I worked the NOC shift ER again. It was a fairly busy night. A lot of discharges had taken place the night before so the ward wasn't that busy either. Also, the two admitted to the ward last night were discharged (the head injury patient was ok and just needed to sober up, which is why he couldn't figure out the paperwork and the patient with the high blood pressure had stabilized and had been prescribed maintenance medication for hypertension).
When I came on duty I went directly to the delivery room because there was a birth in progress. By the time I got there, though, the baby had already been delivered, so I helped measure her and injected her with vitamin K.
After I got out of the delivery the doctor was performing a suture on a minor head wound. I assisted like before, by handing him instruments and soaking cotton balls with Providone-iodine so that he could cleanse areas as needed.
After that, the rest of the NOC shift was slow with no one else coming in.
Showing posts with label Delivery Room. Show all posts
Showing posts with label Delivery Room. Show all posts
Friday, January 25, 2013
Wednesday, January 23, 2013
Day 83 Dalaguete, Cebu DPC# Delivery Room, Intramuscular Injection, Intradermal Injection
I came back to Dalaguete today and worked in the ER. I did a couple skin tests and received a few patients for OPD checkups.
I also got to help with another delivery today. It was fairly quick and the nursing staff let me help prepare the infant right after delivery. After the baby had skin to skin contact with the mother and had started suckling (which is policy for the hospital here), the nursing staff cleaned off the baby and let me help with the measurements. We measured the circumference of the head, overall height, chest size, and weight. Afterwards, the nursing staff let me inject the infant with vitamin K. It's the first time I've ever injected a newborn and, in many ways, it was much easier than injecting adults. Firstly, the nurses loaded a syringe that we usually use for skin tests because the needle is much smaller and the infant doesn't need a huge dose.
There's a trick for loading such a small syringe (we used tuberculin syringes, which are 1cc). When drawing in whatever medication you're gonna use, the syringe has a tendency to fill with a bit of air (I've noticed this is especially true with TB syringes). That might not cause so much of a problem with 5cc syringes because you can always plunge out the excess air after loading some of the medication. With a 1cc chamber though, the amount of air is significant enough to throw off the measurement. Basically, in order to get an accurate measurement, you have to fill what you can and measure off starting from the bottom of the syringe. So let's say you want .3cc's of some medication. Instead of stopping and measuring from the .3cc line, you pull the plunger back and measure form somewhere near the middle or the back. So .3cc's might be loaded between .6cc's and .3cc's (instead of 0-.3). Once you have that measured, you plunge out the excess air and you know that the .3cc's you have left are medication. The actual injection was simple because the needle was small enough that I could insert it all the way without hitting the bone (the injection site was the thigh).
Anyway, a pretty interesting day -- it'a always nice when I get to help with deliveries.
I also got to help with another delivery today. It was fairly quick and the nursing staff let me help prepare the infant right after delivery. After the baby had skin to skin contact with the mother and had started suckling (which is policy for the hospital here), the nursing staff cleaned off the baby and let me help with the measurements. We measured the circumference of the head, overall height, chest size, and weight. Afterwards, the nursing staff let me inject the infant with vitamin K. It's the first time I've ever injected a newborn and, in many ways, it was much easier than injecting adults. Firstly, the nurses loaded a syringe that we usually use for skin tests because the needle is much smaller and the infant doesn't need a huge dose.
There's a trick for loading such a small syringe (we used tuberculin syringes, which are 1cc). When drawing in whatever medication you're gonna use, the syringe has a tendency to fill with a bit of air (I've noticed this is especially true with TB syringes). That might not cause so much of a problem with 5cc syringes because you can always plunge out the excess air after loading some of the medication. With a 1cc chamber though, the amount of air is significant enough to throw off the measurement. Basically, in order to get an accurate measurement, you have to fill what you can and measure off starting from the bottom of the syringe. So let's say you want .3cc's of some medication. Instead of stopping and measuring from the .3cc line, you pull the plunger back and measure form somewhere near the middle or the back. So .3cc's might be loaded between .6cc's and .3cc's (instead of 0-.3). Once you have that measured, you plunge out the excess air and you know that the .3cc's you have left are medication. The actual injection was simple because the needle was small enough that I could insert it all the way without hitting the bone (the injection site was the thigh).
Anyway, a pretty interesting day -- it'a always nice when I get to help with deliveries.
Thursday, December 20, 2012
Day 49 Dalaguete, Cebu #DPC Intradermal skin injection, nebulizer, ECG assist, IVTT
Today was a fairly busy night in the ER.
