cards · checks stay on this phone
OB & Neonatal cards
157 values across 11 cards. Rows check off; per-kg doses compute on the weight.
— kg kg SET WEIGHT drives every per-kg dose below
age mo yr ESTIMATE KG no scale? APLS estimate — prefer a measured weight
Imminent normal delivery 44 OPEN THE LIVE PATHWAY — DELIVERY — THE BIRTH CLOCK ▸ Activate chemical warming pad
Set up newborn BVM, room air to start
PPE and maternal position
Let the head deliver slowly
Sweep one finger around the neck for nuchal cord
Wipe face; suction only for obstruction
Down for anterior shoulder, up for posterior
Support the body onto the mother’s abdomen
BREECH → buttocks or feet first
CORD PROLAPSE → cord felt ahead of the baby
SHOULDER DYSTOCIA → turtle sign
Never cut a loose nuchal cord
Loose nuchal cord — slip over the head
Tight but mobile — over shoulder or deliver through the loop
Tight and fixed — somersault
Only if blocked: double clamp and cut
The 4-yes check — TERM? GOOD TONE? BREATHING? MOTHER STABLE?
ANY ONE NO → clamp, warmer, NRP
GA entry bounds 20 to 45 weeks
Delayed cord clamping — at least 60 s
Two clamps 2–3 in / 5–8 cm from the abdomen, cut between
No cord traction; watch maternal bleeding
Maternal bleeding >500 mL or shock → Postpartum Hemorrhage
Apgar at 1, 5, 10, 15, 20 min
Apgar — Appearance/Color 0/1/2
Apgar — Pulse/HR 0/1/2 (absent / <100 / ≥100)
Apgar — Grimace/Reflex 0/1/2
Apgar — Activity/Tone 0/1/2
Apgar — Respiration 0/1/2
Apgar score interpretation bands
≥7 reassuring · 4–6 moderately depressed · <4 severely depressed; repeat q5 min until ≥7
Score it, do not act on it
Ask the mother — gestation (weeks + days)
Ask the mother — number of babies
Ask the mother — prenatal care
Ask the mother — complications
Ask the mother — membranes / fluid
Ask the mother — opioids in labor
Baby is out — stamp time now
SOURCES ▸ 2025 AHA/AAP Part 5: Neonatal Resuscitation (per in-file comment) Umbilical vein catheterization 12 UVC catheter size by weight
5 Fr ≥1.5 kg · 3.5 Fr <1.5 kg
Free blood return at 2–4 cm, line secured
One vein (11–12 o’clock), two arteries
Sterile prep cord and skin
Umbilical tape loose around cord base
Flush the right catheter, stopcock on, no air
Cut cord horizontally 1–2 cm from skin
Assistant stabilizes stump with forceps
Insert to 2–4 cm, aim cephalad, never force
Secure with purse-string or tape bridge
UVC insertion depth to free blood return
2–4 cm from cut surface; term ≈ 4, preterm ≈ 2
ED C-section 27 Airway attempt ceiling on the card header
2 attempts max · iGel early
Role — ED MD: Head of the bed — airway and intubation.
Role — RT / RN: Head of the bed on the patient's right — suction, tube, bag, meds.
Role — OB: Whichever side the OB chooses — operates.
Role — ED RN: Beside the OB — opens the C-section kit, drops knife and gauze onto the bedside table; IV access and meds.
Role — MOD: At the sliding door by the foot — organizes, clears the room, tracks the clock.
Role — TELE NICU: Screen at the foot on the patient's right — documentation and resuscitation support.
Pre-oxygenate: NRB 15 L for 3 min, PEEP-valve BVM, apneic O2: Non-rebreather 15 L for 3 min; BVM with the PEEP valve attached if poor effort; apneic O₂ by nasal cannula.
Usually ketamine + rocuronium; say doses aloud, wait ≥45 s
State the airway plan and the backup aloud before induction.
Surgical time out 1 — STOP: “Time out.” Nobody cuts, nobody pushes drugs until it is finished.
Surgical time out 2 — WHO IS HERE: Every person says their name and role aloud.
Surgical time out 3 — PATIENT: Name, MRN, allergies, consent — or state the emergency exception.
Surgical time out 4 — PROCEDURE: “Emergency cesarean delivery.” Indication, urgency, incision site.
Surgical time out 5 — SURGEON: Key steps, expected blood loss, blood available, special equipment.
