emt-basic curriculum module 4

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State of WisconsinEMT-Basic: A Practice BasedApproach to EMS Education12. Wrap infant in a warm blanket and place on its side, headslightly lower than trunk13. Keep infant level with vagina until the cord is cut14. Assign partner to monitor infant and complete initial care of thenewborn15. Clamp, tie and cut umbilical cord (between the clamps) aspulsations cease approximately 4 fingers width from infant16. Observe for delivery of placenta while preparing mother andinfant for transport17. When delivered, wrap placenta in towel and put in plastic bag;transport placenta to hospital with mother18. Place sterile pad over vaginal opening, lower mother's legs, helpher hold them together19. Record time of delivery and transport mother, infant andplacenta to hospitalC. Vaginal bleeding following delivery - up to 500 cc of blood loss isnormal following delivery1. A 500 cc blood loss is well tolerated by the mother followingdelivery. The EMT-Basic must be aware of this loss so as not tocause undue psychological stress on himself or the new mother.2. With excessive blood loss, massage the uterus.a) Hand with fingers fully extendedb) Place on lower abdomen above pubisc) Massage (knead) over aread) Bleeding continues - check massage technique andtransport immediately, providing oxygen and ongoingassessment3. Regardless of estimated blood loss, if mother appears in shock,treat as such and transport prior to uterine massage. Massageen route.D. Initial care of the newborn1. Position, dry, wipe, and wrap newborn in blanket and cover thehead.2. Repeat suctioning3. Assessment of infant - normal findingsa) Appearance - color: no central (trunk) cyanosisb) Pulse - greater than 100/minc) Grimace - vigorous and cryingd) Activity - good motion in extremitiese) Breathing effort - normal, crying4. Stimulate newborn if not breathinga) Flick soles of feetb) Rub infant's backE. Resuscitation of the newborn follows the inverted pyramid (seeAppendix K) - after assessment, if signs and symptoms require eithercardiac or pulmonary resuscitation, do the following when appropriate:Module 4-96
State of WisconsinEMT-Basic: A Practice BasedApproach to EMS Education1. Breathing effort - if shallow, slow or absent provide artificialventilations:a) 60/minb) Reassess after 30 secondsc) If no improvement, continue artificial ventilations andreassessments2. Heart ratea) If less than 100 beats per minute provide artificialventilations:(1) 60/min(2) Reassess after 30 seconds(3) If no improvement continue artificial ventilationsand reassessmentsb) If less than 80 beats per minute and not responding tobag-valve-mask, start chest compressionsc) If less than 60 beats per minute, start compressions andartificial ventilations3. Color - if central cyanosis is present with spontaneous breathingand an adequate heart rate administer free flow oxygen -administer oxygen (10-15L) using oxygen tubing held as closeas possible to the newborn's faceV. Abnormal DeliveriesA. Prolapsed Cord - condition where the cord presents through the birthcanal before delivery of the head; presents a serious emergency whichendangers the life of the unborn fetus1. Size up2. Initial assessment3. Mother should have high flow oxygen4. History and physical exam5. Assess baseline vitals6. Treatment based on signs and symptoms7. Position mother with head down or buttocks raised using gravityto lessen pressure in birth canal8. Insert sterile gloved hand into vagina pushing the presentingpart of the fetus away from the pulsating cord9. Rapidly transport, keeping pressure on presenting part andmonitoring pulsations in the cordB. Breech birth presentation - breech presentation occurs when thebuttocks or lower extremities are low in the uterus and will be the firstpart of the fetus delivered1. Newborn at great risk for delivery trauma, prolapse cord morecommon, transport immediately upon recognition of breechpresentation2. Delivery does not occur within 10 minutes3. Emergency medical carea) Immediate rapid transportation upon recognitionModule 4-97
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emt-basic curriculum module 4

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