a crowing-type of sound b. the baby cannot be visualized c. you can visualize the baby's head d. the father is excited and needs care

c

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Once the infant's head has been delivered: a. suction the infant's nose, and then mouth b. apply oxygen over the mother's vagina c. suction the infant's mouth, then the nose d. apply a nasal cannula at 3 L/min to the infant

c

Which of the following is MORE common in children than in adults following a head injury? a) Loss of consciousness b) Seizures and hypoxia c) Nausea and vomiting d) Spinal cord injury

c) Nausea and vomiting

Which of the following statements regarding preschool-age children is MOST correct? a) The preschool age begins after the child turns 2 years old b) They realize that injuries are not a form of punishment c) They can usually identify painful areas when questioned d) Preschoolers are usually not fearful of pain or separation

c) They can usually identify painful areas when questioned.

An oropharyngeal airway should not be used in children who have ingested a caustic or petroleum based product because it may

cause the child to vomit

Hyperthermia differs from fever in that it is an increase in body temperature

caused by inability of the body to cool itself

Vernix

cheesy white coat found on full term baby

Children with Neisseria meningitidis (N. meningitidis) would MOST likely present with

cherry-red spots or a purplish rash

Which of the following statement regarding a pediatric patient's anatomy is correct?

children have larger, rounder occiput compared to adults

Pulmonary Embolism

clot that travels through the blood stream + becomes lodged in pulmonary circulation. Report difficulty breathing/AMS

Often the most important intervention for a sexual assault patient is ... and transport to a facility with a staff specially trained to deal with this scenario.

comforting reassurance

your .... is the best tool to gain the patient's confidence to seek medical help

compassion

supine hypotensive syndrome

compression of the descending aorta by inferior vena caca by the pregnant uterus when patient lies supine. It reduces blood returning to heart. result: hypotension or low blood pressure treatment: transport of (L) side

umbilical cord

conduit connecting mother to infant via the placenta contains 2 arteries + 1 vein

What is the 1st stage of labor?

contracts + ends when cervix is fully dilated.

Early signs of respiratory distress in the pediatric patient include all of the following, EXCEPT:

cyanosis.

All of the following are correct regarding postterm pregnancy except: a. infants can be larger, sometimes weighing 10lbs or more b. there is an increased risk of meconium aspirations c. postterm is considered past 2 weeks gestation d. ultrasounds are not accurate at determining due dates

d

Low blood pressure resulting from compression of the inferior vena cava by the weight of the fetus when the mother is supine is called: a. pregnancy-induced hypertension b. placenta previa c. placenta abruptio d. supine hypotensive syndrome

d

Once the infant is completely delivered, you should: a. dry and wrap the infant in a blanket b. keep the infant at the level of the vagina until the umbilical cord is cut c. use sterile gauze and wipe out the infant's mouth d. all of the above

d

When assisting ventilations in a newborn with a bag-mask device, the rate is ________ breaths/min. a. 20-30 b. 30-50 c. 35-45 d. 40-60

d

When performing CPR on a newborn, a compression to ventilation ratio of 3:1 should be used; this will yield a total of ________ "actions" per minute. a. 90 b. 100 c. 110 d. 120

d

Which of the following is not a reason for delivery of the fetus at the scene? a. delivery can be expected within a few minutes b. there is a natural disaster c. there is severe inclement weather d. the amniotic sac has ruptured

d

Which of the following is not performed immediately following delivery of the infant? a. wrap the infant in a towel and place it on one side with head lowered b. be sure the head is covered and keep the neck in a neutral position c. use a sterile gauze pad to wipe the infant's mouth, then suction again d. obtain an Apgar score

d

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Concerning the delivery of the placenta, which of the following are emergency situations? a. more than 30 minutes have elapsed and the placenta has not delivered b. there is more than 500mL of bleeding before delivery of the placenta c. there is significant bleeding after delivery of the placenta d. all of the above

d

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. If the baby is crowning and the amniotic sac has not yet ruptured, you should: a. leave it in place and wait for ALS b. puncture the sac only after ordered to do so by medical control c. puncture the sac, allow the fluid to drain, and leave the sac in place d. puncture the sac away from the head and then push the sac away from the infant's face

d

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Which of the following signs tell you that the birth is imminent? a. her water has not broken b. her contractions are 3-6 minutes apart c. she is a primigravida d. the infant is crowning

d

__________ is a situation in which the umbilical cord comes out of the vagina before the infant. a. eclampsia b. placenta previa c. abruptio placenta d. prolapsed cord

d

Which of the following should make you MOST suspicious for child abuse? a) Willingness of the child to speak b) Worried or crying parents c) A laceration to the child's chin d) Bruises in various stages of healing

d) Bruises in various stages of healing

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT: a) headache and fever b) an altered mental status c) a stiff or painful neck d) sunken fontanels

d) sunken fontanels

A common cause of shock in an infant is:

dehydration from vomiting diarrhea

What is the 3rd stage of labor?

