Name 5 anatomical differences that pediatric patients have compared to adults
1) Head is larger in proportion to their body
2) Airway structures are generally smaller
3) Bones are softer and more pliable
4) Respiratory rates are much faster than adults
5) Their tongue is proportionately larger
What is a fontanelle and how do you assess it
The fontanelle is the "soft spot" found in patients from birth to 18 months of age. When assessing, look for a flat surface when the child is not crying. It is normal for the fontanelle to bulge when the patient is crying and upset. If you find that the f
Label the following diagram and explain the significance/role of each structure
1) Perimetrium: Thin later of epithelial cells that surround/envelop the uterus
2) Myometrium: this is the smooth muscle layer of the uterus. 3) Endometrium: lining of the uterus. 4) Fundus of Uterus: the top portion of the uterus. 5) Ovary: produces the
What components make up the Pediatric Assesment Triangle (PAT)
- Appearance, work of breathing and circulation. The PAT is a rapid assessment tool based on your general impression of the patient when your first walk in the room. It shouldn't take longer than a few seconds and is used to determine a critical patient
What addition questions should be asked of a pregnant patient
- "Are you pregnant and if so, what is your due date?"
- "Have you been receiving prenatal care?"
- "Are you expecting multiple birth (i.e. twins)?"
- "Has this been a normal pregnancy up until this point?"
- "Have you been told that this was going to be
Describe the 3 stages of labor
1. Onset uterine contraction, ends with full dilation and effacement
2. Begins with full dilation and effacement, ends with birth
3. Begins with birth, ends with placental expulsion
What is the APGAR score used for?
The APGAR score is a tool used just after the birth of a baby that measures how they're doing and if further intervention is needed.
When is the APGAR score used and describe the components of it
It's made up of Appearance, Pulse, Grimace, Activity, and Respirations. It is used at 1 minute after birth and 5 minutes after birth.
1) Appearance:
0 - Cyanotic all over
1 - Pink core, cyanotic extremities
2 - Pink all over
2) Pulse:
0 - Pulseless
1 - <
You suspect PID during the assessment of a 28-year-old female. What is PID and what are the signs/symptoms
PID = Pelvis Inflammatory Disease and it is an infection of the female reproductive organs
Signs/symptoms include lower abdominal pain, fever, irregular menstruation, pain during urination/sex, vaginal discharge
What is SIDS
Sudden Infant Death Syndrome
-unexpected death of seemingly healthy babies 12 months or younger No cause of death is determined.
What is the compression/ventilation ratio for children and infants during CPR
Children and infants are the same:
One-rescuer: 30/2
Two-rescuer: 15/2
What is supine hypotensive syndrome (SHS) and how does it pertain to pregnant patients
SHS is the weight of the uterine and abdominal contents pushing on the inferior vena cava. This can lead to the mother feelings dizzy, weak and she may even lose consciousness.
If an expectant mother tell you she's has one miscarriage and one live birth, how would you describer her history using the gravida/para system
Gravida 3, Para 1
Gravida is the number of times the woman has been pregnant (regardless of outcome). Para is defined as the number of viable live births. This mother is currently pregnant, had one miscarriage, and one delivered child = G3. She has delive
What does the term 'nullipara' mean
a woman who has never given birth
What is meconium staining and what is it indicative of
Meconium is the first stool of the infant. Meconium staining is a green, brown, or yellow tinged amniotic fluid that is a result of the infant defecating (pooping) during labor, or even a considerable time before. This could be a sign of distress in the i
What are some factors that could present themselves on scene that would indicate neonatal resuscitation could be imminent
Meconium staining when the mother's water breaks. History of deliver problems. Multiple births, such as twins or triplets. A baby who is premature. History of a recreational drug used by the mother
What are the signs and symptoms of preeclampsia/eclampsia
Pre-eclampsia presents itself as hypertension, protein in the urine, and pitting edema. It is considered eclampsia when the mother also has a seizure.
Why is eclampsia considered an emergency
Most often, 911 is called when then mother has a seizure and this is a true emergency. The fear is that the blood flow will be reduced to the placenta and cause harm to the fetus
What is Nuchal Cord and why is it an emergency
Nuchal cord occurs when the umbilical cord has wrapped itself around the newborn's head. Most often, it can be slipped over the head and if needed, can be clamped and cut in place. The fear is that the cord can become compressed, cutting off the blood sup
What is the normal blood loss during child birth
300 - 500 ml
What is a Prolapsed Cord and why is it an emergency
A prolapsed cord is when the umbilical cord proceeds the fetus into the birth canal. The fear is that the cord can become compressed between the infant's head and the birth canal, reducing blood flow to the baby
Define placenta previa
The placenta attached to the uterus close to or over the cervical opening
Define abruptio placenta (placental abruption)?
The placenta separates from the uterine wall
Define Uterine rupture
A tear in the wall of the uterus
Define ectopic pregnancy
The egg is implanted outside the uterus, most often in the fallopian tube
What are the 3 types of breech presentation and how do they differ
1) Frank breech: Presentation where the legs are extended upwards and towards the face and the buttocks are presenting
2) Incomplete breech: One or both legs are flexed and often presents with a foot
3) Complete breech: Both legs are flexed and the buttoc
How do you manage a breech birth in the prehospital setting
If birth is imminent prepare the mother by assisting her into an appropriate position for delivery and draped. Administer Oxygen as needed and place an IV if it is in your scope. Allow the delivery of the legs and support with your palm and arm until the
What is shoulder dystocia and how do you recognize it
When the fetal shoulder is wedged against the mothers pubic symphysis. This allows the head to deliver but no the shoulder and can be recognized when the head continues to advance slightly with pushing, but then retracts again at the end and no advancemen
How do you manage a shoulder dystocia in the field
You can attempt to deliver the shoulder by positioning the mother on her left side with her knees to her chest. Then you can try to guide the infants head downward to try to let the anterior shoulder deliver. Then attempt to rotate the shoulders to an ang
What is a shoulder presentation and how do you manage it in the field
A shoulder presentation means that the shoulder is overlying the opening and a hand or arm may be presenting. This cannot be delivered in the field and requires a cesarean section. Place the mother in left lateral recumbency if tolerated, administer Oxyge
What is cord presentation and how do you manage it in the field
A cord presentation means that a part of the umbilical cord has prolapsed and is being compressed against the presenting part of the fetus. You can manage this by applying pressure to the presenting part and attempting to push back into the vagina thereby
What is cephalopelvic disproportion (CD) and how is it managed in the field
CD mean that the head is too large to fit through the pelvis or the pelvis is unusually small. This is characterized by frequent strong contractions without movement of the fetus as the head is unable to fit through the pelvis. This is managed by administ
What type of breech is the most common
Frank breech is the most common type of breech, followed by incomplete breech, and then complete breech
What does occiput posterior presentation mean
Means that the baby is facing up with delivering instead of sideways or down
How is occiput posterior presentation managed in the field
This position can other result in difficult labor and delivery and may require a C-Section. This is managed by administering O2 as needed, placing an IV for possible fluid resuscitation, and rapid transport.