# Paramedic class assignment



## MichiganMedic10 (Aug 5, 2012)

Good day to you readers. This weeks assignment for my paramedic class is to find a paramedic or paramedics with 10 or more years experience and ask them some questions about OB and Neonatology. Our instructor believes that these are two call types that we rarely encounter and it becomes a topic that we take for granted and never seek to continue education on. He also believes it is beneficial that we need to focus more on this topic as we rarely encounter them in the field.


     So as for the questions: (No cheating please)

1. If you were delivering a baby in the field and you see buttocks coming out first, can you deliver that child in the field? If so, how?

2. What if a baby has shoulder dystocia? What kind of procedures or positioning would you do?

3. What medication(s) do you carry in your ambulance that can stop or slow down preterm labor?

4.If you delivered a newborn and their heart rate is 80bpm, what is your next step?

5. What is the proper compression to ventilation ratio for a newborn?

6. What is the ideal drug to give a newborn that has a heart rate less than 60bpm despite other resuscitative efforts?

As always, any help on this is appreciated. Also, in your response if you would list years of field experience and if you work urban, rural or both.

Thank you for your time.


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## Veneficus (Aug 5, 2012)

MichiganMedic10 said:


> Good day to you readers. This weeks assignment for my paramedic class is to find a paramedic or paramedics with 10 or more years experience and ask them some questions about OB and Neonatology. Our instructor believes that these are two call types that we rarely encounter and it becomes a topic that we take for granted and never seek to continue education on. He also believes it is beneficial that we need to focus more on this topic as we rarely encounter them in the field.
> 
> 
> So as for the questions: (No cheating please)
> ...



It is not fair for me to answer these questions as I no longer work as a medic, but I will tell you that in order for mag sulfate to slow down labor, you need 6-10 grams in a drip. (do you have that much?)

I can also tell you that morphine will stop uterine contraction and that will be bad news.

Supposedly toradol can too, but I have never seen it actually do it.


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## MichiganMedic10 (Aug 5, 2012)

Thank you very much for your input. This is really going to help.


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## lawndartcatcher (Aug 6, 2012)

I've been told that a 500 cc fluid bolus will also slow contractions (assuming, of course, that mom can handle the extra fluid).

Buttocks - in general, nope. Local protocols state that that kind of breech delivery gets transported, with mom on her hands and knees and her butt in the air with a paramedic assuring her that this isn't some bizarre form of initiation.

80 bps would depend on APGAR and other presentation. AHA (and our protocols) say we don't start compressions until HR <60 bpm (I think that was the answer you were looking for).

Vis a vis shoulder dystocia: If a small amount of turning alleviates it then we're okay with assisting. Technically, though, that's not true shoulder dystocia. It may be that we end up making an extremely rapid and awkward transport to the ED with a provider holding the cord away from the baby's neck. Yes - that means placing your hand "up there" for the duration of transport. Thank god I work 8 minutes away from an ER.


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## MichiganMedic10 (Aug 6, 2012)

Thanks for your input. I believe the reason we were given this assignment was to see how continuing education in this area is beneficial after we start our careers, and that because these skills are not used in everyday EMS, makes it all that more important to keep those skills and practices sharp. Also if you could say if you work in rural or urban settings. Thanks again for posting.


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## DrankTheKoolaid (Aug 6, 2012)

*re*

3. What medication(s) do you carry in your ambulance that can stop or slow down preterm labor?

Normal Saline. As you get to your A/P portion if you have not already taken a full A and full P class this will eventually make sense.  But until then just read what is in the anterior vs. posterior pituitary gland and there triggers.


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## MichiganMedic10 (Aug 6, 2012)

Good old Albuterol, Mag Sulfate and Terbutaline are good choices. Our instructor also had the washout by NS too. Thanks for the reply.


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## Anjel (Aug 7, 2012)

Where are you taking your medic?


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## Veneficus (Aug 7, 2012)

*Busted.*



MichiganMedic10 said:


> Good old Albuterol, Mag Sulfate and Terbutaline are good choices. Our instructor also had the washout by NS too. Thanks for the reply.



Never heard of this before so I had to look it up...

According to the 23rd edition of Williams Obstentrics,

b-agonists administered IV will prevent preterm labor for up to 48 hours.

Oral B-agonists have no effect.

Furthermore, terbutaline needs to be pumped in subcutaneously and is not approved for the prevention of preterm labor in the US.

Saline is demonstrated to be no more effective than bed rest. 

Saline with morphine is suggested for emergent delay.

The suggested magnesium dose is a 6 gram bolus with 2 grams per hour for at least 12 hours.

All of these therapies are considered risk factors for pulmonary edema in the mother.

Only prostaglandin inhibitors are shown effective without significant risk to the infant and mother.

I will stipulate that any medical control in their right mind would only approve the use of morphine with saline for prehospital EMS.


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## NYMedic828 (Aug 7, 2012)

If I called medical control for any of the above the doctor would probably break out laughing at me...