delivery of placenta

vertex presentation

delivery which head comes out first

When inserting an oropharyngeal airway in an infant or child, you should:

depress the tongue with a tongue depressor.

fetus

developing,unborn infant

Spina Bifida

developmental defect spinal cord or meninges may protrude outside of vertebrae outside body. Seen on newborns back 3rd lumbar region

Trauma in Pregnancy

direct effect on fetus risk of falls: loosened up joints, weight of uterus displacement of abdominal organs 3rd trimester: significant blood volume shock will develop quickly with blood loss blood to fetus is reduced/goes to mom

A 13-year-old child is on a home ventilator. The parents called because the ventilator is malfunctioning. You should

discontinue the ventilator and ventilate with a BVM device

What is the significance of meconium in the amniotic fluid?

distress or disease

Infection should be a possible cause of an airway obstruction in an infant or child, especially if he or she presents with:

drooling or congestion

Newborn OB Kit

dry towels infant blanket bag mask device 450 mL clear mask oxygen tubing

embryo

early stages of fetus after fertilization

The leading cause of maternal death in the first trimester is internal hemorrhage into the abdomen following rupture of a(n) ___________ _________.

ectopic pregnancy

A 6 year old male presents with acute respiratory distress. His mother states that she saw him put a small toy into his mouth shortly before the episode began. the child is conscious, obviously frightened, and is coughing forcefully. You should:

encourage him to cough, give oxygen as tolerated, and transport

Before assessing the respiratory adequacy of an unconscious infant or child, you must:

ensure that the airway is patent and clear of obstructions.

It is common for young females who experience their first menstrual period to:

experience abdominal cramping, which may be misinterpreted.

What is the 2nd stage of labor?

expulsion of fetus ends when infant is born

fallopian tubes

extend from uterus egg travels through fallopian tubes to uterus fertilization with sperm meets egg inside fallopian tube.

Delivery Without Sterile Supplies

eye protection, gloves, mask clean towels wipe inside of newborn's mouth with gloved finger Keep placenta + infant at same level. Keep infant warm.

The ... connect(s) each ovary with the uterus.

fallopian tubes

Due to hormonal changes that cause joints in the musculoskeletal system to "loosen," a pregnant patient has a greater risk of ________.

falls

Braxton Hicks Contractions

false labor

preciptious

fast labor + birth

when assessing the heart rate of a 6 month old infant. you should palpate the brachial pulse or _____ pulse.

femoral

ectopic pregnancy

fertilized egg implants someone other than uterus pregnancy develops outside uterus in fallopian tubes

Patient says amniotic water was green.

fetal stool

fundus

firm grapefruit size mass in lower abdomen controls bleeding, helps uterus to contract stimulates mother's nipples to breast feed

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The patient tells you that she would really like to be transported to the hospital but refuses a physical examination. You should:

follow your system's refusal of treatment policy and respect the patient's wishes without judgement.

During the delivery, be careful that you do not poke your fingers into the infant's eyes or into the two soft spots, called _________, on the head.

fontanelles

In most children, febrile seizures are characterized by:

generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase

Correct way to stimulate infant's breathe?

gently rub baby's back

Painful urination associated with burning and a yellowish discharge is associated with:

gonorrhea

Symptoms of ... appear approximately 2 to 10 days after exposure

gonorrhea

An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of inhalation by

grunting

Immediate transport is indicated for a child when he or she:

has a history suggestive of a serious illness

When caring for a female child who has possibly been sexually abused, you should:

have a female EMT remain with her if possible

When a child experiences a blunt injury to the abdomen

he or she can compensate for blood loss better than adults.

