Sarnia Paramedic Association Case Strudy # 2

You are working the night shift in a blinding snowstorm during a full moon. It is 23:30 hours. You have been busy with ‘miscellaneous’ calls and are just returning to the station to get caught up on paperwork when you are dispatched over the radio.

You are to respond to a private residence for a 28-year-old female patient experiencing active labour. From the residence, due to locale and road conditions, you would be approximately 30 minutes to the nearest medical facility.

You are met at the residence by a 30-year-old male who informs you his wife is in active labour and things appear to be happening so quickly he was afraid to drive her to the hospital. He directs you into the bedroom where you identify a 28 year old female appears to be experiencing uterine contractions. She is sitting on the edge of the bed breathing fast and deeply. From the appearance of her pants and the bed it appears her water has broken. She acknowledges your presence by stating “I think the baby is coming right now!”

She is alert and orientated with a good airway and respiratory exchange. Pulses are strong and regular at the neck and wrist, her skin is warm, pink and diaphoretic. There is no sign of trauma or major bleeding. There are no sensory or motor deficits in the extremities. From your history you discover this is her fourth pregnancy. She has two children and one spontaneous abortion one year prior. She reports regular prenatal assessments with no complications. She is 35 weeks gestation. She reports contractions began suddenly approximately one hour ago. Her water broke approximately 20 minutes ago and the contractions have increased dramatically in frequency and intensity since that time. They are now two minutes apart, lasting approximately 50 seconds and she feels the “urge to push”. Labour with her last two children lasted four and three hours.

Inspection of the perineum reveals the presence of crowning. The amniotic fluid appears clear. No major bleeding is present.

B/P	140/70
Skin:	warm, pink, diaphoretic
Pulse	100 strong/regular
Respiration	24 N.L.
E.C.G. Reveals:

EMT Questions

1. Your transport decision for this patient should be to:

2. Delivery can be expected within a few minutes if:

3. This patient’s obstetrical history would be described as:

4. The three stages of labour are:

5. The second stage of labour ends with:

6. To determine the time between contractions you should time:

7. A premature birth refers to delivery occurring before the:

8. When the infant head is presented you should:

9. If the placenta does not deliver 20 or 30 minutes after the baby’s birth EMS personnel should:

10. ‘Normal’ blood loss after delivery would be considered up to:

11. Apparently stable vital signs in a pregnant woman subjected to trauma:

12. A female of childbearing age presenting with sudden, sharp, abdominal pain, light vaginal bleeding, history of one or two missed menstrual cycles and signs of shock is most likely experiencing:

13. The E.C.G indicates:

14. The presence of meconium indicates:

15. You are transporting a 25-year old female who is 33 weeks gestation. You note edema present in her hands, feet and face. Her blood pressure is 150/90. You suspect her condition is:

16. En route the patient in question 15 begins to experience a grand mal seizure. The treatment of choice would be:

17. When examining a patient experiencing labour you discover a prolapsed cord. Your treatment should include:

18. You arrive on scene to find a female in active labour. The head has presented and the cord is tightly wrapped around the neck. Your attempts to loosen and unwrap the cord are unsuccessful. You should then:

19. If the newborn’s heart rate is less than 60 beats per minute:

20. IV access can be gained in the newborn by:

21. You arrive on scene to find a mother who has already delivered both infant and placenta. You direct your partner to assess and treat the infant, you assess the mother and discover heavy post partum hemorrhage. Your treatment should include:

22. Emergency medical services can both increase this public relations visibility and improve their own comfort level with obstetrical patients by:

The answers to these questions are to industry standards and may not necessarily be correct according to local protocol. If there is any discrepancy between these answers and local protocol, please follow the protocol for your area as set out by your Medical Director.

Heather MacKenzie-Carey Is a paramedic who has 15 years of EMS experience in Nova Scotia and Alberta. She Is currently teaching In the Paramedic Program at the Southern Alberta Institute of Technology. She has a Bachelorof Science degree in Health Education from Dalhousie University In Nova Scotia and Is completing a certificate In Social Work from the University of Waterloo.

She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

Canadian Emergency News and the author of this quiz grant permission for readers to copy It for personal and departmental educational purposes. All other reproduction and republication without written consent is prohibited.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News. It originally appeared in the February / March issue (volume 19, number 1).

EMS Quiz

1. Your transport decision for this patient should be to:

2. Delivery can be expected within a few minutes if:

3. This patient’s obstetrical history would be described as:

4. The three stages of labour are:

5. The second stage of labour ends with:

6. To determine the time between contractions you should time:

7. A premature birth refers to delivery occurring before the:

8. When the infant head is presented you should:

9. If the placenta does not deliver 20 or 30 minutes after the baby’s birth EMS personnel should:

10. ‘Normal’ blood loss after delivery would be considered up to:

11. Apparently stable vital signs in a pregnant woman subjected to trauma:

12. A female of childbearing age presenting with sudden, sharp, abdominal pain, light vaginal bleeding, history of one or two missed menstrual cycles and signs of shock is most likely experiencing:

13. The E.C.G indicates:

14. The presence of meconium indicates:

15. You are transporting a 25-year old female who is 33 weeks gestation. You note edema present in her hands, feet and face. Her blood pressure is 150/90. You suspect her condition is:

