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How comfortable are ED docs with OB issues?? Are deliveries totally out of the question?
EM and OB
- Thread starter dj_smooth
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I'm on my OB/GYN rotation right now (well, on my weeks' vacation now actually)... I feel pretty comfortbale doing deliveries. Obviously if a shoulder dystocia is encountered, you may mess your pants initially, but even OB/GYNs mess their pants with shoudler dystocia. But I think I could handle it.
Q, DO
Q, DO
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Our program rotates at three hospitals that do not have in-house OB, so quite a few of our residents have gotten deliveries. Obviously, it isn't something we do everyday, but "out of the question"... certainly not. 
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Prediction: Some OB resident is going to run across this thread and it will quickly degenerate into the classic "ER docs are incompetent" thread.
I'm psychic for those of you that don't know.
I'm psychic for those of you that don't know.
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Speaking as a patient at a small rural hospital...
My OB didn't make it in in time for my daughter's birth. The ER doc was paged and arrived just in time to catch. (Try not pushing when every cell in your body is screaming, "PUSH!!!PUSH NOW!!!!!!")
The ER doc caught my daughter and took care of me until my OB arrived. I'm thankful she was there. I imagine ER docs at smaller hospitals get quite familiar with deliveries.
My OB didn't make it in in time for my daughter's birth. The ER doc was paged and arrived just in time to catch. (Try not pushing when every cell in your body is screaming, "PUSH!!!PUSH NOW!!!!!!")
The ER doc caught my daughter and took care of me until my OB arrived. I'm thankful she was there. I imagine ER docs at smaller hospitals get quite familiar with deliveries.
As far as I'm concerned there are two types of deliveries. The ones the taxi driver could do and the rest. Heres hoping all the ones I do in the future are the taxi driver sort. Of course my last one involved <32 week twins in a crack head who had no prenatal care. I delivered the first baby in the ED and intubated it-scariest tube I've ever had plus it was a slow day in the ED so I had the ED attending, 2 ED residents, two surgical residents(including the chief) and two peds residents all watching me try to tube the kid. I actually gave the peds resident first shot at it. Then we sent the mom up to post-partum where they discovered the second baby and ended up doing a crash c-section. OB was a bit upset about that one. From now on I'm ultrasounding everyone who hasn't had prenatal care before they go to postpartum
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Originally posted by edinOH
Prediction: Some OB resident is going to run across this thread and it will quickly degenerate into the classic "ER docs are incompetent" thread.
I'm psychic for those of you that don't know.
I think I'll set up a fake account, post in the OB/GYN forums, and let them know about this thread.
Q, DO
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I agree with the previous poster: there are simple deliveries that can be done without anyone's help (women have been doing them for millions of years) and the complicated ones.
As an EMT I learned how to deliver babies. Catcher's position, breathe deeply, cut the cord, etc. As an ER doc we usually don't do that much more. Frankly, we usually spend more time on the kid than the mother. Luckily ER docs also know enough Neonatology to help the kid - warm, blow-by O2, stimulate, CPR if P<60...
Difficult deliveries always involve calling OB. Whether or not they arrive in time is another issue. And there's always the case of the dumb fat women who don't even KNOW THAT THEY'RE PREGNANT, present with abdominal pain, and drop a baby in your lap (happened to me...) That's why ER docs have to know how to do everything.
As an EMT I learned how to deliver babies. Catcher's position, breathe deeply, cut the cord, etc. As an ER doc we usually don't do that much more. Frankly, we usually spend more time on the kid than the mother. Luckily ER docs also know enough Neonatology to help the kid - warm, blow-by O2, stimulate, CPR if P<60...
Difficult deliveries always involve calling OB. Whether or not they arrive in time is another issue. And there's always the case of the dumb fat women who don't even KNOW THAT THEY'RE PREGNANT, present with abdominal pain, and drop a baby in your lap (happened to me...) That's why ER docs have to know how to do everything.
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One delivery I once had was also a stat call up to OB, where a nurse midwife was trying unsucessfully to deliver a breech presentation with everything out but the kid's head.
I had not helped deliver any kid since I was a resident, let alone a complicated one, and had never done a breech. After remembering a few basic maneuvers, I managed to get the kid's head out without too much difficulty. The longest 20 seconds I have ever experienced was suctioning and waiting for the kid to take a breath and start crying after he was out!
In general, seeing cases like that are the exception for EM docs - you certainly want to get the OB involved as soon as possible.