Bed rest for 7 weeks. pre-eclampsia

headache swelling of hands/feet high blood pressure

Miscarriage or Spontaneous Abortion

hemorrhage from vagina

Use of a nonrebreathing mask or nasal cannula in a child is appropriate ONLY if:

his or her tidal volume is adequate

Causes of infant death that may be mistaken for SIDS include all of the following, EXCEPT: a) meningitis b) severe infection c) hyperglycemia d) child abuse

hyperglycemia

Common causes of seizures in children include all of the following, EXCEPT

hyperglycemia

What are complications during pregnancy?

hypertension disorders bleeding diabetes

What happens with enlarged uterus?

increased respiratory rate decreasing minute volume

What is the most important measure in determining the infant's need for resuscitation?

infant does not breathe after 15 seconds

Fetal Alcohol Syndrome

infants born to mothers who have abused alcohol newborn of addicted mother with need CPR right away apply oxygen during transport

Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the

intercostal muscles are not well developed.

leading cause of maternal death in 1st trimester

internal hemorrhage into abdomen following rupture of ectopic pregnancy symptom:missed cycle, stabbing unilateral pain in lower abdomen

The ... and ... are folds of tissue that surround the urethral and vaginal openings.

labia majora; labia minora

Airway + Breathing

life threats to mom causes complicated delivery assess adequate breathing, provide high flow oxygen

umbilical cord

lifeline of the fetus through placenta contains two arteries + one vein.

The physical examination of a sexual assault victim should be:

limited to a brief survey for life-threatening injuries.

endometrium

lining of inside of uterus

Endometrium

lining of the inside of the uterus begins to thicken + prepare for fertilized egg to implant If egg is not fertilized in 36 to 48 hours, lining sheds. It occurs the 28th day of each month in females.

what is the most common presenting sign or symptom of pelvic inflammatory disease or PID is

lower abdominal pain

birth canal

made of vagina + uterus uterus contains mucous plug that seals uterine opening to prevent contamination

What do increased hormone levels do?

make joints less stable or loose

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer:

may be relatively painless.

Febrile seizures in a child:

may indicate a serious underlying illness.

A 6 month old male presents with 2 days of vomiting and diarrhea. He is conscious, but his level of activity is decreased. The infant's mother tells you that he has not had a soiled diaper in over 12 hours. The infant's heart rate is 140 beats/min and his anterior fontanelle appears to be slightly sunken. You should suspect

moderate dehydration

A 4 year old female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she is conscious and alert, is breathing adequately, and had skin burns around her mouth. You should:

monitor her airway and give oxygen

cervix

narrowest portion of uterus that opens into vagina

The first month of life after birth is MOST appropriately referred to as the

neonatal period

Substance Abuse

no prenatal care affects:premature, low birth weight, severe respiratory depression

After determining that an infant or child has strong central pulses, you should

not rule out compensated shock

The MOST accurate method for determining if you are delivering adequate tidal volume to a child during bag mask ventilations is to:

observe the chest for adequate rise

Padding underneath the torso when immobilizing an injured child is generally not necessary if he or she is:

older than 8 to 10 years

Female Anatomy

ovaries - contain follicles + an egg fallopian tubes uterus cervix vagina breasts

When assessing an infant's ventilation status, you should:

palpate the abdomen for rise and fall

Critical burns in children include

partial-thickness burns covering greater than 20% of the body surface

Abortion

passage of fetus + placenta before 20 weeks. self induced

Interventions

patient has low pulse oximeter so does fetus apply oxygen

After using the PAT to form your general impression of a sick or injured child, you should:

perform a hands-on assessment of the ABCs.

The _________ is the area of skin between the vagina and the anus.

perineum

bloody show

pink mucus first stage of labor

To ensure that the airway of an infant or small child is correctly positioned, you may have to:

place a towel or folded sheet behind the shoulders

When caring for a female patient who has been sexually assaulted, you should:

place any bloodstained clothing or other articles in separate paper bags

Before positioning an infant or child's airway, you should

place him or her on a firm surface

When administering oxygen to a frightened child, it would be MOST appropriate to

place oxygen tubing through a hole in a paper cup

if a patient with vaginal bleeding presents with a rapid pulse and pale or cool skin, you should;

place the patient in a supine position

After delivery, the ________, or afterbirth, separates from the uterus and is delivered.

placenta

Placenta Previa

placenta develops over + covers cervix

Abruption placenta

placenta separates prematurely from wall of uterus from hypertension complaints:severe pain/vaginal bleeding calm patient signs:shock treatment:high flow oxygen, put patient on (L) side sterile sanitary napkin, keep napkins + any tissues from vagina Trauma is leading cause of abruption placenta.

presentation

position in which infant is born part of infant that appears first.

