EMTCITY PARAMEDIC CHALLENGE

[Mateo_1387]

I'm not saying that aggressive maneuvers aren't required sometimes, though with c-sections they don't need to be done frequently. There are several things that can be done that are uncomfortable but don't cause severe injury.

Would putting the mother's hips over the edge of the bed, and the pressing down on one shoulder (supra pubic pressure) be helpful?

[ERDoc]

Here is a good link. Basically, have the mother pull her knees up as far as she can. If you have a few extra sets of hands, have them do it. Have someone apply pressure on the shoulder that is stuck in an attempt to push it under the pubic bone. NEVER apply pressure to the fundus. You can also try rotating the baby, but be sure not to twist the neck.

Would putting the mother's hips over the edge of the bed, and the pressing down on one shoulder (supra pubic pressure) be helpful?

[Camulos]

I was chatting to paramedicmike in the chat room yesterday about child birth when he told me of his paramedic rule number four – Always unload just as many pts as you loaded. I’m quite happy to go along with that and luckily have not yet managed to unload more pts than I loaded. I have never delivered a baby before and am quite keen to keep that scorecard clean.

Having no real life experience I admit my answer is purely textbook. Mobey suggested an episiotomy. I guess episiotomy may work however don’t know that it would be my first line management. I’m happier to go with the supra pubic pressure on the baby’s shoulder before reaching for the scalpel.

I also remember something about getting the mother to put her knees as high up on her abdomen as possible to assist delivery through the canal. Some of the mother’s that were present in this lecture laughed at this suggestion saying it could not be done. It was actually an interesting verbal interplay between the male lecturer and the vehement mother’s coalition – LOL. If this position were not possible I believe the mother should get on the ground on all fours - awaiting further assistance. Realistically I don’t know how these positions help. Definitely, and gladly, not my specialty.

I don’t think I need to know the answer to this one anyway. I’ll be far too busy boiling the kettle and getting the towels when this happens

Stay safe,

Curse :evil:

[Camulos]

Damn - I was four minutes too late to get that answer in before ERDOC!!! :x

[akflightmedic]

Sorry for the tangent but it is something I have often wondered about and had no real exposure to until I started working with other cultures.

Why do we insist on placing a mother on her back for delivery? Are we smarter than our design plans?

Once I started assisting with deliveries in different cultures, I soon realized that squatting is a much easier way to bring life into this world. After some research, I discovered there are some hospitals which encourage this, even provide squat bars, however very few OBs even educate their patient on this possibility.

Squatting shortens the path traveled, allows gravity to assist, and in several different women's opinions, is a much easier position to maintain when enduring the pain and when feeling the urge to push.

Oh well, what do I know, I am only a male who plants the seed.

[Camulos]

Great question!! Although I don’t have the answer I will add that the squatting position was the one advocated by the mother’s coalition I referred to earlier. They were claiming it was far more comfortable than lying on their back.

Stay safe,

Curse :evil:

[Mateo_1387]

I have no problem using my field guide for this problem nor do I have a problem using a drip chart that helps me out.

I have no problem admitting that I use a cheat sheet every time I start a dopamine, nitroprusside, dobutamine or epi drip.

As long as the drip rate chart is correct I have no problem using it.

This does not make anyone a lesser medic.

Using a cheat sheet without understanding the 'why' behind it is no different than using protocols without education. If someone uses a cheat sheet because they have no understanding of the 'why', then they are less of a medic than the ones who know the 'why.'

I worked for a service that had cheat sheets, and the only way I would use them is if I went through and did the math to 'double check' the cheat sheet. I found numerous errors.

I do not have a problem with using the cheat sheet as an aid, but not to replace understanding drug calculations.

[crotchitymedic1986]

Agree and disagree. If you have no knowledge of the drugs in your truck, you should not be administering them. But using a "cheat sheet" to double-check your calculations should be mandatory. I would also make it a law that if you do not have an IV pump or atleast a dial-a-flow, you should not be allowed to start medication drips on patients. Regulating medications by eyeball is too dangerous.

[CTXMEDIC]

Describe Pericardial tamponade and its treatments. You work in an extremely aggressive system. Go deep.

Seriously?

[CTXMEDIC]

Agree and disagree. If you have no knowledge of the drugs in your truck, you should not be administering them. But using a "cheat sheet" to double-check your calculations should be mandatory. I would also make it a law that if you do not have an IV pump or atleast a dial-a-flow, you should not be allowed to start medication drips on patients. Regulating medications by eyeball is too dangerous.

agree and disagree. i agree with everything up to the 'eyeball' method. this is where 'titrate to effect' comes in to play. sometimes you just have to manage your patient. medics since Jesus have been 'eyeballing' drips. this is also where you had BETTER know what your drug of choice is going to do to your patient. If youre one of these knob, cookbook medics that gives a drug because the good book says so, youre going to have issues.