I moved back to the ER today for PM
shift (1500 – 2300). It's slower than AM shift because no one comes
in for consultations that late. However, it means when someone does
come in, it's usually an emergency.
The bulk of my time today was spent in
the delivery room (DR), because I finally got to assist in a
delivery! The mother was brought into the DR from the ward after
reaching full dilation (10cm). It's pretty intense here because they
don't give epidurals or any type of anesthesia during the birth. I
mostly observed and rinsed off the vagina every so often and fetched
gauze and stitching equipment (for after the birth) since the doctor
had to maintain sterile conditions. The actual process was a lot of
waiting and a lot of encouraging. The mother was super calm the
entire time. When the babies head was about 2 inches from crowning
the mother was too tired to push on her own so the midwife/pharmacist
came in and physically helped push the baby out of the womb. I didn't
have the best view of the midwife so I couldn't actually see how she
was positioning herself, but the baby came out pretty fast after she
started helping. As soon as the baby started crowning, it was clear
that there wasn't enough room so the doctor had to make an incision
along the bottom of the vagina to make more space. As soon as the
baby was delivered the doctor set her on the mothers stomach, clamped
the umbilical cord, then cut it. The nurse then took the baby and
begin cleaning, measuring, and injected vitamin K. It was the first
time I'd ever seen a newborn immediately after birth. I didn't
realize babies are extremely pale the first few minutes after they
come out of the womb. While the nurse was cleaning and preparing the
newborn, the baby began to gain color and looked pretty healthy. As
this was going on, the doctor was helping remove the placenta. After
the placenta was removed, the doctor injected a local anesthetic near
the vaginal incision and began stitching.
When I got back to the ER, there were
two admits waiting. One was in because of dizziness and vomiting so
he was admitted, given Renatidine vit IVTT (for hyperacidity) and
admitted for observation. The nurse at the ER let me fill out the
admitting paperwork and countersigned anything I signed. I then had
to follow out the doctors orders and fill out how many Plain NSS IV's
needed to be hooked, what medication was to be given at what dosage
and when, the admitting diagnosis, and secure a signature for consent
of admission. After all this, I had to go to the ward and endorse –
physically read off the doctors orders to the charge nurse at the
ward and list off everything that had been done and what needed to be
done.
The second came in because of possible
vaginal bleeding. It turns out the patient was two months pregnant
and had suffered a miscarriage. She was admitted and the nurses in
the ward were told to observe and to let the doctor know when the
fetus was expelled.
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