Page 83 - 2023 SMOG Digital

SPECIAL POPULATIONS

CHILD BIRTH

Signs and Symptoms: Possible Complications:
• Spasmodic Pain • Preterm Labor
• Vaginal Fluid/Bleeding • Spontaneous Vaginal Delivery
• Crowning/Urge to Push • Placenta Previa
• Meconium • Prolapsed Cord
• Abnormal Presentation (e.g., breech)
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
IV/IO Guideline
Tactical Evacuation Guideline Cardiac Monitor
Check Blood Glucose
Place patient in
Left Lateral Position or
Place Pad/Lift Under Right side
OBSTETRIC EMERGENCY Hyper/Hypotension?
Guideline YES Abnormal Bleeding?
Crowning? Assist With Childbirth
(Visually Inspect – NO Digital Exam) YES (*See Pearls)
NO
Monitor and Reassess NEWBORN Guideline
When appropriate, return to:
Tactical Evacuation Guideline Rapid Transfer to Nearest MTF
Pearls:
• Document all times–delivery, contraction frequency/length.
• Assist with birth:
o Position mother as necessary.
o Prepare 2 sets of hemostats and scissors/scalpel, umbilical cord clamp if available, bulb suction.
o If umbilical cord palpable around neck–attempt to reduce manually prior to delivery of head (should
feel rope–like structure around neck). As last resort, and if unable to keep pressure off of the cord,
clamp and cut cord when unable to manually reduce.
o If umbilical cord seen, elevation of presenting part with vaginal hand and maintain elevation until
delivery via C–section AKA “ride the bed” ***Do not place pressure on the cord or monitor pulse via
the cord.
o Suctioning of nose and mouth with bulb aspirate recommended if obvious obstruction from secretions.
o Use slight downward pressure to deliver superior shoulder, then slight upward pressure to deliver
lower shoulder.
o Clamp cord after 1–3 minutes with 2 hemostats and cut between clamps.
o Immediately wrap infant and give to mother–assistant to aid in monitoring child.
o Deliver placenta–should feel lengthening/giving way of cord and gush of blood–keep placenta for
pathology evaluation. (This process may take up to 30min. Never pull on the umbilical cord in
attempts to speed delivery.)
o “Externally” massage uterus to encourage contraction and limit bleeding.
o If neonate appears to be stuck in the birth canal (i.e., turtling of the head), flex the mother’s hips (both
knees to chest) in order to widen the birth canal.
o Provide the neonate with safe and adequate hearing protection and hypothermia prevention as
possible.
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