pals - newborn resuscitation
TRANSCRIPT
NEWBORN
Newborn Resuscitation Outside the Delivery Room
Core Knowledge and Skills
• Establish clear airway
• Support adequate ventilation and oxygenation
• Maintain adequate cardiac output
• Reduce heat loss
Newborn Resuscitation Outside the Delivery Room
Effective Triage
• Ideally births should take place in the delivery or birthing room
• Avoid delays in the field or emergency department
Newborn Resuscitation Outside the Delivery Room
Phases of Resuscitation
• Preparation
• Resuscitation
• Postresuscitation
Newborn Resuscitation Outside the Delivery Room
Preparation
• Advanced
• Immediate
Newborn Resuscitation Outside the Delivery Room
Overhead Warmer Warming Lights
• Picture of an overhead warmer and warming lights underneath the respective title
Newborn Resuscitation Outside the Delivery Room
Equipment for Newborn Resuscitation
• Picture of newborn Resuscitation equipment• Neonatal Resuscitation box
Newborn Resuscitation Outside the Delivery Room
Umbilical Venous Catheter Line With Syringe
• Picture of Syringe
Newborn Resuscitation Outside the Delivery Room
Observe Universal Precautions:Gloves, Goggles, and Gown
• Picture of appropriate items
Newborn Resuscitation Outside the Delivery Room
Aid to Drug Dosing
• Picture of AHA Handbook of Emergency Cardiac Care
• Picture of drug chart
Newborn Resuscitation Outside the Delivery Room
Special Neonatal Drug Preparations
• Picture of Neonatal Drugs
Newborn Resuscitation Outside the Delivery Room
Resuscitation Assignments
• Team leader: airway
• Second rescuer: pulse checkchest compressions
• Third rescuer: medicationsequipment
Newborn Resuscitation Outside the Delivery Room
Antepartum Reasons to Expect a Depressed or Asphyxiated Newborn
• Maternal age older than 35 or younger than 16 years
• Maternal diabetes• Maternal hemorrhage• Drug therapy• Substance abuse• Pevious neonatal death• Lack of prenatal care
Newborn Resuscitation Outside the Delivery Room
• Maternal hypertension • Anemia or isoimmunization• Maternal illness• Multiple fetuses• Small fetus for dates• Preterm/Postterm fetus• Premature rupture of membranes
Newborn Resuscitation Outside the Delivery Room
Antepartum Reasons to Expect a Depressed or Asphyxiated Newborn (cont.)
• Abnormal presentation• Infection• Prolonged labor• Prolonged rupture of membranes• Prolapsed• Maternal sedation
Newborn Resuscitation Outside the Delivery Room
Intrapartum Reasons to Expect a Depressed or Asphyxiated Newborn
• Meconium-stained amniotic fluid• Indexes of fetal distress• Abnormal fetal heart rate• Foul smelling amniotic fluid• Precipitous labor• Profuse bleeding
Newborn Resuscitation Outside the Delivery Room
Intrapartum Reasons to Expect a Depressed or Asphyxiated Newborn (cont.)
• Multiple pregnancy• Meconium-stained fluid• Prematurity• Narcotic use in previous 4 hours
Newborn Resuscitation Outside the Delivery Room
Resuscitation-Oriented History
Newborn Resuscitation Outside the Delivery Room
Inverted PyramidDrying, Warming, Positioning,
Suction, Tactile Stimulation
Oxygen
Bag-Valve-Mask Ventilation
Intubation
Chest Compressions
Medica-tions
Newborn Resuscitation Outside the Delivery Room
Inverted Pyramid--Drying, Warming, Positioning, Suction, Tactile Stimulation
Drying, Warming, Positioning, Suction, Tactile Stimulation
Oxygen
Bag-Valve--Mask Ventilation
Intubation
Chest Compressions
Medica-tions
• Picture of mannequin in proper position
Newborn Resuscitation Outside the Delivery Room
Proper Positioning
• Picture of a oral suctioning
Newborn Resuscitation Outside the Delivery Room
Oral Suctioning
• Picture of Nasal Suctioning
Newborn Resuscitation Outside the Delivery Room
Nasal Suctioning
• Picture of Feet Stimulation
Newborn Resuscitation Outside the Delivery Room
Stimulation of the Feet
• Picture of back Stimulation
Newborn Resuscitation Outside the Delivery Room
Stimulation of the Back, Side View
Newborn Resuscitation Outside the Delivery Room
Inverted Pyramid--OxygenDrying, Warming, Positioning,
Suction, Tactile Stimulation
Oxygen
Bag-Valve--Mask Ventilation
Intubation
Chest Compressions
Medica-tions
Newborn Resuscitation Outside the Delivery Room