The first patient was an infant that came in with a 39.9 degrees Celsius fever (103.8 degrees Fahrenheit). The doctor order paracetamol PO and kept the infant in the ER for a few hours for observation. The medication reduced the infants fever so the doctor told them to come back tomorrow. Normally, the doctor would order a UA and have them wait for the results, but since it was after hours, the lab technician was already gone and wouldn't be back until tomorrow morning.
The second patient to come in was an older gentlemen suffering from breathing problems. I administered three rounds of sulfate salbutamol via nebulizer at fifteen minute intervals after completion of each dose. The nurse hooked him to an IV and I injected hydrocortison and cefuroxime via IVTT. Prior to injecting the cefuroxime, I performed an intradermal injection skin test to confirm a negative allergic response to the antibiotic. After the injections, I helped hook him to to an ECG and prepared the printed readouts for the doctor to interpret.
I also prepped the delivery room but it turned out to be a false alarm and the patient didn't deliver that night.
The first patient was an infant that came in with a 39.9 degrees Celsius fever (103.8 degrees Fahrenheit). The doctor order paracetamol PO and kept the infant in the ER for a few hours for observation. The medication reduced the infants fever so the doctor told them to come back tomorrow. Normally, the doctor would order a UA and have them wait for the results, but since it was after hours, the lab technician was already gone and wouldn't be back until tomorrow morning.
The second patient to come in was an older gentlemen suffering from breathing problems. I administered three rounds of sulfate salbutamol via nebulizer at fifteen minute intervals after completion of each dose. The nurse hooked him to an IV and I injected hydrocortison and cefuroxime via IVTT. Prior to injecting the cefuroxime, I performed an intradermal injection skin test to confirm a negative allergic response to the antibiotic. After the injections, I helped hook him to to an ECG and prepared the printed readouts for the doctor to interpret.
I also prepped the delivery room but it turned out to be a false alarm and the patient didn't deliver that night.
Sunday, December 9, 2012
Day 38 Dalaguete, Philippines #DPC Delivery, Sterile Procedures
Today I helped deliver another baby.
This time the baby came out easily so the nurses were able to carry
out the standard procedures post delivery. As soon as the baby was
out, the midwife placed the baby on the mother's stomach allowing
skin to skin contact. Skin to skin contact keeps the baby from
developing hypothermia and helps the newborn bond with the mother.
SOP here dictates that the baby stays on the mothers stomach until
successfully breastfeeding for the first time. In this case, it took
about thirty minutes. The baby was suckling at the air, and the
midwife placed her as close to the mother's nipple as possible,
allowing the baby to latch on herself. While this was going on, the
doctor was stitching up the vaginal incision made during the
delivery. During this delivery I sterilized the outside of the vagina with Iodine prior to suturing and prepared the delivery instruments using sterile techniques.
Other than the delivery, just OPD checkups for fevers.
Other than the delivery, just OPD checkups for fevers.
Wednesday, December 5, 2012
Day 34 Dalaguete, Philippines
I was able to help deliver another baby
today! It was much quicker than the first one but there was a
problem. When the baby was about two inches from crowning, the mother
was too tired to keep pushing. Like the last birth, the midwives and
nurses took turns pushing down on the womb to help the mother.
Eventually the baby came out, but it wasn't crying and it's skin was
blue. In about 45 seconds, the doctor clamped and cut the umbilical
cord, put the baby on a table, started CPR, and used a bulb syringe
to clear the babies nostrils. Luckily, the reliving doctor was
already at the hospital so she was called in to suction the babies
nose while the first doctor began stitching the vagina. I'm not
certain, but I think it was another MAS baby because the procedure
for helping the baby breath was the same as last time and the fluid
being suctioned from the lungs and stomach was roughly the same color
as the first delivery I experienced.
After the birth, the reliving doctor was called to the ER/OPD in order to perform stitching on a pediatric patients lip. It was challenging to say the least because the child was extremely scared and wouldn't keep still. The doctor ended up injecting him with a sedative, but the parents still had to help hold him down.
Other than that, just a lot of OPD patients for flu like symptoms. It is, after all, flu season.
After the birth, the reliving doctor was called to the ER/OPD in order to perform stitching on a pediatric patients lip. It was challenging to say the least because the child was extremely scared and wouldn't keep still. The doctor ended up injecting him with a sedative, but the parents still had to help hold him down.
Other than that, just a lot of OPD patients for flu like symptoms. It is, after all, flu season.
Monday, December 3, 2012
Day 32 Dalaguete, Philippines #DPC Delivery Room, IVTT
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.
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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