Seattle/King County EMT-B Class

Seattle/King County EMT-B Class

Topics

1

2

Environmental Emergencies: Chapter 18Behavioral Emergencies: Chapter 19

3 Ob/Gyn Emergencies: Chapter 20

1Environmental Emergencies

Factors Affecting Exposure

• Physical condition• Age• Nutrition and

hydration• Environmental

conditions

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Loss of Body Heat

Conduction• Transfer of heat from

body to colder objectConvection• Transfer of heat

through circulating air

Evaporation• Cooling of body

through sweating

Radiation• Loss of body

heat directly into a colder environment

Respirations• Loss of body

heat during breathing

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Rate and amount of heat gain or loss can be modified in three ways:

• Increase or decrease heat production.

• Move to sheltered area where heat loss is increased or decreased.

• Wear insulated clothing.

Loss of Body Heat, continued1

Hypothermia

• Lowering of the body temperature below 95°F (35°C)

• Weather does not have to be below freezing for hypothermia to occur.

• Older persons and infants are at higher risk.

• People with other illnesses and injuries are susceptible to hypothermia.

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Mild Hypothermia

Signs and symptoms include:

• Shivering

• Rapid pulse and respirations

• Red, pale, cyanotic skin

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Severe Hypothermia1


• Shivering stops.

• Muscular activity decreases.

• Fine muscle activity ceases.

• Eventually, all muscle activity stops.

Core Temperature Less Than 80F• Patient may appear dead (or in a

coma).

• Never assume that a cold, pulseless patient is dead.

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• Note weather conditions.

• Identify safety hazards such as icy roads, mud, or wet grass.

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• Decide SICK/NOT SICK• Check temperature on

patient’s abdomen.• Ensure adequate airway.• Palpate for carotid pulse;

wait 30–45 seconds. • ANY kind of pulse=NO

CPR.• Transport immediately or

move to warmer location.

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Initial Assessment

2. Initial Assessment

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• If unconscious, do a rapid physical exam.

• If conscious, obtain SAMPLE history.

• Determine how long the patient was exposed.

• Medications can affect the patient’s metabolism.

• Concentrate on areas of body directly affected by exposure.

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Focused History/Physical Exam


3. Focused History/ Physical Exam

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• Aimed at determining degree and extent of cold injury

• Evaluate skin temperature, texture, and turgor.

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Detailed Physical Exam


3. Focused History/ Physical Exam4. Detailed Physical Exam

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• Rewarming can be harmful; monitor carefully.

• Communicate conditions at scene, clothing, changes in mental status.

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Ongoing Assessment



5. Ongoing Assessment

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Baseline Vital Signs

• Can be altered by hypothermia• Monitor for changes in mental status.• Check body temperature:

(oral, tympanic or axillary)

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Interventions

• Move from cold environment.• Do not allow patient to walk, eat,

use any stimulants, or smoke or chew tobacco.

• Remove wet clothing.• Place dry blankets under and over

patient.• Handle gently.• Do not massage extremities.

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Local Cold InjuriesFrostnip

• Freezing of the skin but not the deeper surface

Immersion (trench) foot• Prolonged exposure to cold water

Frostbite• Freezing of a body part, usually an

extremity

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Emergency Care for Local Cold Injury• Remove the patient

from further exposure to the cold.

• Handle the injured part gently.

• Administer oxygen.• Remove any wet or

restrictive clothing.• Never rub the area.• Do not break blisters.• Transport.

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Warm-Water Bath

• Water temperature should be between 100-112oF.

• Recheck water temperature and stir to circulate.

• Keep body part in water until warm and sensation returns.

• Dress with dry, sterile dressings.

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Cold Exposure and You• EMT-Bs are at risk for hypothermia

when working in a cold environment.• Stay aware of local weather

conditions.• Dress appropriately and be prepared.• Vehicle must be properly equipped

and maintained.• Never allow yourself to become a

casualty!

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Heat Exposure• Normal body temperature is 98.6°F.• Body attempts to maintain normal

temperature despite ambient temperature.

• Body cools itself by sweating (evaporation) and dilation of blood vessels.

• High temperature and humidity decrease effectiveness of cooling mechanisms.

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Heat Cramps• Painful muscle spasms

• Remove the patient from hot environment.

• Rest the cramping muscle.

• Replace fluids by mouth.

• If cramps persist, transport the patient to hospital.

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Heat ExhaustionSigns and symptoms include:

• Dizziness, weakness, or fainting• Onset while working hard or

exercising in hot environment• In older people and young, onset

may occur while at rest in hot, humid, and poorly ventilated areas.

