Diferencia entre revisiones de «Newborn resuscitation»

Sin resumen de edición
Sin resumen de edición
Línea 2: Línea 2:
==Background==
==Background==
===Newborn Vital Signs===
===Newborn Vital Signs===
HR RR SBP^
*HR RR SBP^
 
*>100 40-80 60-70
>100 40-80 60-70


^<3kg (premature) SBP = 40-60
^<3kg (premature) SBP = 40-60
Línea 14: Línea 13:
** Secondary apnea
** Secondary apnea
* [[Hypothermia]]
* [[Hypothermia]]
* [[Hypoglycemia]]
* [[Hypoglycemia (peds)|Hypoglycemia]]
* [[Meconium aspiration]]
* [[Meconium aspiration]]


Línea 44: Línea 43:
### 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 gtt
## [[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]] (give D10W)===
===^[[Hypoglycemia (peds)|Hypoglycemia]] (give D10W)===
*>2.5 kg = <40 mg/dL
*>2.5 kg = <40 mg/dL
*<2.5 kg = <30 mg/dL
*<2.5 kg = <30 mg/dL

Revisión del 19:01 25 mar 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

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

Treatment

Resucitation 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 drip
      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

  1. 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 catheterization

Preemie (<23-24 wks or 500 gms)

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

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

See Also

Source

Obtenido de «https://www.wikem.org/w/index.php?title=Newborn_resuscitation&oldid=34563»