care of the newborn.ppt mr.ppt

7/28/2019 Care of the Newborn.ppt mr.ppt

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Care of the NewbornProvena Regional EMS

December 2012 CE


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Objectives

Discuss the components of the APGARscoring system

Describe how the inverted triangle

concept is used in the resuscitation ofnewborns.

Review the steps of CPR for the newborn

Using scenarios demonstrate theresuscitation of newborn infants in variousstages of distress


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The APGAR Score Standard scoring system used to assess

the status of a newborn

Assigns a number value to five areas: Appearance

Pulse

Grimace or irritability

Activity or muscle tone

Respirations


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The APGAR Score


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Appearance

If the skin of the newborns entire body is

blue (cyanotic) or pale, award 0 points.

If the newborn has blue hands and feet withpink skin at the core of the body, award 1

point

If the skin of the extremities as well as the

trunk is pink, award 2 points.

The APGAR Score


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Pulse Heart rate is one of the most important signs of

whether oxygen is reaching the newbornstissues following birth.

Count the heart rate for at least 30 seconds,preferably with a stethoscope. If you do not have astethoscope, feel the pulse of the umbilical cordwhere it joins the abdomen or at the brachial artery.

If no pulse is present, award 0 points.

If the heart rate is under 100 (also a seriousfinding), award 1 point.

If the heart rate is over 100, award 2 points.

The APGAR Score


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Grimace (reflex irritability)

Gently flick the soles of the newborns feet, or

observe the facial expressions during suctioning.

If the newborn displays no reflexive activity toyour stimulation, award 0 points.

If the newborn displays only some facial

grimace, award 1 point

If your stimulation causes the newborn to

grimace and cough, sneeze, or cry, award 2

points.

The APGAR Score


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Activity This score refers to extremity reflexes/movement, or

the degree of flexion of the arms and legs and theresistance to straightening them. The normalnewborns elbows, knees, and hips are flexed, andyou should encounter some degree of resistance

when you try to extend them. If during your assessment, the newborn is limp

and displays no extremity movement, award 0points.

If the newborn only displays some flexionwithout active movement, award 1 point.

If the newborn is actively moving around, award2 points.

The APGAR Score


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Respiration

Another important assessment sign is the newborns

breathing effort. The newborn should have regular

respirations and a vigorous cry. Distress is indicated

by irregular, shallow, gasping, or absent respirations.

If the newborn displays no respiratory effort,

award 0 points

If the newborn displays only a slow or irregularbreathing effort with a weak cry, award 1 point

If the newborn displays good respirations and a

strong cry, award 2 points.

The APGAR Score


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The APGAR Score The total of the five numbers is the Apgar

score.

A perfect score is 10. Calculate the Apgar score at 1 minute and 5

minutes after birth.


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7

10 pointsThe newborn should beactive and vigorous. Provide routine care.

46 pointsThe newborn is moderately

depressed. Provide stimulation andoxygen.

03 pointsThe newborn is severelydepressed. You will probably need toprovide extensive care including oxygenwith bag-valve-mask ventilations andCPR.

The APGAR Score


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Neonatal Assessment andResuscitation

Follow standard precautions.

Always put on gloves before handling a

newborn. Protecting the newborn against heat loss

is critical!

Also assure that the airway is clear of all

secretion or birth fluids. Perform

additional suctioning as needed.


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Neonatal Assessment and

Resuscitation

Newborn should begin breathingspontaneously within 15 to 30 secondsafter birth

Heart rate should be 100 beats/min orhigher

If you do not observe these responses:

Gently tap or flick the soles of the feet or rubthe back.

Begin resuscitation efforts.


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Most newborns require no resuscitation

beyond temperature maintenance, mild

stimulation, and suctioning.A minority of the newborns will be so

depressed that they also will need chest

compressions or resuscitativemedications.


Resuscitation


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Signs of Severely Depressed

Newborn Respiratory rate over

60 per minute

Diminished breathsounds

Heart rate over 180per minute or under100 per minute

Obvious signs oftrauma from thedelivery process

Poor or absentskeletal muscle tone

Respiratory arrest, orsevere distress

Heavy meconiumstaining of amnioticfluid

Weak pulses

Cyanotic body (coreand extremities)

Poor peripheralperfusion

Lack of or poorresponse tostimulation

APGAR score under 4


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The Inverted Pyramid


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Observe the newborn for spontaneous

respirations, skin color, and movement of

the extremities.

