2.10 Obstetrical Emergencies

EMT/ADVANCED EMT STANDING ORDERS

• 1.0 Routine Patient Care

• Expose as necessary to access for bleeding/discharge, crowning, prolapsed cord, breech, limb presentation.

• Do not digitally examine or insert anything into the vagina.

• Exceptions: fingers may be inserted to manage baby’s airway in breech presentation or to treat prolapsed or nuchal cord.

• Place mother in left-lateral recumbent position except as noted:

• Prolapsed cord:

• Knee-chest position or Trendelenburg position

• If only the cord has prolapsed and the presenting part has yet to go through the cervix, gently elevate the presenting part to remove pressure on the umbilical vessels to permit blood flow through cord.

PARAMEDIC STANDING ORDERS

• Eclamptic Seizures

• Midazolam 2 - 6 mg slow IV/IO/IM or

       Midazolam 2 - 6 mg IN

• Magnesium sulfate 2-4 grams IV/IO over 5 minutes

MEDICAL CONTROL MAY ORDER

• Administration of additional IV Normal Saline.

• Calcium chloride 10%  20 mg/kg IV/IO administer slowly over 5 minutes to a maximum dose of 1 gram. (Antidote for Magnesium Sulfate).

• Further anticonvulsant therapy.

PEARLS:

Special Considerations in Cardiac Arrest (with additional resources)

-If the fundus height is at or above the level of the umbilicus-Manually displace the gravid uterus to the left to enhance venous return.