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Neonatal Resuscitation
-BLS-
RC 290
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Equipment Needed
Overhead radiant warmerBulb syringeBVM with heated & humidified O2De Lee suction deviceSize 5 Fr suction catheters and wall suctionLaryngoscope with proper sized bladesProper sized ET tubesCrash cart/Drug box
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Normal Delivery Procedures
Place under warmer and towel dryUse bulb syringe to clear mouth, than noseTactile stimulation if not breathing yet Auscultate heart and lungs & assess colorProphylactic silver nitrate or erythromycin drops in eyesVitamin K injectionExamine umbilical cordFree flow O2 as needed
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Free Flow O2
Hold O2 connecting tubing ½ inch from infants face. Run flow at 5 LPM
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Resuscitation
Maternal causes:– Drugs– Cardiopulmonary
problems– Infection– Dystocia– Utero-Placental problems
Fetal Causes– Cord compression– Prematurity– Congenital anomalies– Multiple pregnancy– Meconium aspiration– Hypothermia– shock
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NRP Resuscitation Algorithm
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Meconium Baby
Airway is aggressively cleared prior to drying if infant is meconium stained AND baby is NOT vigorous! – Use ET tube as a suction
deviceMay need PD & P after heart rate, respirations, and color stabilizeIf baby is meconium stained but vigorous, proceed with normal resuscitation
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Bagging a Neonate
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BVM Devices
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BVM Devices
Flow-dependent anesthesia bag
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Bagging Technique
Place infant in “sniffing” position by placing a small towel under the shouldersDo not hyperextend neck!
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Bagging technique (cont.)
Apply correctly sized mask over infants mouth and nose with apex of mask over bridge of nose
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Run either type of bag at 5-8 LPM to get 100% FIO2– If self-inflating bag, use reservoir also
Watch for slight rise of chest (Vt ~ 20-30 ml)Rate is 40-60 Pressure– First breath may require 30-40
cmH2O– Then, with normal lungs, 15-20
cmH2O– Poor lung compliance may require
sustained 20-40 cmH2O
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If BVM ventilation lasts over 2 minutes…
Than an orogastric tube has to be inserted
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Neonatal PD & P
Meconium babies and/or C section babiesNo more than 20 degrees of Trendelenberg or ICP will increasePercuss anterior and lateral surfaces 1-2 minutes
Maintain airway throughout using one hand on headSuction PRNBesides suction, need BVM and O2Monitor heart rate, respirations and color throughout
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Neonatal PD & P Percussors
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Neonatal Chest Compressions
Asystole or bradycardia less than 60 that is not increasing with airway and ventilationUse thumbs on lower half of sternum (one finger’s width below nipple line)Compress ½ to ¾ of an inch, 120 times per minuteCompression ventilation ratio is 3:1 (pause to give breath)
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The End Result