MEDICAL STUDENT GUIDE TO OBSTETRICS AT THE ... | Study notes Obstetrics

MEDICALSTUDENTGUIDETOOBSTETRICSATTHEUNIVERSITYOFWASHINGTON



BASICS

 L&Dislocatedonthe6thfloorofthePacificTower

 Postpartumisonthe5thfloorofthePacificTower 

 BothunitscanonlybeaccessedwithyourhospitalID! 

 TheteamroomisjustpasttheL&Dfrontdeskthisiswhereyou’ll

findtheresidentteamandyourdesk



GUIDETOTHEL&DWHITEBOARDS

 Patientsinblackareactiveor“L&Dstatus”thesearepatientswhoarelaboringorillenoughthattheymay

needtobedeliveredwithinthenext24hoursthesearegenerallythepatientsyoushouldfollow

 Patientsinblueareantepartumadifferentresidentteamtakescareofthesepatientswhoaremorestable,

toosicktogohomebutnotsickenoughtobedelivered

 Patientsinpinkarepostpartumuntiltheygodownstairs(oncedownstairs,theirnameismovedovertothe

postpartumboardwhichistheoneallthewaytotheleft)



MEDICALSTUDENTROLEONL&D

 Triage(aka,theERforpregnantpatientsat>20weeksgestationalage)

 AllpatientscomethroughtriagewhentheyarriveonL&Dandseeingpatientsthereisagreat

opportunitytopracticeH&P’sandlearnaboutcommonpregnancycomplaints/complications.

 Whenapatientarrivesintriage,theRN’swilladdthemtotheboardandnotifytheteam

 Youcanreviewtheirchart,(510minutesmax)goseethemtotakeabriefhistoryanddoabasic

physicalexam,(nopelvicexamwithoutaresidentpresent!)(15minutesmax).

 Presenttotheresidentwhowillseethepatientwithyou(internif>37WGA,R2if<37WGA)

 Goseethepatientwiththeresident.Gatheryourthoughts/finalizeaplanwiththeresident.Present

tothechiefand/orattending.

 Almostanypatientwhogetsputinatriageroomisappropriateforyoutoseeunlesstheyhave

specificallyrequestednostudents.

 LaborManagementandVaginalDeliveries

 Wewantyoutogetasmuchexposuretolaboranddeliveriesaspossible!

 PleasehaveyourresidentscheckwitheachpatienttoseeifitisOKforyoutofollowalong

 Thebestwaytofollowapatientistofollowtheintern(theymanagethelaboringpatients)

 Cervicalchecksarepainfulforourpatients,especiallywhentheprovidercheckingislessexperienced

pleasecheckwithyourresidentstoseeifthereareappropriatepatientsforyoutoexamine

(epiduralizedpatientsarethebestaslongasthepatientisOKwithhavingtwoexams)

 CesareanDeliveriesandProceduresintheOR

 YouarealwayswelcomeintheOR(again,aslongasthepatientisOKwithstudentsbeinginvolvedin

theircare)

 IfyouhavenotscrubbedorbeeninanORbefore,pleaseletyourchiefknowASAPandtheywillgive

youanorientationtotheORandteachyoutoscrub(oraskoneofourscrubtechsornursestohelp)

 Hereisalinktoavideoabouthowtoscrubproperly

 Forcesareandeliveries,ifyouscrub,you’llstandonthepatient’srightsidenexttotheattending

 Postpartum

 Everymorningfrom5:306:30amtheresidentteamsroundonthepostpartumpatients

 Youwillbeexpectedtofollow12postpartumpatients(typicallyseenwithoneoftheinterns)and

presentthematboardsignout

 Thebestlearningisifyouseethepatientsyoufollowedonlaboranddelivery

 BoardSignOut

MEDICAL STUDENT GUIDE TO OBSTETRICS AT THE ..., Study notes of Obstetrics

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MEDICAL STUDENT GUIDE TO OBSTETRICS AT THE UNIVERSITY OF WASHINGTON

BASICS

L&D is located on the 6th^ floor of the Pacific Tower

Postpartum is on the 5 th^ floor of the Pacific Tower

Both units can only be accessed with your hospital ID!