Effective methods for providing pain relief to a child with an extremity injury include:

positioning, ice packs, and emotional support.

Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because they are:

proportionately larger and situated more anteriorly.

Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should:

provide emotional support and visually assess her for obvious trauma.

Ovulation

release of egg occurs 2 weeks before menstrual cycle

Systems involved in changes during pregnancy

respiratory cardiovascular musculoskeletal

Cardiac arrest in the pediatric population is MOST commonly the result of:

respiratory or circulatory failure.

In serious trauma, the only chance to save the infant is to adequately _________ the mother.

resuscitate

Drawing in of the muscles between the ribs or of the sternum during inspiration is called:

retracting

Because a tracheostomy tube bypasses the nose and mouth

secretions can build up in and around the tube

When immobilizing an injured child in a pediatric immobilization device, you should

secure the torso before the head

eclampsia

seizures that occur from hypertension treatment: Put patient on (L) side maintain airway supplemental oxygen suction airway rapid transport call ALS

Which of the following inquiries should you make in private when obtaining a SAMPLE history from an adolescent patient?

sexual activity

A tube from the brain to the abdomen that drains excessive cerebrospinal fluid (CSF) is called a

shunt

limb presentation

single arm, or leg or foot prompt transport high flow oxygen

When a child is struck by a car, the area of the greatest injury depends MOSTLY on the

size of the child and the height of the bumper upon impact

Some women experience ... during ovulation.

slight cramping

What further treatment is indicated for this mother?

slow bleeding massage mother's abdomen with firm, circular motion. This stimulates uterus to contract. treat mom for shock/sanitary pad by vagina, elevate legs 6' to 12". high flow oxygen, keep warm. vital signs.

_________ _________ is a developmental defect in which a portion of the spinal cord protrudes outside the vertebrae.

spina bifida

You are dispatched to a local elementary school for an injured child. As you approach the child, you note that he is lying at the base of the monkey bars, he is unresponsive and there are no signs of breathing. You should:

stabilize his head and check for a pulse

If a nasopharyngeal airway is too long, it may:

stimulate the vagus nerve

Obstetric Kit

surgical scissors or scalpel umbilical cord clamps umbilical tape small rubber bulb syringe towels 4x4 gauze 2x10 gauze sterile gloves infant blanket sanitary napkins goggles plastic bag

The EMT should ensure that vaginal bleeding is ...

taken seriously and the patient is transported for gynecologic evaluation

When assessing an 8-year old child, you should

talk to the child, not just the caregiver

The pediatric patient should be removed from his or her car seat and secured to an appropriate spinal immobilization device if:

the car seat is visibly damaged.

When a child experiences a blunt chest injury

the flexible ribs can be compressed without breaking

Greenstick fractures occur in infants and children because

their bones bend more easily than an adult's.

When assessing or treating an adolescent patient, it is important to remember that

they usually do not wish to be observed during a procedure

placenta

tissue attached to uterine wall that nourishes fetus through umbilical cord

When caring for an infant who was found apneic and cyanotic and was resuscitated by the parent or caregiver, you should

transport the infant to the hospital.

Deliver head, umbilical cord wrapped around baby's neck

try to slip cord gently over infant's head

What is a prolapse of the umbilical cord?

umbilical cord first

The _________ ________ carries oxygenated blood from the woman to the heart of the fetus.

umbilical vein

The MOST efficient way to identify the appropriately sized equipment for a pediatric patient is to:

use a length based resuscitation tape measure

Blunt Trauma during Pregnancy

uterus enlarges/rises out of pelvis uterus has rich blood supply hypoxic (insufficient oxygen) or shock or hypovolemia (decreased blood) signs:vaginal bleeding/pain treatment:rapid transport, high flow oxygen, airway, sanitary pad by vagina, put patient on (L) side, ALS backup.

birth canal

vagina + cervix

The signs and symptoms of poisoning in children:

vary widely,depending on the child's age and weight

The MOST common cause of dehydration in children is

vomiting and diarrhea.

amniotic sac

where fetus develops bag of waters 500 mL to 1,000 mL insulates floating fetus

Nuchal Cord

wound tightly around neck could cause infant to strangle. slip cord over infant's head, cut it by placing 2 clamps 2 inches apart suction amniotic fluids from infant's airway