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Fowlers position is standard for any patient with JVD & respiratory distress; it is generally the position of comfort for most patients in mild – moderate distress. There are several types of Fowlers positions: • High Fowler's position is when the patient's head is raised 80-90 degrees • Semi-Fowler's position is when the patient's head is elevated 30-45 degrees • Low Fowler's position is when the head of bed is elevated 15-30 degrees • Fowler's is 45-60 degrees. Scenario Sunday: Conclusion of imminent birth Procedure for out of hospital delivery: 1. One person takes charge, others play gofer as needed. 2. Clear out non-helpful bystanders. 3. Keep calm, keep voice low. 4. Set up clean area that won't accidentally get messed up by mother. Lay out all necessary equipment, set up oxygen. 5. Wash hands and arms if there is time. 6. Place clean drape under mother's buttocks (be prepared for gofer to clean away feces if necessary) Explain to mother what is happening, as it happens. 7. The perineum bulges, place hand gently but firmly over the introituses and the perineum, to prevent sudden uncontrolled expulsion of the fetal head. Encourage the mother to pant or push very gently, explaining you want to avoid a tear. 8. As the head emerges, keep firm gentle pressure on head and perineum until chin delivers. 9. Feel for the cord behind the top ear. If found, gently tug to see if it will slip over the head. If tightly wrapped, clamp in 2 places and cut between. 10. Suction the baby's mouth and nose. This is mainly important if the amniotic fluid is green or brown colored. Otherwise it's probably not a vital step and can actually cause breathing problems. [Note - It is important to suction the mouth before the nose. "The mouth is suctioned first to ensure that there is nothing for the infant to aspirate if he or she should gasp when the nose is suctioned." The head rotates to face mother's thigh, gently press down on head to encourage the top shoulder to deliver. 11. When you can see the baby's top armpit crease, lift up on the head to deliver the bottom shoulder. The rest of the baby should follow. 12. Suction the baby's mouth and nose. 13. Dry the baby vigorously, then DISCARD WET TOWELS and wrap the baby in dry warm clothes or blankets. 14. Administer oxygen at 5 liters 1 1/2 inch from baby's face until trunk is pink and hands and feet less blue. Some cyanosis of extremities is expected. Keep rest of baby's trunk and head well covered while administering oxygen as the draft will chill the child. 15. If not expected to get to the hospital soon, clamp and cut the cord 10-15 minutes after the birth. (Clamp the cord about 3 inches from the abdomen, then 2 inches beyond that, and cut between the 2 clamps.) 16. Place the baby on mother's chest, with head lower than feet to allow gravity to assist the baby in clearing the airway. 17. Watch for sudden gush of blood and lengthening of cord. This means placenta has detached and is ready to be born. Provide gentle traction on the cord. Placenta will usually be pushed out easily by mother. If it doesn't, get to hospital as soon as possible. Normally, approximately one cup of blood is generally lost with the delivery of the placenta. 18. After placenta born, immediately press fingers slowly and gently into abdomen at umbilicus - you'll feel the top of the uterus. It may be somewhat spongy or slightly firm or rock hard if she's having a contraction. Do slow and gentle circular massage to encourage contraction of the uterus. This is extremely important, especially if there's a constant flow of blood. Expedite transport to hospital ASAP. n, should have warm blankets or towels, oxygen with adu

Cardiac output. - Reaper "See, what had happened was..." It's only available in navy unisex shirt.

Some More Abdominal Pain Stuff - Scythe "See, what had happened was..." It's only available in navy unisex shirt.

The Vagus Nerve is important for us to understand, check it out!

Metabolic Acidosis Acidosis is a condition in which there is too much acid in the body fluids. It is the opposite of alkalosis (a condition in which there is too much base in the body fluids). Causes: The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost.

What is Respiratory Acidosis? Respiratory acidosis is a condition that occurs when the lungs cannot remove all of the carbon dioxide the body produces. This causes body fluids, especially the blood, to become too acidic.

Ordinarily, carbon dioxide is not poisonous. It diffuses from your cells into your bloodstream and from there out via your lungs, yet it is always present throughout your body. However, if you breathe high concentrations of carbon dioxide or re-breathe air (such as from a plastic bag or tent), you may be at risk for carbon dioxide intoxication or even carbon dioxide poisoning. Carbon dioxide intoxication and carbon dioxide poisoning are independent of oxygen concentration, so you may have enough oxygen present to support life, yet still suffer from the effects of rising carbon dioxide concentration in your blood and tissues.

Heres a good way to remember the differences.........

Low Blood Volume; Not good! Hypovolemia is a decrease in the volume of blood in your body, which can be due to blood loss or loss of body fluids. Blood loss can result from external injuries, internal bleeding, or certain obstetric emergencies. Diarrhea and vomiting are common causes of body fluid loss. Fluid can also be lost as a result of large burns, excessive perspiration, or diuretics. Inadequate fluid intake can also cause hypovolemia. At the onset of hypovolemia, the mouth, nose, and other mucous membranes dry out, the skin loses its elasticity, and urine output decreases. Initially, the body compensates for the volume loss by increasing the heart rate, increasing the strength of heart contractions, and constricting blood vessels in the periphery while preserving blood flow to the brain, heart and kidneys. With continuing volume loss, the body loses its ability to compensate and blood pressure drops. At this point, the heart is unable to pump enough blood to vital organs to meet their needs and tissue damage is likely to occur. Hypovolemic shock occurs when a fifth of the blood volume is lost. Symptoms may include cold, clammy skin, paleness, rapid breathing and heart rate, weakness, decreased or absent urine output, sweating, anxiety, confusion, and unconsciousness. Hypovolemic shock is a medical emergency requiring immediate intervention.

Sepsis Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammation throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. If sepsis progresses to septic shock, the blood pressure drops dramatically which may lead to death. Anyone can develop sepsis, but it's most common and most dangerous in elderly people or those with weakened immune systems. Many doctors view sepsis as a three-stage syndrome, starting with sepsis and progressing through severe sepsis to septic shock. The goal is to treat sepsis during its mild stage, before it becomes more dangerous. Sepsis To be diagnosed with sepsis, your pt must exhibit at least two of the following symptoms: • Fever above 101.3 F (38.5 C) or below 95 F (35 C) • Heart rate higher than 90 beats a minute • Respiratory rate higher than 20 breaths a minute • Probable or confirmed infection Severe sepsis The diagnosis will be upgraded to severe sepsis if the pt also exhibit at least one of the following signs and symptoms, which indicate an organ, may be failing: • Significantly decreased urine output • Abrupt change in mental status • Decrease in platelet count • Difficulty breathing • Abnormal heart pumping function • Abdominal pain Septic shock To be diagnosed with septic shock, the pt must have the signs and symptoms of severe sepsis — plus • Extremely low blood pressure that doesn't adequately respond to simple fluid replacement.