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Línea 40: Línea 40:
### HR <100/min
### HR <100/min
### Persistent cyanosis
### Persistent cyanosis
## ET** (indications)
## ET^^ (indications); ETT size = Gest age (wks) / 10
 
### BVM ineffect after 30s
    ETT size = Gest age (wks) / 10
### Suction meconium**
 
# Chest compressions (indications)
          i) BVM ineffect after 30s
## HR <60 after above x 30 sec
 
### 120/min (resp 3:1)
          ii) Suction meconium**
### Stop when HR > 60
 
# Medications^^^^
4) Chest compressions (indications)
## Epi (0.01-0.03 mg/kg)
 
## D10W (4 mL/kg = 0.2gm/kg)
    a) HR <60 after above x 30 sec
## Nalaxone (0.4 mg/kg)
 
### For opiod use <4hrs
          i) 120/min (resp 3:1)
## NS (10 mL/kg boluses)
 
## Dopamine gtt
          ii) Stop when HR > 60
###(5-20 mcg/kg/min)
 
## NaHCO3 - prolonged resus
5) Medications****
###(1-2 meQ/kg)
 
(if HR <60 despite above)
 
    a) Epi (0.01-0.03 mg/kg)
 
    b) D10W (4 mL/kg = 0.2gm/kg)
 
    c) Nalaxone (0.4 mg/kg)
 
          i) For opiod use <4hrs
 
    d) NS (10 mL/kg boluses)
 
    e) Dopamine gtt
 
    (5-20 mcg/kg/min)
 
    f) NaHCO3 - prolonged resus
 
    (1-2 meQ/kg)
 
   
   
^HYPOGLYCEMIA (give D10W)
*>2.5 kg = <40 mg/dL
*<2.5 kg = <30 mg/dL


*HYPOGLYCEMIA (give D10W)
===^^MECONIUM SUCTIONING INDICATIONS===
 
>2.5 kg = <40 mg/dL
 
<2.5 kg = <30 mg/dL
 
 
**MECONIUM SUCTIONING INDICATIONS
 
Meconium + -->
Meconium + -->
 
# absent/depressed resp
1) absent/depressed resp
# poor muscle tone
 
# HR <100
2) poor muscle tone
 
3) HR <100


(2 passes w/ ET + suction)
(2 passes w/ ET + suction)


===^^^NEWBORN VENT SETTINGS===
 
***NEWBORN VENT SETTINGS
 
Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)
Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)


===^^^^UMBILICAL VEIN ACCESS===
 
#Cut cord 1 & 1/2 inch
****UMBILICAL VEIN ACCESS
# 5F cath, 3-way stopcock
 
# Feed the 'mouth'
1) Cut cord 1 & 1/2 inch
# Place until get blood flow (-4 cm)
 
2) 5F cath, 3-way stopcock
 
3) Feed the 'mouth'
 
3) Place until get blood flow (-4 cm)
 
 
DETERIORATION AFTER INTUBATION


==DETERIORATION AFTER INTUBATION==
D - Displacement (flexion pushes in, exten pulls it out)
D - Displacement (flexion pushes in, exten pulls it out)


Línea 130: Línea 88:
E - Equipment failure
E - Equipment failure


==PREEMIE (<23-24 wks or 500 gms)==
# rapid volume may inc risk of IVH
# usually ETT immed


PREEMIE (<23-24 wks or 500 gms)
==GROUP B SEPSIS==
 
# Early (1dy-1wk)
1) rapid volume may inc risk of IVH
## p/w PNA, meningitis, sepsis
 
## risk factors
2) usually ETT immed
### premature
 
### maternal fever
### PROM> 18 hrs
 
### low wt.
GROUP B SEPSIS
# Late (2-4 wks)
 
## p/w meningitis
1) Early (1dy-1wk)
 
    a) p/w PNA, meningitis, sepsis
 
    b) risk factors
 
          i) premature
 
          ii) maternal fever
 
          iii) PROM> 18 hrs
 
          iv) low wt.
 
2) Late (2-4 wks)
 
    a) p/w meningitis
 


APGAR: 0 1 2
APGAR: 0 1 2
Línea 173: Línea 114:


Reflex no resp grimace cough
Reflex no resp grimace cough


==Equipment==
==Equipment==
 
# blankets, warmer, umbilical clamps
 
# Bulb suction or wall suction
- blankets, warmer, umbilical clamps
# Catheters (5F,8F,10F)
 
#Meconium aspirators
- Bulb suction or wall suction
#BVM
 
# ETT 2.5-4.0 w/ stylets
- Catheters (5F,8F,10F)
# Blades 0 & 1
 
# IV catheters (22 & 24 g)
- Meconium aspirators
# Umbilical caths (3.5 F & 5F)
 
# syringes, 3 way stop cocks
- BVM
# Epi 1:10,000
 
# Naloxone 0.4 mg/ml or 1 mg/ml
- ETT 2.5-4.0 w/ stylets
# NaHCO3 4.2% or 8.4%
 
# NS & D10W
- Blades 0 & 1
 
- IV catheters (22 & 24 g)
 
- Umbilical caths (3.5 F & 5F)
 
- syringes, 3 way stop cocks
 
- Epi 1:10,000
 
- Naloxone 0.4 mg/ml or 1 mg/ml
 
- NaHCO3 4.2% or 8.4%
 
- NS & D10W
 


==Source==
==Source==
2/26/05 DONALDSON (adapted from Rosen, Lampe, Young)
2/26/05 DONALDSON (adapted from Rosen, Lampe, Young)


[[Category:Peds]]
[[Category:Peds]]
[[Category:Airway/Resus]]

Revisión del 22:13 7 jun 2011

Background

NEWBORN VITAL SIGNS

HR RR SBP^

>100 40-80 60-70

^<3kg (premature) SBP = 40-60

DDx

COMMON NEWBORN PROBLEMS

  1. Hypoxia
    1. Primary apnea
    2. Secondary apnea
  2. Hypothermia
  3. Hypoglycemia
  4. Meconium asp

Consider DDx (esp if older neonate)

  1. Sepsis
  2. Congenital Heart Dz (PGE)
  3. Inborn Error of Metabolism (lactate)

Diagnosis

ASSESSMENT TRIAD

  1. Respiration- adequacy, difficulty
  2. HR >100, umbilical
  3. Color

Treatment

RESUSCITATION INVERSE PYRAMID

  1. Dry, warm, position, suction, stimulate
    1. position: neutral (towel --> thorax)
    2. suction: oral then nasal
    3. stim: along spine or feet
    4. check glucose^
  2. Oxygen (use liberally)
  3. Ventilate (40-60 breaths/min @ 20-25 cmH20)
    1. BVM (indications)
      1. Apnea/gasping
      2. HR <100/min
      3. Persistent cyanosis
    2. ET^^ (indications); ETT size = Gest age (wks) / 10
      1. BVM ineffect after 30s
      2. Suction meconium**
  4. Chest compressions (indications)
    1. HR <60 after above x 30 sec
      1. 120/min (resp 3:1)
      2. Stop when HR > 60
  5. Medications^^^^
    1. Epi (0.01-0.03 mg/kg)
    2. D10W (4 mL/kg = 0.2gm/kg)
    3. Nalaxone (0.4 mg/kg)
      1. For opiod use <4hrs
    4. NS (10 mL/kg boluses)
    5. Dopamine gtt
      1. (5-20 mcg/kg/min)
    6. NaHCO3 - prolonged resus
      1. (1-2 meQ/kg)

^HYPOGLYCEMIA (give D10W)

  • >2.5 kg = <40 mg/dL
  • <2.5 kg = <30 mg/dL

^^MECONIUM SUCTIONING INDICATIONS

Meconium + -->

  1. absent/depressed resp
  2. poor muscle tone
  3. HR <100

(2 passes w/ ET + suction)

^^^NEWBORN VENT SETTINGS

Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)

^^^^UMBILICAL VEIN ACCESS

  1. Cut cord 1 & 1/2 inch
  2. 5F cath, 3-way stopcock
  3. Feed the 'mouth'
  4. Place until get blood flow (-4 cm)

DETERIORATION AFTER INTUBATION

D - Displacement (flexion pushes in, exten pulls it out)

O - Obstruction of tube

P - PTX

E - Equipment failure

PREEMIE (<23-24 wks or 500 gms)

  1. rapid volume may inc risk of IVH
  2. usually ETT immed

GROUP B SEPSIS

  1. Early (1dy-1wk)
    1. p/w PNA, meningitis, sepsis
    2. risk factors
      1. premature
      2. maternal fever
      3. PROM> 18 hrs
      4. low wt.
  2. Late (2-4 wks)
    1. p/w meningitis

APGAR: 0 1 2

HR absent <100 >100

Resp absent slow,irr good

Tone limp some flex active

Color blue,pale blue ext pink

Reflex no resp grimace cough

Equipment

  1. blankets, warmer, umbilical clamps
  2. Bulb suction or wall suction
  3. Catheters (5F,8F,10F)
  4. Meconium aspirators
  5. BVM
  6. ETT 2.5-4.0 w/ stylets
  7. Blades 0 & 1
  8. IV catheters (22 & 24 g)
  9. Umbilical caths (3.5 F & 5F)
  10. syringes, 3 way stop cocks
  11. Epi 1:10,000
  12. Naloxone 0.4 mg/ml or 1 mg/ml
  13. NaHCO3 4.2% or 8.4%
  14. NS & D10W

Source

2/26/05 DONALDSON (adapted from Rosen, Lampe, Young)

Obtenido de «https://www.wikem.org/w/index.php?title=Newborn_resuscitation&oldid=2591»