RE: OB transport

[Mauseth Patrice <Patrice.Mauseth@HCAHealthcare.com>]

Terbutaline is not approved for a tocolytic here either.  It is a community
standard.  Most obstetrical drugs are not approved.

I don't know of any perinatal teams in Alaska.  I know our Director of
Newborn Services used to head a neonatal team in Alaska.  I can ask him.

Patti Mauseth, RN
Perinatal Transport/Outreach Coordinator
Good Samaritan Hospital
408 559-2153


> -----Original Message-----
> From:	Ken Lawson-Williams [SMTP:Macgyver@FlightMedicMail.com]
> Sent:	Monday, September 16, 2002 3:23 PM
> To:	flightmed@flightweb.com
> Subject:	RE: OB transport
> 
> Almost thanks - if only we had terbutaline!! Not approved for that use in
> Canada. Use MgS04 most commonly, Indocid suppositories as well in less
> acute cases. Some areas still use Ritodrine, and there is an on-going
> trial of Nitro-patches at the Royal Alexandra Hospital in Edmonton.
> 
> Do you know of any high-risk perinatal teams in the NorthWest/Alaska?
> 
> Fly Safe. 
> Ken L-W CCEMT-P/WMT
> 
> Duct tape is like the force, it has a light side and a dark side, and it
> holds the universe together.
> 
> 
> --- Mauseth Patrice <Patrice.Mauseth@HCAHealthcare.com> wrote:
> >Your right.  I did interpret the definition of ultrasound to mean
> abdominal
> >ultrasound.  We call the fetal heart rate monitor a fetal doppler.  You
> >definitely are aiding yourself in determining fetal lie by combining it
> with
> >leopolds.  Though I have heard many babies high on the abdomen that could
> >have been either vertex or breech, so obviously it's not absolute.  We
> >monitor our patients according to AWHONN standards during transport.  We
> do
> >all interfacility flights, so we can assume our patients fit into the
> high
> >risk category.  We monitor every 15 minutes for one minute, and/or
> through
> >every contraction including one minute after.  The purpose is to listen
> for
> >decelerations in the fetal heart rate.  If you do experience decels, you
> >could reposition the patient, start O2, maybe give some terbutaline to
> >decrease the U/C's further.  The decels could be caused by either cord
> >compression, uterine insufficiency or head compression.  Of course there
> are
> >other causes, but these are the most common.  Basically, the fetal heart
> >rate pattern is the only way to reassure the caregiver that the baby is
> well
> >oxygenated.  For laboring patients we now have fetal oximetry, but for
> >transport fetal doptone is sufficient.  I'm not sure if I addressed all
> your
> >questions.
> >
> >Patti Mauseth, RN
> >Perinatal Transport/Outreach Coordinator
> >Good Samaritan Hospital
> >408 559-2153
> >
> >
> >> -----Original Message-----
> >> From:	Ken Lawson-Williams [SMTP:Macgyver@FlightMedicMail.com]
> >> Sent:	Monday, September 16, 2002 1:17 PM
> >> To:	flightmed@flightweb.com
> >> Subject:	RE: OB transport
> >> 
> >> David, Patrice, Jery et al:
> >> 
> >> Thanks for the advice. I guess the difference is in the definition of
> >> ultrasound. I was refering to using a doppler to determine fetal
> >> heart-rate and then combining that with palpation to determine lie. Not
> an
> >> abdominal ultrasound in the hospital diagnostic imaging suite sense of
> >> the word. 
> >> 
> >> However I am not sure exactly which the Jery intended to determine....
> Not
> >> to many teams fly with abdominal ultrasound machines, although I am
> sure
> >> that more will soon now they are small and available.
> >> 
> >> As to community standards etc, what was the purpose of the ultrasound?
> If
> >> it is to determine if the fetus is alive, twins or a breech
> presentation
> >> prior to deciding to deliver in the community or fly to a specialist
> >> centre, then I agree poor reading and poor outcome could be a concern.
> >> Brow presentations, nuccal cord and disporportion etc cannot be
> determined
> >> by a handheld doppler (at least not as far as I know) used for FHR
> >> measurement. 
> >> 
> >> On scene calls, where the team is from 1 to 4 hours from a community
> >> hospital (with abd U/S), and 4 to 8 to a tertiary centre (with a
> nursery
> >> and specialists etc) and no access to a MD, Midwife or NNP etc. the
> choice
> >> is to fly or deliver. We would love to have the equipment and skill to
> do
> >> full abd U/S but it is not likely to happen this decade for us. 
> >> 
> >> So far in 10 years operation, we have never had an adverse outcome -we
> >> also have never had an in-flight delivery. (Although we have had the
> odd
