MCPC - Emergencies - Health Education To Villages


Section 1 - Clinical Principles Emergencies Emergencies can happen suddenly, as with a convulsion, or they can develop as a result of a complication that is not properly managed or monitored. Preventing emergencies Most emergencies can be prevented by: careful planning; following clinical guidelines; close monitoring of the woman. Responding to an emergency Responding to an emergency promptly and effectively requires that members of the clinical team know their roles and how the team should function to respond most effectively to emergencies. Team members should also know: clinical situations and their diagnoses and treatments; drugs and their use, administration and side effects; emergency equipment and how it functions. The ability of a facility to deal with emergencies should be assessed and reinforced by frequent practice emergency drills. Initial management In managing an emergency: Stay calm. Think logically and focus on the needs of the woman. Do not leave the woman unattended. Take charge. Avoid confusion by having one person in charge. SHOUT FOR HELP. Have one person go for help and have another person gather emergency equipment and supplies (e.g. oxygen cylinder, emergency kit). If the woman is unconscious, assess the airway, breathing and circulation. If shock is suspected, immediately begin treatment. Even if signs of shock are not present, keep shock in mind as you evaluate the woman further because her status may worsen rapidly. If shock develops, it is important to begin treatment immediately. Position the woman lying down on her left side with her feet elevated. Loosen tight clothing. Talk to the woman and help her to stay calm. Ask what happened and what symptoms she is experiencing.Perform a quick examination including vital signs (blood pressure, pulse, respiration, temperature) and skin colour. Estimate the amount of blood lost and assess symptoms and signs. Top of page		Clinical principles Rapid initial assessment Talking with women and their families Emotional and psychological support Emergencies General care principles Clinical use of blood, blood products and replacement fluids Antibiotic therapy Anaesthesia and analgesia Operative care principles Normal Labour and childbirth Newborn care principles Provider and community linkages Symptoms Shock Vaginal bleeding in early pregnancy Vaginal bleeding in later pregnancy and labour Vaginal bleeding after childbirth Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure Unsatisfactory progress of Labour Malpositions and malpresentations Shoulder dystocia Labour with an overdistended uterus Labour with a scarred uterus Fetal distress in Labour Prolapsed cord Fever during pregnancy and labour Fever after childbirth Abdominal pain in early pregnancy Abdominal pain in later pregnancy and after childbirth Difficulty in breathing Loss of fetal movements Prelabour rupture of membranes Immediate newborn conditions or problems Procedures Paracervical block Pudendal block Local anaesthesia for caesaran section Spinal (subarachnoid) anaesthesia Ketamine External version Induction and augmentation of labour Vacuum extraction Forceps delivery Caesarean section Symphysontomy Craniotomy and craniocentesis Dilatation and curettage Manual vacuum aspiration Culdocentesis and colpotomy Episiotomy Manual removal of placenta Repair of cervical tears Repair of vaginal and perinetal tears Correcting uterine inversion Repair of ruptured uterus Uterine and utero-ovarian artery ligation Postpartum hysterectomy Salpingectomy for ectopic pregnancuy Appendix Essential drugs for managing complications in pregnancy and childbirth Index