• Cold, clammy skin

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• Dry tongue and thirst

• Patients usually have normal vital signs, but pulse can increase and blood pressure can decrease.

• Normal or slightly elevated body temperature

1 Heat Exhaustion, continued

Emergency Medical Care• Remove extra clothing and remove

from hot environment.• Give patient oxygen.• Have patient lie down and elevate

legs.• If patient is alert, give water slowly.• Be prepared to transport.

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Heatstroke

Signs and symptoms include:• Hot, dry, flushed skin• Change in behavior leading to

unresponsiveness• Pulse rate is rapid, then slows.• Blood pressure drops.• Death can occur if the patient is not

treated.

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Care for Heat Stroke• Move patient out of the

hot environment.

• Provide air conditioning at a high setting.

• Remove the patient’s clothing.

• Give the patient oxygen.

• Apply cold packs to the patient’s neck, armpits, and groin.

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Care for Heat Stroke, continued• Cover the patient with wet towels or

sheets.

• Aggressively fan the patient.

• Immediately transport patient.

• Notify the hospital of patient’s condition.

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• Do environmental assessment.

• Protect yourself from heat and biological hazards.

• ALS may need to give IV fluids.

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• Decide SICK/NOT SICK• The more altered the

mental status, the more severe the exposure.

• Keep airway patent.• Oxygen may decrease

nausea.• Treat for shock

aggressively.

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Initial Assessment


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• Note activities/medications that may make patient susceptible to heat-related problems.

• Determine exposure and activities prior to symptoms.

• Assess for muscle cramps, confusion.

• Examine for mental status, skin temperature, wetness.

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• Pay attention to skin temperature, turgor, wetness.

• Turgor = skin’s ability to resist deformity

• In dehydration, skin will tent when pinched on back of hand.

• Perform careful neurologic exam.

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• Watch for deterioration.• Reassess vital signs

every 5 minutes.• Do not cause shivering.• Document weather

conditions and activities prior to emergency.

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Ongoing Assessment




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Baseline Vital Signs

• May be tachycardic or tachypneic• In heat exhaustion, patient may

have normal skin temp; may also be cool and clammy.

• In heat stroke, patient will have hot skin.

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Interventions

• Remove from hot environment.• Give cool fluids by mouth.• Cover with sheet and soak with

cool water.• Set A/C on high.• Place ice packs on groin and

axillae.• Fan aggressively.

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Drowning and Near Drowning

Drowning• Death as a result of suffocation after

submersion in waterNear drowning

• Survival, at least temporarily, after suffocation in water

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Drowning Process1

Spinal Injuries

Suspect spinal injury if:

• Submersion has resulted from a diving mishap or long fall.

• Patient is unconscious.

• Patient complains of weakness, paralysis, or numbness.

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Spinal Stabilization in Water• Turn the patient supine.

• Restore the airway and begin ventilation.

• Secure a backboard under the patient.

• Remove the patient from the water.

• Cover the patient with a blanket.

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Resuscitation Efforts1

• Hypothermia can protect vital organs from hypoxia.

• Documented case of a survivor of a 66-minute cold water submersion

• Diving reflex may cause heart rate to slow.

Diving Problems

Descent problems

• Usually due to the sudden increase in pressure on the body as the person dives

Bottom problems

• Not commonly seen

Ascent problems

• Air embolism and decompression sickness

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Air Embolism


• Blotching

• Froth at the mouth and nose

• Severe pain in muscle, joints, or abdomen

• Dyspnea and/or chest pain

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1 Air Embolism, continued


• Dizziness, nausea, and vomiting

• Dysphasia

• Difficulty with vision

• Paralysis and/or coma

• Irregular pulse or cardiac arrest

Decompression Sickness (Bends)• Can result from rapid

ascent

• Most common symptom is abdominal and/or joint pain.

• Symptoms may develop after hours.

• Treatment is BLS and hyperbaric chamber.

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• Never drive through moving water; be cautious driving through still water.

• Never attempt water rescue without proper training and equipment.

• Consider trauma and spinal stabilization.

• Check for additional patients.

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• Decide SICK/NOT SICK.• Pay attention to chest

pain, dyspnea, complaints of sensory changes.

• Be suspicious of alcohol use.

• Maintain airway; suction.• If pulse cannot be

obtained, begin CPR.• Evaluate for shock and

adequate perfusion.

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Initial Assessment


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• If responsive, listen to breath sounds.