Surgical time out 6 — AIRWAY & MEDS: Airway plan and backup, drugs given, drugs due.
Surgical time out 7 — NURSING: Sterility, counts, C-section kit open, knife and gauze on the table.
Surgical time out 8 — ANTIBIOTICS: Name the drug and the time — within 60 min of incision.
Surgical time out 9 — NEONATAL: Who catches, warmer on, NRP team named, tele NICU connected.
Surgical time out 10 — QUESTIONS: “Any concerns before incision?” Then: “Time out complete — OB, you may start.”
Antibiotics within 60 min of incision — Name the drug and the time — within 60 min of incision.
ETT sizing for the pregnant airway
ETT 6.5 — 6.0 and 7.0 open
Two attempts maximum — go early to the iGel.
2 attempts maximum → iGel
Confirm the tube: bilateral sounds + ETCO₂. Secure at ≈21 cm at the lips; confirm on CXR.
Post-intubation ventilator settings — Volume control 6–8 mL/kg IBW, FiO₂ 100% then titrate down as needed, RR 12–14, PEEP 5.
Ketamine re-dose 1 mg/kg after 10 minutes.
IV
Breech delivery 10 To the umbilicus, then the scapula, then flex the head
Hands off to the umbilicus
Extended legs: flex behind the knee, sweep out
Grasp the bony pelvis only, thumbs on the sacrum
Løvset maneuver — rotate half a turn, sweep arm, rotate back
Mauriceau–Smellie–Veit — fingers on cheekbones, flex chin to chest
Assistant suprapubic pressure; never lift the body
Never grip abdomen or soft tissue
Baby out → stamp time of birth → 4-yes check
Umbilical cord prolapse 10 OPEN THE LIVE PATHWAY — CORD PROLAPSE — CRASH SECTION ▸ Gloved hand in — lift the fetal head off the cord
Do not let go until delivery
Announce; activate OB, anesthesia, OR
Two large-bore IVs (14 or 16 G) early
Steep Trendelenburg or knee–chest
Stop oxytocin; terbutaline 0.25 mg SC for persistent bradycardia
Long transfer: fill bladder with 500 mL saline via Foley, clamp
Wrap protruding cord in warm saline-soaked gauze; minimal handling
Do not push the cord back in
Delivery is by cesarean — every other measure is temporizing until the OR
Resuscitative hysterotomy 21 TIME SINCE MATERNAL ARREST 0:00 START ✕ CLEAR
Indication — maternal arrest, fundus ≥ umbilicus
fundus at or above the umbilicus; not reversible
Gestation >20 weeks = If FUNDUS above UMBILICUS → PROCEED
Scalpel, 10 blade is the only truly essential item
Splash prep if immediately at hand
For after delivery/ROSC: oxytocin 5 units IV, 0 chromic, stapler
Manual left uterine displacement — continuous until delivery
Call “ED OB emergency”; activate telehealth
Decision rule to cut
no ROSC after one defibrillation or one round of trauma resuscitation → cut now
Set up for the infant; activate neonatal chemical heat pad
Splash prep — never delay the incision for it
10 blade Incise vertical midline, above umbilicus to symphysis, deep to fascia
Fingers separate the rectus; scissors on fascia only if needed
Vertical uterine incision; extend with fingers or bandage scissors
Extract infant, note time, hand to neonatal team
Three cord clamps — two baby side, cut between; one toward placenta
Manually remove placenta, wipe cavity
Close uterus with running locked 0 chromic; staple skin
Continue maternal ACLS; recheck rhythm
Cord gas segment — draw within 60 min
SOURCES ▸ Adapted from The Procedures Course — Resuscitative Hysterotomy Reference, Alfred STAR Program (Alfred Health) OB cart 6 Drawer 1 · Airway / Breathing: Infant LMA 0 and 0.5 · ETT 2.5–3.5 · blades 00–1 · Neonatal BVM + PEEP valve, masks · Bulb syringe, suction catheters, meconium aspirator · Pulse oximeter + monitor leads · Adult: ETT 6.0/6.5/7.0, bougie, iGel
