1. A 14 year old F is brought in after being found obtunded with an empty, unlabeled pill bottle in her hand. She was last seen in her usual state of health approximately 4 hours ago. Upon arrival, EMS hands you the following EKG from the field:
The patient is sleepy but is maintaining her airway with clear lungs and strong pulses; she opens her eyes to pain, mumbles incomprehensibly and withdraws from painful stimuli. Of the following, the medication you are most likely to give next is:
a) Narcan
b) Magnesium
c) Activated charcoal
d) Sodium bicarbonate
e) Calcium
2. Despite intubation and resuscitation efforts, the patient continues to decompensate. She becomes pulseless and her monitor now shows:
CPR is initiated. According to the PALS algorithm, your next step is to :
a) Immediate defibrillation at 2J/kg
b) Immediate defibrillation at 4J/kg
c) Administer epinephrine 0.01 mg/kg of 1:10,000 concentration
d) Administer epinephrine 0.01 mg/kg of 1:1,000 concentration
3. A 17 year-old pregnant female is rushed back from triage with abdominal pain and complaints of contractions for the last several hours now coming ‘every second’. She is alert and screaming in pain. Of the following, which is your initial priority as she is brought into a room?
a) Obtain a brief history regarding gestational age, parity, and problems with the pregnancy
b) Obtain maternal IV access and place on monitors
c) Visually assess the perineum for fetal presenting part and station/descent/prolapsed cord
d) Perform a vaginal exam to determine fetal presenting part and station/descent/prolapsed cord
4. You obtain more history from mom- she is G2P0 at 39 weeks with a history of a first trimester miscarriage 2 years ago. She has received prenatal care and has had an uncomplicated pregnancy, she has no infections that she knows of and had a normal first trimester ultrasound. She thinks ‘her water broke’ on the way into the hospital. You are awaiting the arrival of Ob when she begins to have more frequent contractions and you see that the baby is crowning. You successfully deliver the baby’s head and find a tight nuchal cord around baby’s neck that cannot be reduced. Your next step is to:
a) Gently push the baby’s head back into the vagina
b) Clamp and cut the nuchal cord at baby’s neck
c) Attempt to continue delivery of the remainder of the body with the cord in place
d) Await the arrival of the obstetrician
5. The obstetrician arrives just as you are contemplating the nuchal cord. She successfully delivers the infant, noting meconium staining of the amniotic fluid. The baby does not cry immediately upon delivery and is limp without respiratory effort. You take him over to the warmer and:
a) Warm, dry, and stimulate the baby
b) Begin positive-pressure ventilation with bag-mask ventilation
c) Intubate and suction the trachea
d) Check the baby’s heart rate
Answers here
Labor and Delivery Pearls
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