Evaluate the heart rate at the base of the

umbilical cord or the brachial artery.

The heart rate is the most importantmeasure in determining the need for further

resuscitation.


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If cyanosis is present but breathing andheart rate are adequate, provide blow-by

oxygen


Resuscitation


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Provide ventilations by bag-valve-mask with

supplemental oxygen at the rate of 4060 per

minute if the newborn displays any of the

following: The infants breathing is shallow, slow,

gasping, or absent following brief stimulation.

The infants heart rate is less than 100 beatsper minute.

The infants core body remains cyanotic

(blue) despite provision of blow-by oxygen.


Resuscitation


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Resuscitation

Reassess after 30

seconds of

ventilation.

If the breathing hasnot improved and the

heart rate is less than

100/minute, continue

ventilations andreassess every 30

seconds.


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If, despite adequate ventilations, the

infants heart rate drops to less than 60

beats per minute, continue ventilations

and begin chest compressions at a rate

of 120/min


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Use either the hand-

encircling technique or

the two-finger technique.

Coordinate chest

compressions with

ventilations at a ratio of

3:1.


Resuscitation


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ResuscitationALS

If heart rate is < 60 beats/min after another

30 seconds CPR, consider intubation. Prepare epinephrine dose of 0.01 to 0.03

mg/kg (0.1 to 0.3 mL/kg of the 1:10,000

solution) ET/IV/IO.


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ResuscitationBLS Shock Treatment

Shock symptoms:

Poor perfusion

Weak pulses

Poor response to resuscitation.

Shock treatment: Rapid transport.


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ResuscitationALS Shock Treatment

Assure adequate oxygenation and ventilation.

Obtain intravenous access: Intravenous: first choice

Intraosseous: second choice

Umbilical venous: if trained and equipped

1020 mL/kg normal saline or Ringers lactate


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Key Concept: The Inverted

Pyramid


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Review

Answer the following questions as a group.

If doing this CE individually, please e-mail your

answers to:

[email protected]

Use Dec 2012 CE in subject box.

You will receive an e-mail confirmation. Print

this confirmation for your records, and documentthe CE in your PREMSS CE record book.


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Review

Scenario: You and your partner aredispatched to the local shopping mall for a17 year old female with severe abdominal

pain. When you arrive you find yourpatient lying on the floor of the bathroomand discover that she has just given birth.The newborn is face down on the

bathroom floor. The mother is stable.


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Review

1. What are your initial treatment priorities

for this newborn infant?

2. Calculate the initial APGAR score from

the following information. Cyanosis to hands and feet

Crying; non-labored respirations

Heart rate is 120 Arms and legs held in flexed position


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Review

Scenario: You and your partner deliver a 31

week gestation baby girl . You dry, warm,

position, suction and stimulate the infant

but despite these interventions the infantremains flaccid with irregular respiratory

effort and a weak cry. Central cyanosis is

also present and the heart rate is 40.


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Review

3. Calculate the AGPAR score of this

newborn infant.

4. What are the BLS treatment priorities for

this newborn infant?

5. ALS providers: What, if any, are the ALS

treatment priorities for this newborn

infant?


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Review

6. What is the appropriate rate of

compressions and the compressions to

ventilations ratio during CPR for the

newborn?


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Answers

1. Reposition the infant and suction the

mouth first, then the nose. Dry and

warm the infant. Stimulate by rubbing the

infants back or flicking the soles of thefeet. Calculate the APGAR score at 1

and 5 minutes. Complete the initial

assessment (ABCs).2. APGAR score = 9


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Answers

APGAR score = 2

4. Begin bag valve mask ventilations and

chest compressions immediately.Reassess heart rate after 30 seconds.


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Answers

5. If despite ventilations and chest

compressions the heart rate remains

below 60, consider endotracheal

intubation and IV/IO access. AdministerEpinephrine 1:10,00 0.01-0.03 mg/kg

ET/IV/IO if needed.

6. 120 /minute; 3:1 (compressions toventilations)

care of the newborn.ppt mr.ppt

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