Diferencia entre revisiones de «Newborn resuscitation»

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Sin resumen de edición
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==Diagnosis==
==Diagnosis==
Assessment Triad
Assessment Triad
# Respiration- adequacy, difficulty
* Respiration- adequacy, difficulty
# HR >100, umbilical
* HR >100, umbilical
# Color
* Color


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


(2 passes w/ ET + suction)
(2 passes w/ ET + suction)
Línea 71: Línea 71:


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


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


==See Also==
==See Also==

Revisión del 18:38 14 may 2015

Use this note for immediate after-delivery resuscitation; see neonatal resuscitation for the non-delivery related resuscitation of the newborn.

Background

Newborn Vital Signs

  • HR RR SBP^
  • >100 40-80 60-70

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

Differential Diagnosis

Common Newborn Problems

Diagnosis

Assessment Triad

  • Respiration- adequacy, difficulty
  • HR >100, umbilical
  • Color

Treatment

Resucitation Inverse Pyramid

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

^Hypoglycemia (give D10W)

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

^^Meconium Suctioning Indications

  • Meconium + -->
    • absent/depressed resp
    • poor muscle tone
    • HR <100

(2 passes w/ ET + suction)

^^^Newborn Vent Settings

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

^^^^Umbilical vein catheterization

Preemie (<23-24 wks or 500 gms)

  • rapid volume may inc risk of IVH
  • usually ETT immed

Equipment

  • blankets, warmer, umbilical clamps
  • Bulb suction or wall suction
  • Catheters (5F,8F,10F)
  • Meconium aspirators
  • BVM
  • ETT 2.5-4.0 w/ stylets
  • 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

See Also

Source

Obtenido de «https://www.wikem.org/w/index.php?title=Newborn_resuscitation&oldid=37612»