Neonatal SpO₂ After Birth Newborns do not immediately have adult oxygen saturations after birth. During normal transition, SpO₂ gradually rises over the first several minutes of life. This is why 90% at 1 minute is not expected in a normal newborn transition. Preductal SpO₂ For neonatal resuscitation, SpO₂ is usually measured preductally. Preductal location: Right hand or right wrist Why right hand? The right hand reflects blood oxygen levels before blood passes through the ductus arteriosus, making it the preferred site during newborn resuscitation. Target Preductal SpO₂ After Birth Time After Birth 1 minute 60–65% 2 minutes 65–70% 3 minutes 70–75% 4 minutes 75–80% 5 minutes 80–85% 10 minutes or more 85–95% These ranges are consistent with neonatal resuscitation oxygen-target references. Tocolytics What Are Tocolytics? Tocolytics are medications used to slow or suppress uterine contractions. They are used in preterm labor to delay delivery, usually for a short period of time. Why Delay Preterm Labor? The goal is usually to buy time for: - Maternal transport to a higher-level OB/neonatal facility - Steroids to improve fetal lung maturity - Additional hospital-based OB management Example Terbutaline is an example of a tocolytic medication. It is a beta-agonist that can relax uterine smooth muscle and reduce contractions. EMS/NREMT Key Point Tocolytics do not “fix” preterm labor. They temporarily slow contractions to buy time.

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What gives it away that it's CHF over any other respiratory emergency? Dispatch 74-year-old female with severe shortness of breath. Patient Presentation The patient is sitting upright in a recliner. She is anxious, pale, cool, and diaphoretic. She says, “I can't catch my breath.” History - History of CHF, hypertension, prior MI, and kidney disease - Woke up suddenly gasping for air - Cannot lie flat - Missed recent furosemide doses - Reports mild chest pressure Initial Vitals Mental Status: Alert, anxious BP190/104 HR122 RR34, labored SpO₂82% room air EtCO₂30 mmHg Lung Sounds: Crackles bilaterally Skin: Pale, cool, diaphoretic ECG: Sinus tachycardia 12-Lead: No STEMI noted

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During the assessment of a patient with chronic bronchitis, you hear low-pitched, rattling sounds that resemble snoring. Which term best describes this finding?