> >> stillborn, dystocia, nuccal cord, twins, breech etc usually because the
> >> mother was too far along in labour for it to be stopped - so a field
> >> delivery was the safest option.) 
> >> 
> >> With an overall average of only 18 (+/- 6) field deliveries annually
> from
> >> 140 or so fetal position assessments performed, we obviously don't have
> >> the depth of experience that a specialty team would have. And I am not
> >> aware of studies that show the optimum number of FHR/position
> assessments
> >> annually that would be required to "maintain proficency". However,
> there
> >> also is in almost all cases, no other option in our area. Sometimes we
> >> scoop and run, sometimes we stay and deliver. Flight duration, mothers
> >> condition/history, stage of labour, dilation and fetal position are all
> >> variables that constantly have to be assessed. 
> >> 
> >> I can't see how NOT attempting to determine fetal position prior to
> making
> >> these decisions can be better in a medico-legal sense - or from the
> >> mothers/baby's perspective!! I don't want to revisit the "get them to
> >> aurgery" debate again, as with the available resources in the Arctic,
> >> acceptable community medical standards are not the same as in the
> highly
> >> populated areas south of the 49th (or even 55th) parallel. In fact, the
> >> closest dedicated perinatal specialty team probably would have to come
> out
> >> of Seattle or Denver (possibly Anchorage?) as there are none in
> Edmonton,
> >> Calgary, Vancouver, Saskatoon or Winnipeg.   
> >> 
> >> Fly Safe. 
> >> Ken L-W CCEMT-P/WMT
> >> 
> >> Duct tape is like the force, it has a light side and a dark side, and
> it
> >> holds the universe together.
> >> 
> >> 
> >> 
> >> >The above are 'Words of Wisdom'.   It is difficult enough to keep
> >> physicians
> >> credentialed and comfortable in FAST ultrasounds in the Trauma Resus
> area
> >> given the complexity (false negatives) of Ultrasound.
> >>  
> >> Granted, Fetal Presentation Ultrasound exam may be less complex than a
> >> F.A.S.T.
> >> Ultrasound, but what is your "community Standard of Care"; given a poor
> >> outcome
> >> when decisions for patient care were determined by this exam?
> >>  
> >> Just an opinion.
> >>  
> >> David Summers RN, etc
> >> Jupiter FL
> >> 
> >> --- Mauseth Patrice <Patrice.Mauseth@HCAHealthcare.com> wrote:
> >> >Just food for thought.  I'm responding from a specialty team that you
> >> didn't
> >> >want to hear from...  Our hospital does over 4000 deliveries per year.
> >> We
> >> >have a hand full of RN's who are certified through AWHONN for
> ultrasound.
> >> >They barely do enough ultrasounds to keep their skills up.  I always
> >> caution
> >> >people doing more and more specialty work when they may not do enough
> >> >consistently to maintain their skills.
> >> >
> >> >Patti Mauseth, RN
> >> >Perinatal Transport/Outreach Coordinator
> >> >Good Samaritan Hospital
> >> >408 559-2153
> >> >
> >> >
> >> >
> >> >
> >> >> -----Original Message-----
> >> >> From:	Ken Lawson-Williams [SMTP:Macgyver@FlightMedicMail.com]
> >> >> Sent:	Monday, September 16, 2002 10:58 AM
> >> >> To:	flightmed@flightweb.com
> >> >> Subject:	Re: OB transport
> >> >> 
> >> >> Medics as well as RN's are (and do) at Medflight (Yellowknife).
> >> Assuming
> >> >> that you mean determining the fetal lie by the use of traditional
> >> handheld
> >> >> doppler in conjunction with 'Leopoulds' style hands-on assessment. 
> >> >> 
> >> >> We do about 1000 flights a year (6.5 hr average length, fixed wing)
> and
> >> >> about 55% are primary transports (scene calls). Roughly 35% of all
> of
> >> our
> >> >> flights in total are high risk perinatal/neonatal/pede patients -
> with
> >> >> perinatal about 2/3rds of those. Only about 2/5 of our perinatal
> trips
> >> are
> >> >> interfacility. Average out over 4 crews and you do about 35
> perinatal
> >> >> scene responses a year each. 
> >> >> 
> >> >> Fly Safe. 
> >> >> Ken L-W CCEMT-P/WMT
> >> >> 
> >> >> Duct tape is like the force, it has a light side and a dark side,
> and
> >> it
> >> >> holds the universe together.
> >> >> 
> >> >> 
> >> >> --- message from "jery" <jery@internetcds.com> attached: << Message:
> OB
> >> >> transport >> 
> >> >
> >> 
> >> I would like to know if there are "garden variety" flight RN's that are
> >> trained in identifying fetal positioning by ultrasound.  I would like
> >> responses from flight programs that do the OB transports instead of
> using
> >> specialty OB teams.  Thanks.
> >>  
> >> 
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