10 free AEMT practice questions: Obstetric and Gynecologic Emergencies

Correct answer · Avoid washing the patient and preserve clothing as evidence when possible

Patient care comes first, and preserving evidence happens alongside it. Most of evidence preservation is things you do not do. Do not let the patient wash. Avoid cutting through tears or holes in the clothing when you can. If clothing has to come off, bag it and hand it over instead of throwing it away. Discourage eating, drinking, and using the bathroom if those can reasonably wait, for the same reason. Document objectively: the patient's own words and what you actually saw, with no conclusions about what happened. All of it comes second to a calm, private approach that lets the patient lead. A patient who is not treated with care may refuse the exam altogether.

Correct answer · As internal hemorrhage, with two large-bore lines and rapid transport

This patient most likely has a ruptured ectopic pregnancy and is bleeding into the abdomen. The period is about three weeks late, the pain is on one side, and the skin is pale and cool. The pulse is 124 and the blood pressure is 92/68. Any patient of childbearing age with abdominal pain gets ectopic pregnancy on your list. A missed period with one-sided pain and signs of shock puts ectopic pregnancy at the top. A ruptured ectopic bleeds into the belly, so the patient mostly looks like a shock patient with one-sided pain. Treat the bleeding. Start two large-bore lines, give crystalloid titrated to perfusion, keep the patient warm, and transport fast. Notify early so the surgical team is ready. The pregnancy test gets done at the hospital, and you do not need the test to treat the bleeding.

Correct answer · The patient is awake and has a palpable radial pulse

This patient is in hemorrhagic shock from heavy postpartum bleeding. The pressure is 92/56 and the pulse is 120. IV fluid does not stop the bleeding. Fluid only keeps the patient perfused until the hospital can stop it. That is why you dose fluid against the patient, not against a number. Give it in measured amounts and check mental status, skin, and the radial pulse between each one. An awake patient with a pulse you can feel at the wrist is perfusing. Awake with a radial pulse is the endpoint for the fluid. Pushing fluid past that point gives volume the patient does not need. The extra fluid dilutes the clotting factors that are left, and the blood clots worse. Pregnancy expands the blood volume. The bigger blood volume lets this patient hold a normal-looking pressure through serious blood loss and then drop quickly. Keep reassessing between every increment.

Correct answer · Transport immediately with the hips elevated and notify en route

This patient has a limb presentation, with one arm coming out of the vaginal opening. A limb presentation cannot be delivered in the field. The fix is an operating room, and no prehospital provider at any level carries what this patient needs. An abnormal delivery is a rapid transport problem, not a reason to call for a higher level of care. Calling a unit, waiting for an intercept, or holding on scene for advanced care only costs time. Place the patient knee-chest, or on her back with the hips elevated. Cover the arm with a moist sterile dressing. Get vascular access on the way if it does not slow you down, and notify the hospital while you are moving.

Correct answer · Place two clamps on the cord, cut between them, and deliver

This newborn has a tight nuchal cord, which is a cord wrapped tightly around the neck. The loop will not slip over the head, and it will not loosen enough for the shoulders to pass. After the head delivers, you run a finger around the neck to feel for a loop of cord. A loose loop slips over the head, and the delivery goes on as normal. A tight loop is different, because the body is about to deliver against it. Place two clamps on the cord, cut between them, and deliver the newborn right away. This is the one time in a field delivery that you cut the cord before the body is out. Once the cord is cut, the newborn has no placental circulation. The delivery and the newborn assessment have to happen without a pause.

Correct answer · Push the uterus up and toward the left with both hands

This patient has supine hypotensive syndrome, which is the uterus pressing on the inferior vena cava. The patient is 34 weeks pregnant, flat on a long board, and lightheaded, with a pressure of 90/56 and a pulse of 118. Your goal is to get the uterus off the vena cava. If the patient does not need spinal precautions, roll her onto her left side. If she is on a board that can tilt, tilt the whole board 15 to 30 degrees to the left. Put padding under the right side and keep her spine in line with the board. This board cannot be tilted, so you move the uterus with your hands. Place one or both hands on the right side of the abdomen. Push the uterus up and toward her left, and hold it there. You push toward the left because the inferior vena cava runs on the right side of the spine.

Correct answer · The uterus is pushed up and toward the left by one provider

This patient is in cardiac arrest at 32 weeks of pregnancy. An arrest in a pregnant patient past about 20 weeks is a standard arrest with one change. Compressions go in the usual place, at the usual depth and rate. Ventilations are normal. You use the automated external defibrillator the same way you would on anyone else. The one change is that a provider moves the uterus off the inferior vena cava by hand. The provider pushes the uterus up and toward the patient's left. You have a third provider on this call, so that provider does the uterine displacement. Tilting is for a pregnant patient who still has a pulse. During CPR, a tilted torso makes good compressions impossible. After every analysis, compressions start again right away, whether a shock was given or not.

Correct answer · Preeclampsia with severe features

This patient has preeclampsia with severe features. Preeclampsia is new high blood pressure after 20 weeks of pregnancy. You look for a group of findings, not just one number. Watch for a headache that will not ease, vision changes like blurring or spots, and pain in the epigastric area or the right upper quadrant. This patient has each of those. The headache did not ease with acetaminophen, the vision is blurred, and the pain is under the right rib margin. The right upper quadrant pain comes from the capsule of the liver stretching. Swelling of the face and hands supports preeclampsia, but normal pregnancy causes swelling too. Severe features start at a systolic of 160 or higher or a diastolic of 110 or higher. This patient's pressure is 166/112, which is above both. Eclampsia is the next step on the same spectrum. A seizure is what defines eclampsia, not how high the pressure is.

Correct answer · Continue routine care and recheck the saturation at 10 minutes

This newborn is transitioning normally, and an SpO₂ of 83% at 5 minutes is on target. A newborn starts life with a saturation around 60% and climbs over the first 10 minutes. The targets are about 60 to 65% at 1 minute, 65 to 70% at 2, and 70 to 75% at 3. The targets keep climbing to 75 to 80% at 4 minutes, 80 to 85% at 5, and 85 to 95% by 10. This newborn has a strong cry, moves all extremities, and has a heart rate of 148. Comparing a newborn saturation to adult normals is the most common way to over-treat a newborn who is doing fine. The probe belongs on the right hand or wrist, which is preductal. That is because the right subclavian artery comes off the aorta before the ductus arteriosus. Breathing, tone, and heart rate still decide what you do. Continue routine care and recheck the saturation at 10 minutes.

Correct answer · Suction the mouth first and then the nose with a bulb syringe

This newborn needs suctioning, and the order is mouth first, then nose, with a bulb syringe. The newborn has thick secretions in the mouth and is not moving air well after drying and stimulation. Those findings mean suctioning is actually needed here, not just routine. Suctioning the nose sets off a reflex gasp. If the mouth is still full, the gasp pulls the mouth secretions down into the trachea. Stimulating the nose can also cause vagal bradycardia. Clear the mouth first, then the nose. Use a soft bulb syringe sized for a newborn, not a rigid catheter. Keep each attempt to 5 seconds or less.