• If unresponsive, look for signs of trauma.

• Check divers for indications of air embolism or bends.

• Focus on pain in joints and abdomen.

• Check for signs of hypothermia.

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• Examine respiratory, circulatory, neurologic systems.

• Distal circulatory, sensory, and motor function tests determine extent of injury.

• Examine for peripheral pulses, skin color, and discoloration, itching, pain, numbness/tingling.

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• Assess mental status frequently.

• Document:—Circumstances of drowning

and extrication—Time submerged—Temperature of water—Clarity of water—Possible spinal injury —Bring dive log, dive

computer, and dive equipment to hospital.

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Ongoing Assessment




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Transport Decision

• Always transport near-drowning patients to hospital.

• Decompression sickness and air embolism must be treated in recompression chamber.

• Perform interventions en route.

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Baseline Vital Signs/ SAMPLE History• Check pulse rate, quality, rhythm.• Check peripheral, central pulses.• Check for pupil size, reactivity.• Determine length of time patient was

underwater or time of onset of symptoms.

• Note physical activity, alcohol/drug use, other medical conditions.

• Determine dive parameters in history depth, time, previous dive activity.

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Drowning Interventions1

• Begin artificial ventilations as soon as possible.

• Stabilize and protect spine.• Maintain patent airway. If there is

no spinal injury, turn patient on side to allow draining from upper airway.

• Make sure patient is warm, especially after cold-water immersion.

Diving Interventions1

• Remove patient from water.• Begin BLS; administer oxygen.• Place patient in left lateral

recumbent position with head down.

• Provide prompt transport to nearest recompression facility.

• Administer oxygen and provide rapid transport.

Other Water Hazards

• Hypothermia from water immersion

• Breath-holding syncope• Injuries from recreational

equipment or marine animals

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Prevention

• Pools should be surrounded with appropriate enclosures.

• Alcohol involved in adult and teenage drownings.

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Lightning• Strikes boaters, swimmers, golfers,

anyone in large, open area• Cardiac arrest and tissue damage are

common.• Three categories of lightning injuries

—Mild: Loss of consciousness, amnesia, tingling, superficial burns

—Moderate: Seizures, respiratory arrest, asystole (spontaneously resolves), superficial burns

—Severe: Cardiopulmonary arrest

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Emergency Medical Care• Protect yourself.• Move patient to

sheltered area or stay close to ground.

• Treat as for other electrical injuries.

• Transport to nearest facility.

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Spider Bites• Spiders are numerous and

widespread in the US.• Many species of spiders bite.• Only the female black widow

spider and the brown recluse spider deliver serious, even life-threatening bites.

• Your safety is of paramount importance.

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Black Widow Spider

• Found in all states except Alaska• Black with bright red-orange marking

in hourglass shape on abdomen • Venom poisonous to nerve tissue• Requires patient transport as soon as

possible

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Brown Recluse Spider (Hobo) cousin• Mostly in southern and central US• Short-haired body has violin-

shaped mark, brown to yellow in color, on its back.

• Venom causes local tissue damage.

• Area becomes swollen and tender, with pale, mottled, cyanotic center.

• Requires patient transport as soon as possible.

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Snake Bites• 40,000 to 50,000 reported snake

bites in the US annually.• 7,000 bites in the US come from

poisonous snakes.—Death from snake bites is rare.—About 15 deaths occur each

year in the US.

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Poisonous Snakes in the US

Copperhead

Cottonmouth

Coral snake

Rattlesnake

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Pit Vipers• Rattlesnakes,

copperheads, and cotton mouths

• Store poison in pits behind nostrils

• Inject poison to victim through fangs

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Pit Viper BiteSigns and symptoms include:

• Severe burning at the bite site• Swelling and bluish discoloration• Bleeding at various distant sites

Other signs may include:—Weakness —Fainting—Sweating —Shock

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Care for Pit Viper Bites• Calm the patient.• Locate bite and cleanse the area.• Do not apply ice.• Splint area to minimize

movement.• Watch out for vomiting caused by

anxiety.• Do not give anything by mouth.

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Care for Pit Viper Bites, cont'd• If the patient is bitten on the trunk,

lay the patient supine and transport quickly.

• Monitor patient’s vital signs.• Mark the swollen area with a pen.• Care for shock if signs and

symptoms develop.• Bring the snake to hospital if it has

been killed.

