Medical, Obstetrics, and Gynecology
Medical
The assessment tools
Use SAMPLE for history (signs/symptoms, allergies, medications, past medical history, last oral intake, events) and OPQRST for pain. Obtain a set of vital signs and repeat them; trends matter more than a single number.
High-yield conditions
Asthma/COPD: wheezing, prolonged exhalation, tripod position; help with the patient's prescribed inhaler, give oxygen, and assist ventilations if the patient tires. Anaphylaxis: hives, swelling, and difficulty breathing after exposure; help with an epinephrine auto-injector if authorized and transport. Hypoglycemia: altered mental status, sweating, and tremors; if the patient can protect their airway and swallow, give sugar-never give anything by mouth to an unresponsive patient or one who cannot swallow. Seizures: protect from injury, do not restrain or put anything in the mouth, time the seizure, and transport; a seizure lasting more than 5 minutes or repeated seizures without recovery is an emergency. Stroke: sudden weakness, facial droop, or speech difficulty; note the time last known well, because treatment windows depend on it. Poisoning: identify the substance and amount, follow poison control guidance per protocol, and bring the container.
Traps
Do not assume a diabetic patient is hypoglycemic without checking a glucometer if one is available; do not give oral glucose to a patient with altered mental status who cannot swallow. Do not dismiss a headache accompanied by neurologic signs.
Rule of thumb
If the patient is unresponsive or cannot swallow safely, nothing by mouth-oxygen, airway management, and rapid transport instead.
Obstetrics and Gynecology
Normal delivery
Childbirth has three stages: dilation, delivery of the baby, and delivery of the placenta. Signs of imminent delivery include crowning, the urge to push, and a bulging perineum. If crowning is present, prepare to deliver at the scene; if it is not, and transport is not delayed, transport.
Delivery steps
Position the mother, use standard precautions, and support the head as it emerges. Check for a nuchal cord-if present and loose, slip it over the head; if tight, keep the baby's face at the vaginal opening and call for help. Suction the mouth then the nose if needed, support the body, and note the time of birth. Dry, warm, and stimulate the newborn; keep the head covered. Clamp and cut the cord only per protocol, and never pull on it. Do not pull on the placenta; allow it to deliver and save it for transport. Place the baby on the mother's chest and encourage breastfeeding if appropriate.
Complications
Postpartum hemorrhage is a leading cause of maternal death; massage the uterine fundus and transport. Prolapsed cord: position the mother knee-chest or head-down and keep pressure off the cord. Breech or limb presentation: do not attempt delivery-transport. Eclampsia: seizures in pregnancy; protect the airway and transport.
Traps
Do not delay transport for a non-imminent delivery; do not cut a cord that is still pulsing unless protocol directs; do not ignore the mother after the baby is born-hemorrhage can follow quickly.
Rule of thumb
Crowning means deliver; no crowning means transport. After delivery there are two patients, mother and baby-reassess both.