What 3 things to you assess when starting NLS?
Breathing, tone, heart rate.
If a newborn is not breathing after initial assessment, what do you do?
Give 5 inflation breaths of 3 seconds each.
After your inflation breaths, what do you do?
Reassess breathing, tone and heart rate. Check that the chest was moving with inflation breaths.
If the chest did not move with inflation breaths - what should you do?
- Check the mask, head and jaw position
- 2 person support
- Consider suction and iGel
Then repeat inflation breaths
Once the chest is moving, what should you do?
Continue ventilation breaths for 30 seconds, then reassess heart rate.
If the heart rate is still not detectable or is <60bpm after ventilation breaths, what should you do?
Start 3:1 chest compressions
What should you always do when attending an inferior STEMI?
A V4R reading (V4 lead on opposite side of chest).
If the V4R is normal then this indicates a pump problem and giving a fluid bolus might be more harmful so be cautious.
What is the order of the airway tree?
iGel - Catheter mount - Filter - Capnography - BVM
What should you be cautious of giving when attending an inferior STEMI?
GTN as patient’s with an inferior STEMI are more sensitive to hypotension.
What symptoms and findings might be found with a patient with Pericarditis?
- Breathlessness on exertion
- Sitting forward can ease chest pain
- Global “saddle back” ST elevation on ECG
What are the first 2 things you should do at a PPH?
Administer high flow O2 and uterine massage.
Fundus is located at or below the umbilicus - should feel like a hard cricket ball (good tone).
What drugs should you give at a PPH (and what order?)?
- Syntometrine (uterotonic)
- Misoprostol (uterotonic)
- TXA (anti-fibrinolytic)
During a breech birth, what is a good sign of tone in the baby?
Stomach crunches
During a breech birth, what rotation do you expect the baby to be in?
Baby’s bum to mum’s bum OR baby’s bum to mum’s stomach (facing forward or facing backwards).
During a breech birth, and the baby is in partial rotation, what does this mean and what should you ask mum to do?
- Partial rotation is when the baby’s belly button is at a 45 degree angle away from mum’s bum/tummy.
- You should ask mum to lift her leg into the “running” position.
During a breech birth, and the baby is in an incomplete rotation, what does this mean and what should you ask mum to do?
- Incomplete rotation is when the baby is completely sideways (bellybutton is 90 degrees away from mum’s tummy), which means they will have shoulder dystocia if born like this.
- Mum should move legs into running position and alternate sides to move baby.
No internal manoeuvres to be done by us - you need a midwife ASAP.
If the head is not delivering in a breech birth, what can you do?
The shoulder press - Push underneath baby’s clavicle and push straight back towards mum.
If after the shoulder press the baby’s head has not been delivered in breech birth - what should you do?
Maternal buttock manoeuvre - holding the mum’s buttocks and pulling upwards and outwards to try and pull the perineum over the baby’s head.
If this doesn’t work then you need to mobilise to hospital as soon as possible as we are unable to do any other manoeuvres without a midwife.
What is more likely to happen after a breech birth and why?
PPH is more likely as the uterus is empty for longer due to the head being delivered last.