Morphine/saline MAYBE but it would probably still take more convincing than the 10 minute time to hospital is worth.


Also, isn't that a dangerously high dose of mag?


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## NomadicMedic (Aug 7, 2012)

Interesting. 0.25mg of SQ Terbutaline was still in the protocols for preterm labor when I left Washington a year ago. I never used it and don't know if it is in the current protocols.


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## MichiganMedic10 (Aug 7, 2012)

Paramedic Practice Today Above and Beyond Volume II, Chapter 35 Obstetrics and Gynecology, page 20, Under the complications of Childbirth, Under the heading of Preterm Delivery. This is a quote straight out of the first paragraph. "Treatment includes rapid transport to an appropriate facility, rest, fluids, and administration of a tocolytic to slow contractions. The uterus is made of smooth muscle. As a result the administration of beta2 agonists or smooth muscle relaxants reduces labor by causing the relaxation of smooth muscles. Magnesium sulfate, ritodine, and terbutaline are examples of tocolytic agents.


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## epipusher (Aug 7, 2012)

While doing clinicals in our local facilities,I have noticed terbutaline is still given. A recent EMS World article about New Mexico CCP's listed it as one of their CCP medications.


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## Veneficus (Aug 7, 2012)

epipusher said:


> While doing clinicals in our local facilities,I have noticed terbutaline is still given. A recent EMS World article about New Mexico CCP's listed it as one of their CCP medications.



It is not to say it is not used off label, only that it is not labeled for that.


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## Veneficus (Aug 7, 2012)

MichiganMedic10 said:


> Paramedic Practice Today Above and Beyond Volume II, Chapter 35 Obstetrics and Gynecology, page 20, Under the complications of Childbirth, Under the heading of Preterm Delivery. This is a quote straight out of the first paragraph. "Treatment includes rapid transport to an appropriate facility, rest, fluids, and administration of a tocolytic to slow contractions. The uterus is made of smooth muscle. As a result the administration of beta2 agonists or smooth muscle relaxants reduces labor by causing the relaxation of smooth muscles. Magnesium sulfate, ritodine, and terbutaline are examples of tocolytic agents.



:rofl:

Over William's Obstetrics?

With mag being the only one demonstrated to work...

Sometimes.


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## Veneficus (Aug 7, 2012)

NYMedic828 said:


> Also, isn't that a dangerously high dose of mag?



Since it is listed as being initiated for both fetal neuroprotection in the 24 week in addition to delaying preterm labor, usually infused by an implanted pump, I am going with "no."


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## NYMedic828 (Aug 7, 2012)

Veneficus said:


> Since it is listed as being initiated for both fetal neuroprotection in the 24 week in addition to delaying preterm labor, usually infused by an implanted pump, I am going with "no."



Why do people make it out to seem like a 2g drip for asthmatics is too crazy for most patients? Are they just using it as an excuse for laziness? If 6g isn't that high I can't see 2g being harmful. (Granted thats what the hospital seems to do for every unresolved asthmatic we bring in)



MichiganMedic10 said:


> Paramedic Practice Today Above and Beyond Volume II, Chapter 35 Obstetrics and Gynecology, page 20, Under the complications of Childbirth, Under the heading of Preterm Delivery. This is a quote straight out of the first paragraph. "Treatment includes rapid transport to an appropriate facility, rest, fluids, and administration of a tocolytic to slow contractions. The uterus is made of smooth muscle. As a result the administration of beta2 agonists or smooth muscle relaxants reduces labor by causing the relaxation of smooth muscles. Magnesium sulfate, ritodine, and terbutaline are examples of tocolytic agents.



Paramedic Practice Today is an awful textbook.


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## Veneficus (Aug 7, 2012)

NYMedic828 said:


> Why do people make it out to seem like a 2g drip for asthmatics is too crazy for most patients? Are they just using it as an excuse for laziness? If 6g isn't that high I can't see 2g being harmful. (Granted thats what the hospital seems to do for every unresolved asthmatic we bring in).




I think it is like anything else, the effect is dose dependant.

Stopping preterm labor is a grander task than inhibiting ICAMs and T-cell reproduction.


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## Veneficus (Aug 7, 2012)

NYMedic828 said:


> Paramedic Practice Today is an awful textbook.



It is just a little league text.

It is not possible to trump an international medical text for OB/GYN residents with a chapter from a book authored by somebody who made study guides for ACLS and PALS.


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## NYMedic828 (Aug 7, 2012)

Veneficus said:


> It is just a little league text.
> 
> It is not possible to trump an international medical text for OB/GYN residents with a chapter from a book authored by somebody who made study guides for ACLS and PALS.



Do you just have a library of all these texts at your disposal at any given moment?


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## Veneficus (Aug 7, 2012)

NYMedic828 said:


> Do you just have a library of all these texts at your disposal at any given moment?



It is my personal library, it is quite extensive.


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## MichiganMedic10 (Aug 7, 2012)

Thanks for all the help everyone. It is much appreciated.


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