medications. medications epinephrine volume expanders sodium bicarbonate naloxone dopamine
TRANSCRIPT
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MEDICATIONS
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Medications Epinephrine
Volume expanders
Sodium bicarbonate
Naloxone
Dopamine
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Neonatal Resuscitation
No role of Atropine Calcium Dexamethasone Dextrose
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Epinephrine
Indications HR < 60 per minute despite 30 seconds of
BMV plus chest compressions
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Epinephrine
Formulation 1:1000 Dilution 1:10000 (Ten times)
0.2 ml in 1.8 ml Load 1 ml (in 1ml syringe) Dose 0.1-0.3 ml/kg Route IV (preferable) Rate Rapid bolus
IT * - use only if IV access is not available; dose of up to1ml/kg to be used; Efficacy ?
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Epinephrine
Effect : Inotropic, chronotropic, peripheral vasoconstriction
Expect : HR > 60 within 30 seconds
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Epinephrine
Follow up: if HR < 60 Repeat epinephrine q 3-5 minutes Ensure:
effective ventilation
effective chest compressions
endotracheal intubation (if not done already)
Consider using volume expander
Consider using sodium bicarbonate
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Volume expanders
Consider Pallor persisting after oxygenation Weak pulses, good heart Tachy / bradycardia No improvement despite effective
ventilation, chest compressions & Epinephrine
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Volume expanders
Normal saline
Ringer’s lactate
Whole blood (O Neg cross matched with mother’s blood)
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Normal saline
Indications Evidence or suspicion of acute blood loss
with signs of hypovolemia and/or baby responding poorly to resuscitation
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Normal saline
Dosage 10 ml/kg
40 ml in syringe or infusion set
Route IV- umbilical is best
Rate over 5-10 minute
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Volume expanders
Effect : Volume expansion, correction of metabolic acidosis
Expectation : Better BP & pulses, less pallor
Follow up : If signs of hypoperfusion persist, repeat volume
expander, consider sodium bicarbonate or dopamine
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Sodium bicarbonate
Indications
Prolonged arrest that does not respond to other therapy
if ABG shows metabolic acidosis with normal PaCO2
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Sodium bicarbonate
Preparation 0.9 mEq (approx. 1mEq)/ml
Dilution 1:1 dilution
Load 10 ml of diluted solution
Dose 2 mEq/kg of diluted solution
Route IV; Never through ET tube
Rate Slow over 2 minutes or more @ not >1 mEq/kg/min
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Sodium bicarbonate
Effect : Control of metabolic acidosis; volume expansion
Expectation : HR > 100 within 30 seconds
Follow up : If persistent metabolic acidosis
Use epinephrine and volume expansion, consider
dopamine
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Naloxone hydrochloride
Indications Severe respiratory depression after BMV has
restored a normal heart rate & color
And
A history of maternal narcotic administration within the past 4 hours
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Naloxone
Preparation 0.4 mg/ml
Load 1 ml in syringe
Dose 0.1 mg/kg (0.25 ml/kg)
Route IV, IM; No intratracheal
Rate Rapidly
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Naloxone
Effect : Narcotic antagonist
Expectation : Spontaneous respiration
Follow up : If no response, repeat dose
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Dopamine
Indication : Persisting evidence of shock
Effects : Increases cardiac output
Expectation : Better perfusion, better pulses
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Dopamine
Preparation : 40 mg/ml
Dose : 5 mcg/kg/min to
20 mcg/kg/min
Route : IV
Rate : Constant infusion for
hours to days
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-Medications Begin Epinephrine • HR below 60/min after 30 seconds ofVolume Expander PPV and chest compressions Sodium Bicarbonate Dopamine Give epinephrine May be repeated every 3-5
minutes if required
HR above 60 Discontinue medications
Prolonged arrest that does not Evidence or suspicion of acute May be repeated respond to other therapy blood loss with signs of if signs of hypovolvemia hypovolemia
persist
Give sodium bicarbondte Give volume expander
Evidence of continuing depression
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Evidence of continuing depression
• Consider other causes, eg: - Pneumothorax - Diaphragmatic hemia
- Persistant pulmonary hypertension
• Consider starting dopamine
• Obtain consultation
Naloxone Respiratory depression and historyof narcotics administered in the mother within past 4 hours after
30 seconds of BMV