Anyone here ever actually done a post-mortem c-section?
I had not helped deliver any kid since I was a resident, let alone a complicated one, and had never done a breech. After remembering a few basic maneuvers, I managed to get the kid's head out without too much difficulty. The longest 20 seconds I have ever experienced was suctioning and waiting for the kid to take a breath and start crying after he was out!
In general, seeing cases like that are the exception for EM docs - you certainly want to get the OB involved as soon as possible.
Anyone here ever actually done a post-mortem c-section?
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Didn't that happen a couple of years ago in one episode of "Trauma" at your hospital? How often does that actually happen there?
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We do a month of OB in my program.
We are only there to deliver and sono. We didn't do any floor work. Caught babies and handled early preg vag bleeders. I did 12 delieveries on my own. I feel reasonably comfortable. As quinn said. I would panic with a dystocia but so does OB. Am I as suave or comfortable as an Ob? nope. Don't really want to be.
But my rotation on ob was great. They were really good about the 'this is stuff you really have to worry about in the Ed'. Not the subtleties of suturing a 2nd or 3rd degree lac.
We are only there to deliver and sono. We didn't do any floor work. Caught babies and handled early preg vag bleeders. I did 12 delieveries on my own. I feel reasonably comfortable. As quinn said. I would panic with a dystocia but so does OB. Am I as suave or comfortable as an Ob? nope. Don't really want to be.
But my rotation on ob was great. They were really good about the 'this is stuff you really have to worry about in the Ed'. Not the subtleties of suturing a 2nd or 3rd degree lac.
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We had a visiting guy from Emory one day, and he was talking about this - said, in his 7 years at Emory, it had only happened once (almost a second time, but the patient just turned out to be REALLY REALLY fat).
I asked an attending who did her residency in Philly, and she said it was "the Holy Grail of EM"; she said that they had one, but she wasn't in on it. I never in the field had one, either (but, as I told a partner who was lollygagging along, expecting to have a kid be delivered, and I rushed him along, and we got Mom to the hospital without a precipitated delivery, when my partner asked how I got her not to have the kid, I said, "I willed her not to have it" - that's kind of my OB luck).
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One of my attendings who did his residency at Temple said he had one or one of his colleagues did up there.
Q, DO
Q, DO
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I don't know if she was at Temple, or Einstein, or where, so it might be one and the same.
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Any delivery involves calling OB.
If a woman presents in labor, call OB. The EM physician delivers only out of necessity, not by choice. At least that's my take on things. I hate delivering kids -- they're messy and slippery little suckers!
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We did one when I was doing my paramedic clinicals in the ED. 20ish year old Hispanic female with a history of seizures and this disease called pregnancy (that was about 35 weeks along), was off her Dilantin, had a seizure in the tub, found by family in arrest. Family did CPR on her until EMS arrived. EMS got a pulse back, sent her priority to the ED (they actually block intersections here for priority traffic -- so priority is rarely used). We had OB standing by. As soon as she hit the door, OB took the baby, patient arrested again, and then was pronounced. The baby lived for about 5 days but never really responded to anything.
It was an awesome site, let me tell you. I was in awe the whole time this was going on. (I had a great view too because I got stuck bagging the patient.)
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When I was an intern we had one traumatic code c-section (which the senior on that day took of course). Pretty dramatic stuff, which I hope never to have to see again.
Speaking of pregnancy-related weirdness, how about that f*cked up case in Oklahoma where that woman alleged killed a co-worker and cut the fetus out of her and tried to pass it off as her own? Sure glad I don't live in that part of the country anymore.
Speaking of pregnancy-related weirdness, how about that f*cked up case in Oklahoma where that woman alleged killed a co-worker and cut the fetus out of her and tried to pass it off as her own? Sure glad I don't live in that part of the country anymore.
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We were just talking about a similar case in Ohio. If someone can kidnap a lady she met at WalMart and read in a book how to do a perimortem C-Scetion on her and the baby is doing fine 3 years later, I hope if the time came I could do it too.
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What's wrong with that? Actually I was just back there for the holidays and I caught that in the paper. Won't be too difficult to prove insanity on that one I would imagine.
By the way, I'm glad you don't live out here too.
And considering the original topic, there was a guy in OKC a couple of years ago who performed a successful post-mortem section in one of the community EDs. The lady had just been shot by her loving boyfriend/husband, lost her vitals at the door I believe and he grabbed a knife and let her rip. He was on the local news and everything!
