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| == Principles of Resuscitation ==
| | #REDIRECT[[Neonatal resuscitation]] |
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| === Thermal Regulation ===
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| *Place newborn in neutral thermal environment even before initiate ABCs
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| *Gently dry newborn with warm towel
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| === Airway ===
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| *Optimize
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| **Position head in sniffing position
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| **Suction nose and mouth
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| *Intubate
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| **Indicated if pt is poorly responsive or fails BVM
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| **If have time precut ET tube at 13cm mark
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| **Lip placement = 6 + wt (kg)
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| **After intubation suction trachea to prevent aspiration (if +meconium)
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| {| width="200" border="1" cellpadding="1" cellspacing="1"
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| |-
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| | Tube Size / age / wt
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| | Blade
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| | Suction Catheter
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| |-
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| | 2.5 / <28 / <1000
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| | Miller 0
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| | 5F or 6F
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| |-
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| | 3.0 / 28-34 / 1000-2000
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| | Miller 0
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| | 6F or 8F
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| |-
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| | 3.5 / 34-38 / 2000-3000
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| | Miller 0
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| | 8F
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| |-
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| | 3.5-4.0 />38 / >3000
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| | Miller 0-1
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| | 8F or 10F
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| |}
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| ===Breathing===
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| *Apneic and/or bradycardic (<100 bpm)
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| **Attempt tactile stimulation first
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| **If unsuccessful perform BMV at 40-60 breaths/min
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| **After intubation use:
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| ***Inflation pressure ~ 20
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| ===Circulation===
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| *CPR
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| **Begin if despite assisted ventilation x30s HR still <60
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| **3 compressions:1 breath (total 90 compresions:30 breaths per min)
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| ====Vascular Access====
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| *Umbilical vein is site of choice
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| ====Volume Expansion====
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| *NS 10-20mL/kg IV over 5-10min
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| *O Rh-negative blood
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| ====Medications====
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| *Epinephrine
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| **Indicated for aystole or HR < 60 despite CPR >30s
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| **0.01-0.03mg/kg IVP q3-5min
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| *Sodium Bicarbonate
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| **Helps to counteract negative inotropy/pulm HTN caused by acidosis
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| **Only give once adequate ventilation is established
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| **1-2 mEq/kg of 4.2% solution (2-4 mL/kg)
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| *Naloxone
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| **Give if persistent resp depression AND maternal narcotics w/in 4hr
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| **0.1mg/kg IV
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| ==Special Problems==
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| ===Cyanosis===
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| *Must distinguish between central and peripheral
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| *Consider prostaglandin E1 0.05-0.1 mcg/kg/min for cyanotic heart dz
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| ===Pneumothorax===
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| *Tension PTX is highly related to subsequent ICH
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| **Place 18-20ga catheter into 4th IC in ant axillarly line
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| ===Hypoglycemia===
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| *<30-35 in preterm newborn
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| *<35-40 in term newborn
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| *Treatment
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| **D10W 2mL/kg IV
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| ===Congenital Diaphragmatic Hernia===
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| *Persistent respiratory distress w/ "seesaw" pattern
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| *Treat via immediate intubation, OG tube placement
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| **Use lowest peak insp presure that allows for adequate chest rise
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| ==Withholding Resuscitation==
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| *Consider if:
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| **<22wk or <400g
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| **No signs of life after 10min of CPR
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| == See Also ==
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| [[Pediatric Advanced Life Support (PALS)]] | |
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| == Source ==
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| Tintinalli
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| [[Category:Peds]]
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| [[Category:Critical Care]]
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| [[Category:EMS]]
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