Describe the components of CSCATTT
Command
Safety
Communications
Assessment
Triage
Treatment
Transportaion
Describe METHANE
MI standy/declare
Exact location
Type of incident
Hazards
Access/egress
Number of casualties/severity
Emergency services on scene/required
Describe Ten Second Triage
Describe MITT
What should be done to prepare for an imminent birth? (7)
- Request additional resources
- Apply PPE
- Equipment -dry towels, maternity pack, baby hat, thermal mattress
- Set up neonatal resus area
- Advise patient adopt most comfortable position for them
- Warm room/close windows etc - ideally 25 degrees C
- Offer entonox
How do the PROMPT cards describe actions for normal delivery?
- Prepare birth area
- Once crowning advise panting to slow down birth of head and protect perineum
- Support head then both and lift onto mothers abdomen
- Dry baby and assess
- Remove wet towel, new dry one and hat
- Allow cord to stop pulsing before clamping
- 2 clamps around 15cm from umbilicus and 3 cm apart
What actions do the PROMPT cards suggest for cord prolapse? (6)
- Place woman immediately on all 4s, knee to chest
- Walk them to ambulance (avoid carry chair if possible)
- On DSA place on side with pillows under hips to raise pelvis above head (right side allows for reassurance)
- If possible use catheter to fill bladder with 500ml normal saline to raise presenting part
- Entonox to decrease urge to push
- Minimal handling of cord - 1 gentle attempt. If not cover with dry padding and use underwear to keep in place
Why is minimal handling advised in breach deliveries?
Startle reflex can lead to extension of arms/neck and make situation worse
What do the PROMPT cards recommend for breach delivery? (3)
- Mother to end of bed with legs supported or sit edge of bed/chair or all 4s position
- Baby should be ‘tum to bum’ whatever position mum is in - only place hands on baby to correct this (use hips to rotate not abdomen)
- Once nape of neck allow slow spontaneous birth of head
What maneuver should be performed in breech delivery if there is a delay caused by:
1. Legs
2. Arms
3. Head
- Pinards maneuver = if extended then gentle pressure on popliteal fossa to flex knee
- Loveset maneuver = hold bony pelvis and rotate infant 90 degrees in each direction.
- Can also use 2 fingers to sweep arms off face and downwards to aid delivery - Mauriceau-Smellie-Velt maneuver =
- assistent provides suprapubic pressure
- support baby with arm and place left hand into vagina along anterior infant + place pressure on cheekbones with index and middle fingers to flex head
- right hand provides gentle traction on shoulders using 2 fingers to flex occiput
What is Pinard maneuver and what is it for?
Delay to delivery in breech babies due to legs being stuck
= if extended then gentle pressure on popliteal fossa to flex knee
What is the Loveset maneuver and what is it used for?
Delay to delivery in breech babies due to arm being stuck
= Hold bony pelvis and rotate infant 90 degrees in each direction.
- Can also use 2 fingers to sweep arms off face and downwards to aid delivery
What is the Mauriceau-Smellie-Velt maneuver and what is it used for?
For breech babies delayed due to failure to deliver head
= assistant provides suprapubic pressure
- support baby with arm and place left hand into vagina along anterior infant + place pressure on cheekbones with index and middle fingers to flex head
- right hand provides gentle traction on shoulders using 2 fingers to flex occiput
Once the buttocks have been delivered in a breech delivery what should occur according to JRCALC?
- Start clock (should be fully born <5mins)
- Women should push continously from this point (do not wait for contractions) as hypoxia increases as baby descends further down birth canal.
What are the 5 steps that PROMPT suggest trying in shoulder dystocia in order?
- McRoberts position
- Gentle axial traction
- Suprapubic pressure
- All 4s position
- Walk to DSA
Describe McRoberts position and what it is for
Shoulder dystocia
- lie flat and bottom to end of bed
- knees to chest, thighs to abdomen
- 1 person supporting each leg
Describe the suprapubic pressure in shoulder dystocia
- CPR hands above symphysis pubis and pish on same side as fetal back in downwards and lateral direction
- aims to move shoulder under pubic arch
How should the all 4 positions be used to help shoulder dysocia? (4)
- All 4s with hips well flexed
- Any movement of pelvis can release shoulder
- Mum should continue to push
- Consider gentle axial traction
In shoulder dystocia how should axial traction be applied?
Gently and keeping head in line with spine - do not pull down or laterally
What are the 4 T’s of PPH?
Tone (>common, no contraction following birth, ‘boggy’ uterus)
Trauma (perineal/vaginal/cervical)
Tissue (retained products stops uterus contracting)
Thrombin (clot abnormalities)
How should PPH be managed? (5)
- Examination including palpation uterus and external genitalia for tears
- Uterotonics
- syntometrine 11ml IM (if no HTN)
- Misoprostol 800mcg PR
- Oxytocin 5IU IV (can be repeated once) or 10IU IM - If placenta delivery then massage uterus fundus (find top of uterus uterus and cup between to hands and massage). If not delivered cautious as can lead to partial seperation of placenta (on do if life threatening)
- TXA
- Bimanual compression (gloved hand pressure anterior vaginal wall, second hand on abdomen pushing down on posterior wall compressing uterus between them.
Which patients does the FPHC consensus statement suggest may not need a binder? (5)
- Mechanism not suggestive of pelvic injury and
- Haemodynamically stable (HR<100, SBP >90)
- GCS >13
- no distracting injury
- no pain in pelvis
What are the increased risk factors needing imagine in the Canadian c-spine rules? (3)
- Over 65years
- Dangerous MOI
- Parasthesia in the extremities
What constitutes a dangerous MOI in the Canadian C-spine rules? (5)
- Fall over 3 foot or 5 stairs
- Axial load to head
- High speed MVC (>100kmph)/rollover/ejection
- Motorised recreational vehicles
- Bicycle collision