Inverted Pyramid--Mask DeviceDrying, Warming, Positioning,
Suction, Tactile Stimulation
Oxygen
Bag-Valve--Mask Ventilation
Intubation
Chest Compressions
Medica-tions
• Apnea or gasping respirations• Heart rate less than 100 bpm• Persistent cyanosis despite oxygen therapy
Newborn Resuscitation Outside the Delivery Room
Indications for Bag-Valve-Mask Ventilation
Newborn Resuscitation Outside the Delivery Room
Bag-Valve-Mask Device in Use
• Assisted rate=40 to 60 breaths per minute• Signs of adequate ventilation
� Bilateral chest expansion� Bilateral breath sounds� Adequate heart rate, color
Newborn Resuscitation Outside the Delivery Room
Ventilation in the Newborn
Newborn Resuscitation Outside the Delivery Room
Inverted Pyramid--IntubationDrying, Warming, Positioning,
Suction, Tactile Stimulation
Oxygen
Bag-Valve--Mask Ventilation
Intubation
Chest Compressions
Medica-tions
• Bag-valve-mask ventilation not effective• Thick meconium• Prolonged positive-pressure ventilation
Newborn Resuscitation Outside the Delivery Room
Indications for Intubation
• Picture of newborn being intubated
Newborn Resuscitation Outside the Delivery Room
Intubation
Newborn Resuscitation Outside the Delivery Room
Inverted Pyramid--Chest Compressions
Drying, Warming, Positioning, Suction, Tactile Stimulation
Oxygen
Bag-Valve--Mask Ventilation
Intubation
Chest Compressions
Medica-tions
• Despite adequate stimulation and effective ventilation with 100% oxygen� Heart rate less than 60 bpm
or
� Heart rate 60 to 80 bpm but not increasing
Newborn Resuscitation Outside the Delivery Room
Indications for Chest Compressions
• Rate: 120 per minute, interposed with ventilations
• Compression-ventilation ratio: 3:1• Stop compressions when heart rate is less
than or equal to 80 bpm
Newborn Resuscitation Outside the Delivery Room
Neonatal Chest Compressions
• Picture of title
Newborn Resuscitation Outside the Delivery Room
Bag-Valve-Mask Ventilation and Two-Finger Chest Compressions
• Picture of title
Newborn Resuscitation Outside the Delivery Room
Bag-Valve-Mask Ventilation and Hands-Around-the-Chest Chest Compression
• Picture of Title
Newborn Resuscitation Outside the Delivery Room
Meconium-Covered Baby
• Picture of suctioning device
Newborn Resuscitation Outside the Delivery Room
Meocium Aspiration Suctioning
Newborn Resuscitation Outside the Delivery Room
Inverted Pyramid--MedicationsDrying, Warming, Positioning,
Suction, Tactile Stimulation
Oxygen
Bag-Valve--Mask Ventilation
Intubation
Chest Compressions
Medica-tions
• Indication: Heart rate less than or equal to 80 bpm despite positive-pressure ventilation and chest compressions
• Dose: 0.01 to 0.03 mg/kg IV, ET, IO (0.1 to 0.3 mL/kg of 1:10,000)
• If no response to ET administration, may increase ET dose to up to 0.1 mg/kg (0.1 mL/kg of 1:1000)
Newborn Resuscitation Outside the Delivery Room
Epinephrine
• Indication� Respiratory depression� Recorded narcotic administration within 4 hours
of delivery• Dose: 0.1 mg/kg IV, IO, ET, IM, SQ• Caution: May cause acute withdrawal
symptoms in infants of chronically addicted mothers
Newborn Resuscitation Outside the Delivery Room
Naloxone
• Picture of title
Newborn Resuscitation Outside the Delivery Room
Umbilical Venous Access
• Picture of Title
Newborn Resuscitation Outside the Delivery Room
Umbilical Artery and Vein inCross-Section
If a newborn deteriorates suddenly, assume airway compromise until this has been ruled out.
Newborn Resuscitation Outside the Delivery Room
Postresuscitation Intubation Complications
• Displaced endotracheal tube• Obstructed endotracheal tube• Pnuemothorax• Equipment failure PLUS:
� Inadequate ventilatory support� Gastric distention
Newborn Resuscitation Outside the Delivery Room
Common Postresuscitation Airway Complications (“DOPE” plus)
• Temperature regulation• Acid-base status• Blood glucose• Laboratory studies• Chest x-ray
Newborn Resuscitation Outside the Delivery Room
Postresuscitation Evaluation and Care
Newborn Resuscitation Outside the Delivery Room
Summary--Inverted PyramidDrying, Warming, Positioning,
Suction, Tactile Stimulation
Oxygen
Bag-Valve-Mask Ventilation
Intubation
Chest Compressions
Medica-tions