NEWBORN RESUSCITATION

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Presentation Transcript

NEWBORN RESUSCITATION : 

NEWBORN RESUSCITATION

CORE KNOWLEDGE & SKILLS : 

CORE KNOWLEDGE & SKILLS Establish clear airway Support adequate ventilation & oxygenation Maintain adequate cardiac output Reduce heat loss

EFFECTIVE TRIAGE : 

EFFECTIVE TRIAGE Ideally births should take place in the delivery or birthing room Avoid delays in the field or emergency department

PHASES OF RESUSCITATION : 

PHASES OF RESUSCITATION Preparation Resuscitation Post Resuscitation

PREPARATION : 

PREPARATION Advanced Immediate

RESUSCITATION ASSIGNMENTS : 

RESUSCITATION ASSIGNMENTS Team leader: airway Second rescuer: pulse check chest compressions Third rescuer: medications equipment

Resuscitation Oriented History : 

Resuscitation Oriented History Multiple pregnancy Meconium stained fluid Prematurity Narcotic use in previous 4 hours

Slide 11: 

Clear of meconium Breathing or crying Good muscle tone Color pink Term gestation Routine care Provide warmth Clare airway Dry YES RESUSCITATION PROCEDURES Provide warmth Position, clear airway (as necessary) Dry, stimulate, reposition Give O2 (as necessary) Evaluate respirations heart rate and color Supportive Care Breathing HR > 100 and pink

Slide 12: 

Provide positive pressure ventilation Ongoing Care Ventilating HR > 100 and pink Provide positive ventilation Administer chest compressions Administer epinephrine Apnea or HR < 100 HR < 60 HR > 60

INDICATIONS FOR BAG VALVE MASK VENTILATION : 

INDICATIONS FOR BAG VALVE MASK VENTILATION Apnea or gasping respirations Heart rate < 100 bpm Persistent cyanosis despite oxygen therapy

VENTILATION IN THE NEWBORN : 

VENTILATION IN THE NEWBORN Assisted rate – 40 – 60 breaths per minute Signs of adequate ventilation Bilateral chest expansion Bilateral breath sounds Adequate heart rate,colour

INDICATIONS FOR INTUBATION : 

INDICATIONS FOR INTUBATION Bag valve mask ventilation is ineffective Thick meconium is present Prolonged positive pressure ventilation is required

INDICATIONS FOR CHEST COMPRESSIONS : 

INDICATIONS FOR CHEST COMPRESSIONS Despite adequate stimulation and effective ventilation with 100% oxygen Heart rate < 60bpm

NEONATAL CHEST COMPRESSIONS : 

NEONATAL CHEST COMPRESSIONS Rate : 120 per minute interposed with ventilations Compression ventilation ratio : 3:1 Stop compressions when heart rate is > 80 bpm

Slide 31: 

SPECIAL SITUATIONS MECONIUM ASPIRATION DIAPHRAGMATIC HERNIA

SPECIAL CONSIDERATIONS : 

SPECIAL CONSIDERATIONS MAS – Vigorous VS Non Vigorous Vigorous determined by tone ,respiration & colour Proceed with initial steps Non vigorous – Direct tracheal suctioning Diaphragmatic hernia – NO BVM Nasogastric decompression

Slide 34: 

MEDICATIONS

EPINEPHRINE : 

EPINEPHRINE Indication : Heart rate < 80 bpm despite positive pressure ventilation and chest compressions Dose: 0.01-0.03mg/kg IV,ET,IO(0.1-0.3ml/kg of 1:10,000) If no response to ET administration,may increase ET dose to up to 0.1mg/kg(0.1ml/kg of 1:1000)

NALOXONE : 

NALOXONE Indication : Respiratory depression Recorded narcotic administration within 4 hrs of delivery. Dose

CAUSES OF ACUTE DETERIORATION IN THE INTUBATED INFANT : 

CAUSES OF ACUTE DETERIORATION IN THE INTUBATED INFANT Displaced endotracheal tube Obstructed endotracheal tube Pneumothorax Equipment failure PLUS -Inadequate ventilatory support -Gastric distention

POST RESUSCITATION EVALUATION & CARE : 

POST RESUSCITATION EVALUATION & CARE Temperature regulation Acid Base Status Blood Glucose Laboratory Studies Chest Xray

Slide 41: 

PREVENTION OF NEUROLOGIC SEQUALE Development Assessment at 1,3,6,9,12 months Assessment of Early Indicators of CP Early Identification of sequale and specific treatment and rehabilitation

Mortality Statistics for the Month of Jan-09INBORN Ward : 

Mortality Statistics for the Month of Jan-09INBORN Ward

Mortality Statistics for the Month of Feb-09INBORN Ward : 

Mortality Statistics for the Month of Feb-09INBORN Ward

Mortality Statistics for the Month of March-09INBORN Ward : 

Mortality Statistics for the Month of March-09INBORN Ward

Mortality Statistics for the Month of April-09 INBORN Ward : 

Mortality Statistics for the Month of April-09 INBORN Ward

Mortality Statistics for the Month of May-09INBORN Ward : 

Mortality Statistics for the Month of May-09INBORN Ward