yenidoğan canlandırma programı 5-1 6. lesson drugs
TRANSCRIPT
Yenidoğan Canlandırma Programı 5-2
Course contents
• Neonatal drug indications in newborn resuscitation• The drugs used in resuscitating a newborn• Routes of administration of drugs during the
resuscitation of a newborn • Umbilical venous catheter insertion• Adrenaline use• The use of volume expanders during the
rescuscitation of a newborn
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If the heart rate, in spite of ventilation and chest compression is below 60
beats / min, be sure that the ventilation and compression are
applied effectively .!
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Newborn drug delivery routes
• Umbilical
• Endotracheal tube
• Intraosseous
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Performing umbilical catheterization
• Clean with iodine
• Do a flat incision just leaving 1-2
cm on the cord
• Insert the catheter into the
umbilical vein through the skin
• Control by 0.5 ml saline
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Endotracheal tube
• The fastest way to apply
• However, absorption is not reliable
• Higher doses should be used ,n comparison to intravenous route
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Intraosseous
• Limited data on its use in newborns
• May be an alternative
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Adrenaline indication Effective positive pressure ventilation for 30
seconds
Effective ventilation for 60 sec + compression
Heart rate below 60 beats / min
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As a result of effective ventilation and compression for a period of 60
seconds, if heart rate is below 60 beats / min adrenaline should be
administered through the umbilical way .
!
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Adrenaline
• Increases both the rate and strength of heart contractions
• Leads to peripheral vasoconstriction
• May increase blood flow to the brain and coronary arteries
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If adrenaline is given early
• Time for appropriate ventilation is consumed for the drug administration
• If adrenaline is given without ensuring adequate ventilation, increased oxygen demand may cause myocardial damage
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Adrenaline useRecommended concentration= 1/10 000
The recommended route= intravenous (endotracheal route should be considered until you open intravenous access )
The recommended dose =1/10 000 solution, 0.1 - 0.3 ml / kg (for endotracheal route, consider 0.5 to 1ml / kg)
Recommended preparation = 1/10 000 solution in a 1 mL syringe ( Use a larger syringe in case of endotracheal route)
Recommended delivery speed = Fast- as possible
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Dilution of adrenaline
1 mg=1 mL (1/1 000) Adrenaline + 9 mL distilled water =1/10 000
0,5 mg=1 mL (1/2 000) Adrenaline + 4 mL distilled water =1/10 000
0,25 mg=1 mL (1/4 000) Adrenaline + 1.5 mL distilled water= 1/10 000
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The expected effect of adrenaline
• Continue ventilation with 100% oxygen and heart compression
• Heart rate increases above 60 beats/min in 60 secs.
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If no improvement • Control the efficacy of ventilation and compression
• Insert endotracheal tube/check
• Dose may be repeated in every 3-5 min
• If low dose is used in beginning, increase to highest doses during the repeat doses.
• Apply repeated doses via intravenous route, if possible
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If the baby seems to be in shock and does not respond to
resuscitation, consider to give volume expander.
!
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Signs of shock
• Paleness
• Prolonged capillary filling time
• Weak pulse
• Low or "0" blood pressure
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Volume expanders
• 0.9% NaCl (normal saline)
• Ringer's lactate
• O Rh (-) erythrocyte suspension (in case of severe fetal anemia)
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Volume expanders
Recommended solution = saline solution
Recommended dose = 10 ml / kg
Recommended route = umbilical vein
Recommended speed = 5 to 10 min