16. En route the patient in question 15 begins to experience a grand mal seizure. The treatment of choice would be:

17. When examining a patient experiencing labour you discover a prolapsed cord. Your treatment should include:

18. You arrive on scene to find a female in active labour. The head has presented and the cord is tightly wrapped around the neck. Your attempts to loosen and unwrap the cord are unsuccessful. You should then:

19. If the newborn’s heart rate is less than 60 beats per minute:

20. IV access can be gained in the newborn by:

21. You arrive on scene to find a mother who has already delivered both infant and placenta. You direct your partner to assess and treat the infant, you assess the mother and discover heavy post partum hemorrhage. Your treatment should include:

22. Emergency medical services can both increase this public relations visibility and improve their own comfort level with obstetrical patients by:

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EMS Quiz

1. Your transport decision for this patient should be to: A. Load and go B. Prepare for home delivery prior to transport and call for backup as you may have two patients C. Transport, preparing for delivery en route D. Transport cautiously, no lights or sirens

2. Delivery can be expected within a few minutes if: A. Amniotic fluid has broken B. Crowning has occurred C. Contractions are five minutes apart and irregular D. All of the above

3. This patient’s obstetrical history would be described as: A. Gravida 4 Para 2 Abortion I B. Gravida 2 Para 4 Abortion 1 C. Gravida 4 Para 3 D. Gravida 3 Para 4

4. The three stages of labour are: A. Labour, transition, delivery B. Dilation, expulsion, placental C. Membrane rupture, delivery, afterbirth D. None of the above

5. The second stage of labour ends with: A. Cervical dilation B. Infant delivery C. Placental delivery D. Uterine contractions E. None of the above

7. A premature birth refers to delivery occurring before the: A. Expected due date B. 36th week gestation C. 42nd week gestation D. 38th week gestation

8. When the infant head is presented you should: A. Suction the nostrils then the mouth B. Suction the mouth then nostrils C. Dry off the head D. Not suction or stimulate until body has presented as well.

9. If the placenta does not deliver 20 or 30 minutes after the baby’s birth EMS personnel should: A. Wait another 10 minutes B. Transport mother and baby C. Pull gently on the umbilical cord D. Massage the abdomen

10. ‘Normal’ blood loss after delivery would be considered up to: A. 250cc B. 500cc C. 1000cc D. No blood loss is normal after delivery

11. Apparently stable vital signs in a pregnant woman subjected to trauma: A. May not reflect fetal status B. Should not rule out injury C. May indicate blood shunted from fetus to mother D. All of the above

12. A female of child­bearing age presenting with sudden, sharp, abdominal pain, light vaginal bleeding, history of one or two missed menstrual cycles and signs of shock is most likely experiencing: A. Ruptured uterus B. Placenta Previa C. Ectopic pregnancy D. Toxemia

13. The E.C.G indicates:

14. The presence of meconium indicates: A. Possible fetal distress B. The need to perform deep suctioning before the infant breathes C. The need to suction the mouth and nose immediately D. A and B E. A and C

15. You are transporting a 25-year old female who is 33 weeks gestation. You note edema present in her hands, feet and face. Her blood pressure is 150/90. You suspect her condition is: A. Gestational diabetes B. Pre-eclampsia C. Eclampsia D. Placenta Previa

16. En route the patient in question 15 begins to experience a grand mal seizure. The treatment of choice would be: A. Oxygen, IV, Magnesium sulfate B. Oxygen, IV, Oxytocin C. Oxygen, I.M. Valium D. All of the above are acceptable

19. If the newborn’s heart rate is less than 60 beats per minute: A. Ventilate with 100 per cent oxygen B. Stimulate the infant C. Begin cardiac compressions D. Intubate

20. IV access can be gained in the newborn by: A. Peripheral lines B. Intraosseous C. Umbilical cannulation D. All of the above E. A and B

Your comments are appreciated!

Just complete this form. Click on Submit when ready to send.

Your name:

Email address:

Any comments about the Case Study?

1. Your transport decision for this patient should be to:

2. Delivery can be expected within a few minutes if:

3. This patient’s obstetrical history would be described as:

4. The three stages of labour are:

5. The second stage of labour ends with:

7. A premature birth refers to delivery occurring before the:

8. When the infant head is presented you should:

9. If the placenta does not deliver 20 or 30 minutes after the baby’s birth EMS personnel should:

10. ‘Normal’ blood loss after delivery would be considered up to:

11. Apparently stable vital signs in a pregnant woman subjected to trauma:

12. A female of childbearing age presenting with sudden, sharp, abdominal pain, light vaginal bleeding, history of one or two missed menstrual cycles and signs of shock is most likely experiencing:

14. The presence of meconium indicates:

15. You are transporting a 25-year old female who is 33 weeks gestation. You note edema present in her hands, feet and face. Her blood pressure is 150/90. You suspect her condition is:

16. En route the patient in question 15 begins to experience a grand mal seizure. The treatment of choice would be:

19. If the newborn’s heart rate is less than 60 beats per minute:

20. IV access can be gained in the newborn by: