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- 1. EMS Resuscitation of the Newborn Jim Morgan , D.O. FAAEM Emergency Medicine EMS Medical Director Joplin, MO
2. Epidemiology 10% of newborns will require assistance when theyre bornIncidence of complications increase as Birth weight decreases Prenatal problems increase Prenatal age decreasesLook for antepartum & intrapartum issues 3. Physiology Prior to delivery, newborn lungs filled with fluidCapillaries & arterioles of lungs are closedBlood pumped by heart bypasses lungs thru ductus arteriosis 4. Ductus Arteriosis 5. Physiology During delivery (or shortly after), the newborn begins using lungs Compression of chest removes fluid Sudden inspiration causes air movement to displace fluid Resistance thru lungs decreases & blood flow preferentially bypasses ductusDuctus closes & becomes ligamentum arteriosum 6. Initial Care Airway Maintain at level of mothers vagina Bulb suction Gentle stimulationAssess initial APGAR scorePrevent heat loss Gently dry Swaddle in warm receiving blanket Avoid air drafts Skin-to-skin with motherCutting umbilical cord Do not milk the cord Clamp 30 seconds after delivery Clamp ~ 4 cm from newborn 7. At Birth Is newborn full-term?Is newborn breathing &/or crying?Does newborn have good muscle tone? 8. At Birth Is meconium present? Thin meconium Thick meconiumAssess O2 saturation 60 70% at birth May take 5 10 minutes to reach > 95%Cyanosis common esp. acrocyanosisHR ~ 150 180 slowing to 130 140 HR < 100 abnormal begin resuscitation 9. The Distressed Newborn 10. Inverted Pyramid ofResuscitation 11. Basic Resuscitation Initial care Drying Warming Positioning Suctioning Tactile stimulationAssessment Respiratory effort Heart rate Color 12. Airway Ventilation Use neonatal BVM with pop-off valve with supplemental oxygen HR < 100 Apnea Poor O2 saturation Persistence of central cyanosisVentilate @ 40 60 bpm Ventilate @ ~ 35 45 cm H2O OR adequate chest riseSupplemental oxygen 100% oxygen in the field 13. Neonatal Ambu Bag 14. Airway Consider intubation Chest compressions Difficult to ventilate Thick meconium Inadequate response 15. Chest Compressions Encircle chest with both hands & use thumbsCompress lower half of sternum @ 100 per minuteDiscontinue if HR increases to > 80 16. Vascular Access MOST distressed newborns respond to initial care, ventilation, & chest compressionsIf vascular access needed, can use umbilical catheter Umbilical cord with 2 arteries & 1 vein Insert catheter into vein & secure with umbilical tape 17. Medications Naloxone Glucose Do not use in newborn resuscitation No specific glucose level at birth can be agreed upon Prehospital glucose administration difficultEpinephrine 0.05 - 0.1 mg/kg (0.3 to 1 mL/kg of a 1:10,000 solution) 18. Specific Neonatal Situations Meconium-stained amniotic fluid Apnea Diaphragmatic hernia Bradycardia Prematurity Respiratory distress/cyanosis Hypovolemia Seizures Fever Hypothermia Hypoglycemia Vomiting Diarrhea Common birth injuries 19. Congenital heart conditions Atrial septal defect (ASD) Ventricular septal defect (VSD) Tetralogy of Fallot Transposition of the great vessels Coarctation of the aorta Pulmonary stenosis Aortic stenosis 20. Failure to respond Mechanical blockage Impaired lung function Pneumothorax Diaphragmatic hernia Pulmonary atresiaCentral cyanosis MeconiumCongenital heart diseaseApnea Brain injury Neuromuscular disease 21. Enroute to the call Review how you will handle Normal birth & newborn Newborn in distressWarm patient compartmentConsider possibility of needing back-up personnel 22. Remember. Most newborns will respond to minimal interventionIf meconium is present AND Child is vigorous, light suctioning Child is flaccid, may need ETT + suctionIf HR > 100, supplemental oxygen Between 60 100, positive pressure ventilation < 60, chest compressionsRarely..epinephrine thru umbilical veinReassess every 30 seconds 23. Questions?