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Coral Snakes• Small snake with red, yellow, and black

bands• “Red on yellow will kill a fellow, red on

black, venom will lack.”• Injects venom with teeth, using a

chewing motion that leaves puncture wounds

• Causes paralysis of the nervous system

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Care for Coral Snake Bites• Quiet and reassure the patient.• Flush the area with 1 to 2 quarts

of warm, soapy water. • Do not apply ice.• Splint the extremity. • Check and monitor baseline vital

signs.

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Care for Coral Snake Bites, cont'd• Keep the patient warm and elevate

the lower extremities to help prevent shock.

• Give supplemental oxygen if needed.

• Transport promptly. Give advance notice to hospital of coral snake bite.

• Give the patient nothing by mouth.

1

Scorpion Stings• Venom gland and

stinger found in the tail end.

• Mostly found in southwestern US

• With one exception, the Centruroides sculpturatus, most stings are only painful.

• Provide BLS care and transport.

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Tick Bites• Ticks attach

themselves to the skin.

• Bite is not painful, but potential exposure to infecting organisms is dangerous.

• Ticks commonly carry Rocky Mountain spotted fever or Lyme Disease.

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Tick Bites, continued• Rocky Mountain spotted fever

develops 7 to 10 days after bite.• Symptoms include:

—Nausea, vomiting—Headache—Weakness—Paralysis—Possible cardiorespiratory

collapse

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• Lyme Disease has now been reported in over 35 states.

• Lyme Disease symptoms may begin 3 days after the bite.

• Symptoms include:—Target bull’s-eye pattern—Rash—Painful swelling of the joints

1 Tick Bites, continued

Caring for a Tick Bite• Do not attempt to suffocate or burn

tick.• Use fine tweezers to grasp tick by

the body and pull it straight out.• Cover the area with disinfectant

and save the tick for identification.• Provide any necessary supportive

emergency care and transport.

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Injuries from Marine Animals• Coelenterates are responsible for

more envenomations than any other marine life animal

• Have stinging cells called nematocysts

• Results in very painful, reddish lesions• Symptoms include headache,

dizziness, muscle cramps, and fainting.

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Care for Marine Stings• Limit further discharge by

minimizing patient movement.• Inactivate nematocysts by

applying alcohol.• Remove the remaining tentacles

by scraping them off.• Provide transport to hospital.

1

2Behavioral Emergencies

Myth and Reality

• Everyone has symptoms of mental illness problems at some point.

• Only a small percentage of mental health patients are violent.

• Perfectly healthy people may have symptoms occasionally.

2

Defining Behavioral EmergenciesBehavior

• What you can see of a person’s response to the environment and his or her actions

Behavioral crisis• Any reaction to events that interferes with

activities of daily living or that becomes unacceptable to the patient, family, or others

• A pattern, not an isolated incident

2

Causes of Behavioral EmergenciesOrganic Brain Syndrome

• Caused by disturbance in brain tissue function

Functional Disorder• Cannot be traced to change in

structure or physiology of the brain

2

Organic Brain Syndrome

Causes include:• Sudden illness• Recent trauma• Drug or alcohol intoxication• Diseases of the brain• Low blood glucose• Lack of oxygen• Inadequate blood flow to the brain• Excessive heat or cold

2

Safety Guidelines• Be prepared to

spend extra time.• Have a plan of

action.• Identify yourself.• Be calm.• Be direct.• Assess the scene.• Stay with patient.

• Encourage purposeful movement.

• Express interest.• Do not get too

close.• Avoid fighting.• Be honest and

reassuring.• Do not judge.

2

• Scene safety is most important. Consider calling appropriate resources if needed.

• Take BSI precautions at all times.

• Avoid tunnel vision.

1. Scene Size-up

Scene Size-up2

• Start from the doorway.• State why you are

there. • Decide SICK/NOT SICK. • Be calm and relaxed.• Provide appropriate

interventions.• Transport to

appropriate facility based on condition.

1. Scene Size-up

Initial Assessment


2

• If unconscious, do rapid exam for life threats.

• Assess three major areas as contributors:

• Is patient’s CNS functioning properly?

• Are hallucinogens or other drugs or alcohol a factor?

• Are psychogenic circumstances, symptoms, or illness involved?

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2

• Use reflective listening: repeating what the patient has said in question form to help patient expand thoughts.

• Tears, sweating, blushing may be indicators.

• Look at patient’s eyes.• Coping mechanisms are

stressed; perception of reality may be distorted.

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2

• Rarely called for.1. Scene Size-up




2

• Never let your guard down.

• Use law enforcement personnel with transport if available.

• Give advance warning to hospital.

