|
|
| (One intermediate revision by the same user not shown) |
| Line 1: |
Line 1: |
| == Principles of Resuscitation ==
| | #REDIRECT[[Neonatal resuscitation]] |
| | |
| === Thermal Regulation ===
| |
| | |
| *Place newborn in neutral thermal environment even before initiate ABCs
| |
| *Gently dry newborn with warm towel
| |
| | |
| === Airway ===
| |
| | |
| *Optimize
| |
| **Position head in sniffing position
| |
| **Suction nose and mouth
| |
| *Intubate
| |
| **Indicated if pt is poorly responsive or fails BVM
| |
| **If have time precut ET tube at 13cm mark
| |
| **Lip placement = 6 + wt (kg)
| |
| **After intubation suction trachea to prevent aspiration (if +meconium)
| |
| | |
| {| width="200" border="1" cellpadding="1" cellspacing="1"
| |
| |-
| |
| | Tube Size / age / wt
| |
| | Blade
| |
| | Suction Catheter
| |
| |-
| |
| | 2.5 / <28 / <1000
| |
| | Miller 0
| |
| | 5F or 6F
| |
| |-
| |
| | 3.0 / 28-34 / 1000-2000
| |
| | Miller 0
| |
| | 6F or 8F
| |
| |-
| |
| | 3.5 / 34-38 / 2000-3000
| |
| | Miller 0
| |
| | 8F
| |
| |-
| |
| | 3.5-4.0 />38 / >3000
| |
| | Miller 0-1
| |
| | 8F or 10F
| |
| |}
| |
| | |
| | |
| ===Breathing===
| |
| | |
| *Apneic and/or bradycardic (<100 bpm)
| |
| **Attempt tactile stimulation first
| |
| **If unsuccessful perform BMV at 40-60 breaths/min
| |
| **After intubation use:
| |
| ***Inflation pressure ~ 20
| |
| | |
| ===Circulation===
| |
| *CPR
| |
| **Begin if despite assisted ventilation x30s HR still <60
| |
| **3 compressions:1 breath (total 90 compresions:30 breaths per min)
| |
| ====Vascular Access====
| |
| *Umbilical vein is site of choice
| |
| ====Volume Expansion====
| |
| *NS 10-20mL/kg IV over 5-10min
| |
| *O Rh-negative blood
| |
| ====Medications====
| |
| *Epinephrine
| |
| **Indicated for aystole or HR < 60 despite CPR >30s
| |
| **0.01-0.03mg/kg IVP q3-5min
| |
| *Sodium Bicarbonate
| |
| **Helps to counteract negative inotropy/pulm HTN caused by acidosis
| |
| **Only give once adequate ventilation is established
| |
| **1-2 mEq/kg of 4.2% solution (2-4 mL/kg)
| |
| *Naloxone
| |
| **Give if persistent resp depression AND maternal narcotics w/in 4hr
| |
| **0.1mg/kg IV
| |
| | |
| ==Special Problems==
| |
| ===Cyanosis===
| |
| *Must distinguish between central and peripheral
| |
| *Consider prostaglandin E1 0.05-0.1 mcg/kg/min for cyanotic heart dz
| |
| ===Pneumothorax===
| |
| *Tension PTX is highly related to subsequent ICH
| |
| **Place 18-20ga catheter into 4th IC in ant axillarly line
| |
| ===Hypoglycemia===
| |
| *<30-35 in preterm newborn
| |
| *<35-40 in term newborn
| |
| *Treatment
| |
| **D10W 2mL/kg IV
| |
| ===Congenital Diaphragmatic Hernia===
| |
| *Persistent respiratory distress w/ "seesaw" pattern
| |
| *Treat via immediate intubation, OG tube placement
| |
| **Use lowest peak insp presure that allows for adequate chest rise
| |
| ==Withholding Resuscitation==
| |
| *Consider if:
| |
| **<22wk or <400g
| |
| **No signs of life after 10min of CPR
| |
| | |
| == See Also ==
| |
| [[Pediatric Advanced Life Support (PALS)]] | |
| | |
| == Source ==
| |
| Tintinalli
| |
| | |
| [[Category:Peds]]
| |
| [[Category:Airway/Resus]]
| |
| [[Category:EMS]]
| |