Drawer 2 · Circulation: UVC 5 Fr and 3.5 Fr, umbilical tape · Stopcocks, flushes, three-way · Large-bore IV 14/16 G · IO · NS / LR, pressure bag · Blood pressure cuffs
Drawer 3 · Labs / Misc.: Type & cross, CBC, CMP, coags · Cord gas syringes, ABG kit · Feeding tubes · Foley bag, urine container · Labels, specimen bags
Drawer 4 · Postpartum Hemorrhage: Oxytocin 10 units · TXA 1 g · Misoprostol 1000 mcg · Sterile Kerlix for packing · Foley catheter kit · Graduated drape, sterile gloves · JADA System (vacuum-induced uterine tamponade)
Drawer 5 · C-section: Sterile C-section kit · 10 blade, bandage scissors, forceps · 0 chromic suture, skin stapler · Chlorhexidine / betadine splash prep · Sterile drapes, gowns
Drawer 6 · Vaginal Delivery: Sterile OB kit — cord clamps, scissors, bulb · Chemical warming pad · Receiving blankets, towels, hat · Saline gauze · Umbilical tape
Eclampsia / severe preeclampsia 17 Eclampsia recognition
seizing + pregnant or ≤6 wk postpartum = eclampsia
Protect, left lateral, suction, oxygen, glucose; magnesium, not a benzodiazepine
Magnesium sulfate loading dose
4–6 g IV over 15–20 min; no IV: 10 g IM (5 g each buttock) · IV / IM
Magnesium re-bolus for recurrent seizure
2 g IV · IV
Not waking between seizures → assume non-convulsive status
Call OB — say “eclampsia” first
Magnesium maintenance infusion
2 g/h, continued at least 24 h after last seizure or delivery · IV infusion
Magnesium toxicity watch
hourly: RR ≥12, patellar reflexes present, urine >30 mL/h
Calcium gluconate for magnesium toxicity
1 g IV over 2–3 min · IV
Severe-range blood pressure treatment
labetalol 20→40→80 mg IV q10 min · hydralazine 5–10 mg IV q20 min · nifedipine IR 10–20 mg PO q20 min · ≥160/110 over 15 min — treat within the hour
BP target
≈130–150 / 80–100
Symptoms and labs — platelets, creatinine, LFTs
Stabilize mother first — seizure alone not an indication for crash cesarean
Transfer with OB: magnesium infusing, BP controlled
Postpartum eclampsia window
up to 6 weeks after delivery
SOURCES ▸ ACOG Practice Bulletin 222 (2020) ACOG Committee Opinion 767 (2019) ACOG PB 222; ACOG CO 767 Umbilical vein catheterization — dose engine 8 ETT depth from weight
depth = 6 + weight(kg) cm
LMA size rule — site stocks 0 and 0.5 only
LMA 0.5 if ≥2 kg / ≥34 wk, else 0
Neonatal code-dose epinephrine IV/UVC
0.02 mg/kg = 0.2 mL/kg of 0.1 mg/mL (1:10,000)
ETT epinephrine when no access
0.05–0.1 mg/kg = 0.5–1 mL/kg of 0.1 mg/mL, once
Not the auto-injector — code-cart epinephrine 0.1 mg/mL
0.2 mL/kg IV/UVC of code-cart 0.1 mg/mL; dilute 1 mg/mL: 1 mL + 9 mL NS; ETT 0.05–0.1 mg/kg
Normal saline volume — 10 mL/kg (10 × weight mL)
IV
Birth-weight unit reconciliation bounds
≥300 → grams; >6.5 kg implausible; <0.2 kg implausible
Suction sizing note
ETT suction ≈2 × ID Fr; mouth 10–12 Fr or bulb
SOURCES ▸ NRP equipment checklist (per in-file note) Hand in — lift the head off the cord 1 OPEN THE LIVE PATHWAY — CORD PROLAPSE — CRASH SECTION ▸ Do not let go until the baby is delivered.
SOURCES ▸ v1 ob-neonatal card c09 (harvest ob-c09-never-let-go) Cord care 1 ✕ DO NOT PUSH THE CORD BACK IN — Cover it, keep it warm, and move to cesarean delivery. If the cord is protruding, wrap it gently in warm saline-soaked gauze. Keep handling to a minimum.
SOURCES ▸ v1 ob-neonatal card c09 (harvest ob-c09-no-replace + ob-c09-cord-care) CLEAR CHECKS & TIMERS — THIS PAGE Checks, weight and timers stay on this phone — no names, no record numbers, nothing leaves the device. Verbatim from the v1 harvest (@ ee60d25). Contested values were ruled 2026-08-25 — the ruling wins over anything shown here that lost. Each card's sources sit closed at its foot.