• Can involve legal matters; document clearly and well.

• Be clear and specific on restraint use.

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Ongoing Assessment




2

Interventions

• Be caring and careful.• Intervene only to safely

transport.

2

Suicide

• Depression is the single most significant factor that contributes to suicide.

• An attempted suicide is a cry for help.

• Immediate intervention is necessary.

• Suicidal patients will usually exhibit warning signs.

2

Critical Warning Signs of Suicide• Does the patient have an air of

tearfulness, sadness, deep despair, or hopelessness?

• Does the patient avoid eye contact, speak slowly, or project a sense of vacancy?

• Does the patient seem unable to talk about the future?

• Is there any suggestion of suicide?• Does the patient have any specific plans

relating to death?

2

Risk Factors for Suicide• Are there any unsafe objects in the

patient’s hands or nearby?

• Is the environment unsafe?

• Is there evidence of self-destructive behavior?

• Keep in mind the suicidal patient may be homicidal as well.

2

Medicolegal Considerations• Mental incapacity may take many

forms.

• Once a patient has been determined to have an impaired mental capacity, you must decide if care is needed.

• Do not leave the patient alone.

• Obtain help from law enforcement as necessary.

2

Consent

• When a patient is not mentally competent, the law assumes that there is implied consent.

• The matter is not always clear-cut with psychiatric emergencies.

• If you are not sure about the situation, request law enforcement assistance.

2

Limited Legal Authority

• As an EMT-B, you have limited legal authority to require or force a patient to undergo care.

• Police may put a patient in protective custody to allow you to provide care.

• Know your local laws and protocols.

2

Restraints • You cannot restrain a

patient unless it is an emergency.

• Transport a disturbed patient without restraints if possible.

• If you must restrain the patient, use only reasonable force.—Law enforcement

personnel should be involved.

2

Potentially Violent PatientsUse a list of risk factors to assess the level of danger:

• Past history• Posture• Scene• Vocal activity• Physical activity

2

Other Factors to Consider• Poor impulse control• History of uncontrollable

temper• Low socioeconomic status• Substance abuse• Depression• Functional disorders

2

3Ob/Gyn Emergencies

Female Reproductive System3

Three Stages of Labor

First stage: Dilation of the cervix

Second stage: Expulsion of the infant

Third stage: Delivery of the placenta

3

Predelivery Emergencies

Preeclampsia

• Headache, vision disturbance, edema, anxiety, high blood pressure

Eclampsia

• Convulsions resulting from hypertension

Supine hypotensive syndrome

• Low blood pressure from lying supine

3

Hemorrhage

• Vaginal bleeding that occurs before labor begins

• If present in early pregnancy, it may be a spontaneous abortion or ectopic pregnancy.

3

Ectopic Pregnancy

• Pregnancy outside of the uterus

• Should be considered for any woman of childbearing age with unilateral lower abdominal pain and missed menstrual period

• History of PID, tubal ligation, or previous ectopic pregnancy

3

Placenta ProblemsPlacenta abruptio• Premature separation

of the placenta

Placenta previa• Development of

placenta over the cervix

3

Gestational Diabetes

• Develops only during pregnancy.• Treat as regular patient with

diabetes.

3

• Woman’s balance is altered. Be aware for falls and the need for spinal stabilization.

• Use BSI.• Usual threats to your

safety still exist.• Be calm. • Protect the mother and

the child.

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Scene Size-up3

• Is the mother in active labor?

• Evaluate trauma or medical problems first.

• Treat ABCs in line with local protocols.

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Initial Assessment


3

• Obtain full SAMPLE history, and also:

• Prenatal history• Complications during

pregnancy• Due date• Number of babies (twins)• Drugs or alcohol• Water broken• Green fluid (meconium)

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• Mainly abdomen and delivery of fetus

• Based on her chief complaints and history

• Pay close attention to tachycardia, hypotension, or hypertension.

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3

• Only if other treatments are not required.

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• Continue to reassess the patient for changes in vital signs. Watch for hypoperfusion.

• Notify hospital of your preparations for delivery.

• Document carefully, especially baby’s status.

• Obstetrics is one of the most litigated specialties in medicine.

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Ongoing Assessment




3

Transport Decision• If delivery is imminent, prepare for delivery

in warm, private location.• If delivery is not imminent, transport on left

side if in last two trimesters of pregnancy.• If the patient was subject to spinal injury,

stabilize and prop backboard with towel roll on right side.

3

Interventions

• Childbirth is natural, does not require intervention in most cases.