The team room is just past the L&D front desk this is where you’ll

find the resident team and your desk

GUIDE TO THE L&D WHITEBOARDS

Patients in black are active or “L&D status” these are patients who are laboring or ill enough that they may

need to be delivered within the next 24 hours these are generally the patients you should follow

Patients in blue are antepartum a different resident team takes care of these patients who are more stable,

too sick to go home but not sick enough to be delivered

Patients in pink are postpartum until they go downstairs (once downstairs, their name is moved over to the

postpartum board which is the one all the way to the left)

MEDICAL STUDENT ROLE ON L&D

Triage (aka, the ER for pregnant patients at >20 weeks gestational age)

All patients come through triage when they arrive on L&D and seeing patients there is a great

opportunity to practice H&P’s and learn about common pregnancy complaints/complications.

When a patient arrives in triage, the RN’s will add them to the board and notify the team

You can review their chart, (510 minutes max) go see them to take a brief history and do a basic

physical exam, (no pelvic exam without a resident present!) (15 minutes max).

Present to the resident who will see the patient with you (intern if >37 WGA, R2 if <37 WGA)

Go see the patient with the resident. Gather your thoughts/finalize a plan with the resident. Present

to the chief and/or attending.

Almost any patient who gets put in a triage room is appropriate for you to see unless they have

specifically requested no students.

Labor Management and Vaginal Deliveries

We want you to get as much exposure to labor and deliveries as possible!

Please have your residents check with each patient to see if it is OK for you to follow along

The best way to follow a patient is to follow the intern (they manage the laboring patients)

Cervical checks are painful for our patients, especially when the provider checking is less experienced

please check with your residents to see if there are appropriate patients for you to examine

(epiduralized patients are the best as long as the patient is OK with having two exams)

Cesarean Deliveries and Procedures in the OR

You are always welcome in the OR (again, as long as the patient is OK with students being involved in

their care)

If you have not scrubbed or been in an OR before, please let your chief know ASAP and they will give

you an orientation to the OR and teach you to scrub (or ask one of our scrub techs or nurses to help)

Here is a link to a video about how to scrub properly

For cesarean deliveries, if you scrub, you’ll stand on the patient’s right side next to the attending

Postpartum

Every morning from 5:306:30am the resident teams round on the postpartum patients

You will be expected to follow 12 postpartum patients (typically seen with one of the interns) and

present them at board signout

The best learning is if you see the patients you followed on labor and delivery

Board SignOut

Twice a day we have formal, sitdown rounds where both the day and the night team review each

patient on labor and delivery and postpartum.

Your residents will work with you to develop a succinct presentation of the patients you are following

so that you can get practice presenting patients formally

Notes

Below are the note templates we use on L&D. Please put them into your Orca smartphrases

(instructions below) so you have them ready to use on your first day.

Medical students can write notes in patient charts but they must be cosigned by a resident and they

cannot be admission notes or discharge summaries.

However, to get practice with the things we think about when admitting an OB patient, your residents

might ask you to write an admission note in Microsoft Word and send it to them for review.

Learning

Clinical volume on L&D is hit or miss, you can optimize your down time by bringing Blueprints or Case

Files with you to read

Because L&D is such a crazy place, a lot of learning happens by “osmosis” in that we rarely have time

for formal sitdown teaching. Try to ask questions as we go and learn as much as you can through

observation and participation.

COMMON ABBREVIATIONS (we use a lot of them)

_

_

Fetal well being.

Prenatal care.

Disposition: patient status reviewed, inpatient _observation _

LABOR & DELIVERY TRIAGE NOTE

REFERRING PROVIDER: _

PRIMARY OB PROVIDER: _

_.

_.

Fetal well being. _reactive on monitor.

Followup: in _ weeks with _ (provider)