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Sexual Assault

• Verbally Obtain Permission to Treat
• Protect Crime Scene
• Remove Only Clothing Necessary to Treat
• Give Clothing to Law Enforcement
• Examine Genitalia Only of Bleeding Profusely
• Discourage Patient from Bathing, Douching, Changing Clothes, Voiding, Combing Hair, Cleaning Nails
• Clean Wounds Only as Necessary
• Transport to Rape Crisis Center

Eclampsia / Toxemia

Obstetrical Emergencies – Eclampsia:

Toxemia:  >20weeks Gestation – up to – 2 weeks Post Partem

• Total Body Edema,
• Sz’s p 6 months pregnancy
• HTN
  • >140 Systolic
  • >90 Diastolic
  • Change in Diastolic > 15mm/Hg from antenatal

Eclampsia: Toxemia + Sz’s Treatment:

• IV
• Monitor
• Protect from Sz Activity
• Suction
• Transport: Left Lateral Decubitus Position
• Secure Airway

Prolapsed Cord

• IV - O₂  for Mother
• Position Mother – Head Down / Buttocks Elevated
• Check Cord Pulsations
• If FHR 120-160: Recheck q 5mins & Transport
• If FHR <120: Forewarn Mother & Insert gloved hand push baby’s head off cord
  • Effective Positioning: FHR=120-160

Breech Delivery

• O₂  for Mother
• Position Mother in Head Down Hips Elevated Position
• Transport ASAP / Notify Facility
• IV
• Support Presenting Part and Assist Delivery if Immanent
• If Head Does Not Deliver in 4-6mins: Insert gloved hand to create airway
• Monitor FHT’s q 5mins

Meconium Delivery

• IV - O₂  for Mother
• Do not stimulate before suctioning mouth then nose
• Maintain Airway
• Transport ASAP
• Intubate & Suction below cords with Meconium Aspirator Until Clear
• If not clear on third pass, leave tube in place and ventilate

Multiple Birth Delivery

• IV - O₂  for Mother

• Ensure Adequate Manpower
• Prepare for > 1 Resuscitation
• Have 1 ALS Unit/Infant & Mother

Childbirth / Labor

• Position Mother in Birthing Position
• Monitor FHT’s q 5mins
• IV – O₂
• Transport
• Knead Lower Abdomen if Bleeding continues