• Treating the mother will benefit the baby.

3

When to Consider Field Delivery• Delivery can be expected within a

few minutes

• A natural disaster or other catastrophe makes it impossible to reach a hospital

• No transportation is available

3

Preparing for Delivery

• Use proper BSI precautions.• Be calm and reassuring while

protecting the mother’s modesty.• Contact medical control for a

decision to deliver on scene or transport.

• Prepare OB kit.

3

Positioning for Delivery3

Delivering the Baby• Support the head as it emerges.

• Once the head emerges, the shoulders will be visible.

3

Delivering the Baby, cont'd• Support the head and upper body

as the shoulders deliver.

3

Delivering the Baby, cont'd• Handle the infant firmly but gently

as the body delivers.

3

Complications

Unruptured amniotic sac

• Puncture the sac and push it away from the baby.

Umbilical cord around the neck

• Gently slip the cord over the infant’s head.

• It may have to be cut.

3

Postdelivery Care

• Immediately wrap the infant in a towel with the head lower than the body.

• Suction the mouth and nose again.

• Clamp and cut the cord.

• Ensure the infant is pink and breathing well.

3

Delivery of Placenta

• Placenta is attached to the end of the umbilical cord.

• It should deliver within 30 minutes.• Once the placenta delivers, wrap it

and take to the hospital so it can be examined.

• If the mother continues to bleed, transport promptly to the hospital.

3

APGAR Scoring

A Appearance

P Pulse

G Grimace

A Activity

R Respirations

3

Neonatal Resuscitation3

Chest Compressions to an Infant1. Find the proper position

• Just below the nipple line• Middle third of the sternum

2. Wrap your hands around the body, with your thumbs resting at that position.

3. Press your thumbs gently against the sternum, compressing 1/3 to 1/2 the depth of the patient’s chest.

3

• Ventilate with a BVM device after every third compression.

• 100 compressions to 20 ventilations per minute

• Continue CPR during transport.

3Chest Compressions to an Infant

Breech Delivery• Presenting part is the

buttocks or legs.• Breech delivery is usually

slow, giving you time to get to the hospital.

• Support the infant as it comes out.

• Make a “V” with your gloved fingers then place them in the vagina to prevent it from compressing infant’s airway.

3

Rare Presentations

Limb presentation• This is a very

rare occurrence.• This is a true

emergency that requires immediate transport.

3

Rare Presentations, cont'd

Prolapsed cord• Transport

immediately.• Place fingers into

the mother’s vagina and push the cord away from the infant’s face.

3

Excessive Bleeding• Bleeding always occurs with delivery

but should not exceed 500 mL.

• Massage the mother’s uterus to slow bleeding.

• Treat for shock.

• Place pad over vaginal opening.

• Transport to hospital.

3

Spina Bifida

• Defect in which the portion of the spinal cord or meninges may protrude outside the vertebrae or body.

• Cover area with moist, sterile compresses to prevent infection.

• Maintain body temperature by holding baby against an adult for warmth.

3

Abortion (Miscarriage)• Delivery of the fetus or placenta

before the 20th week • Infection and bleeding are the most

important complications.• Treat the mother for shock.• Transport to the hospital.• Bring tissue that has passed through

the vagina to the hospital.

3

Twins

• Twins are usually smaller than single infants.

• Delivery procedures are the same as that for single infants.

• There may be one or two placentas to deliver.

3

Delivering for Addicted Mothers• Ensure proper BSI precautions

• Deliver as normal.

• Watch out for severe respiratory depression and low birth weight.

• Infant may require immediate care.

3

Premature Infants and Procedures• Delivery before 8

months or weight less than 5 lbs at birth.

• Keep the infant warm.• Keep the mouth and

nose clear of mucus.• Give oxygen.• Do not infect the

infant.• Notify the hospital.

3

Fetal Demise• An infant that has died in the uterus

before labor

• This is a very emotional situation for family and providers.

• The infant may be born with skin blisters, skin sloughing, and dark discoloration.

• Do not attempt to resuscitate an obviously dead infant.

3

Delivery Without Sterile Supplies• You should always have goggles and

sterile gloves with you.• Use clean sheets and towels.• Do not cut or clamp umbilical cord.• Keep placenta and infant at same

level.

3

Gynecologic Emergencies

• Do not examine genitalia unless there is obvious bleeding.

• Leave any foreign bodies in place, after packing with bandages

• Treat as any other patient with blood loss.

3

• What questions do you have?

Questions

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Documents

Seattle/King County EMT-B Class