Neonatal Resuscitation. Jess Paul UBC RCPC-EM Residency Program RCH Grand Rounds April 23, 2014

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Neonatal Resuscitation. Jess Paul UBC RCPC-EM Residency Program RCH Grand Rounds April 23, 2014"

Transcription

1 + Neonatal Resuscitation Jess Paul UBC RCPC-EM Residency Program RCH Grand Rounds April 23, 2014

2 + NRP: Who cares?

3 + Who cares? 4.2% participation in a NNR 38.7% previous NNR training 75-85% rated comfort, knowledge, and preparedness for caring for sick neonates as poor or very poor

4 + Who cares? 90% make intrauterine to extrauterine transition without aide 10% require basic resuscitation 1% require advanced resuscitation

5 + NRP Stop, breathe WARM, DRY, STIMULATE!!! Ventilation

6 + NRP Lesson 1: Overview and Principles of Resuscitation Lesson 2: Initial Steps of Resuscitation Lesson 3: Use of Resuscitation Devices for Positive-Pressure Ventilation Lesson 4: Chest Compressions Lesson 5: Endotracheal Intubation and LMA Insertion Lesson 6: Medications Lesson 7: Special Considerations Lesson 8: Resuscitation of Babies Born Preterm Lesson 9: Ethics and Care at the End of Life

7 + Lesson 1: Overview and Principles of Resuscitation

8 +

9 +

10 +

11 +

12 + Transition Trouble Persistent pulmonary Hypertension Failure of pulmonary arterioles to relax Systemic hypotension Poor cardiac contractility Bradycardia Lungs not filling with air Fluid remaining despite initial breaths Meconium blockage

13 +

14 +

15 +

16 + Equipment No longer optional in the birth setting, and should be available for every birth: a. Compressed air source b. Oxygen blender to mix oxygen and compressed air with flowmeter c. Pulse oximeter for neonatal use and oximeter probe d. Laryngeal mask airway (size 1) Suction, warmer, intubation kit, umbilical catheter set

17 + Quiz What % of newborns need extensive resuscitation?

18 + Quiz A baby doesn t begin breathing in response to stimulation, you assume she is in apnea and should provide.

19 + The Bottom Line Only 10% require some assistance. Only 1% need major resuscitation measures. Ventilation!!! (most often fixes HR) Teamwork! Flow: A: Initial Steps B: Adequate Ventilation C: Chest Compressions D: Epinephrine

20 + Lesson 2: Initial Steps of Resuscitation

21 + 3 Essential Questions

22 +

23 +

24 +

25 +

26 +

27 +

28 +

29 +

30 +

31 +

32 + CPAP/blended O2/sup O2 If HR >100 but not at target sats or if irregular resps Start at 21% O2 then blend up to target sat CPAP: 5-6 mm H20 pressure

33 +

34 + Meconium!!!

35 + Suction to mm H2O

36 + Quiz 3 questions you ask at every delivery?

37 + Term infant, mec delievery, good tone and crying. Resuscitation?

38 + The Bottom Line Sniffing position Tackle stimulation Fetus has O2 sat of 60%, can take 10 mins to reach >90% If persistent apnea despite stimulation: PPV! Oximeter guided O2 targets Vigorous: Good tone Strong resp efforts HR <100

39 + Lesson 3: Positive Pressure Ventilation

40 +

41 +

42 +

43 + OG: 8 F feeding tube

44 + Quiz Begin resuscitation of term newborns with %O2? Indications for PPV? (3) PPV PIP and PEEP pressures?

45 + The Bottom Line No blow-by or CPAP with self inflating bags PPV can be discontinued: HR >100 Appropriate O2 sats Onset of spontaneous resps Effective ventilation: Bilateral breath sounds Chest movement PPV: Apnea/gasping HR <100 Persistent cyanosis and low O2 if supp O2 at 100%

46 + Lesson 4: Chest Compressions HR <60 despite 30 seconds of adequate ventilation 100% O sec before pulse check If still HR <60; intubate and epi Rate: Chest compressions 90/min Breathes 30/min 3:1 ratio

47 +

48 +

49 +

50 + Quiz A baby has required 60secs of chest compressions and is ventilated with a BMV. The chest is not moving well. The heart rate is 4 in 6 seconds. Now what?

51 + Quiz Chest compressions are indicated after seconds of adequate ventilation for a heart rate below? O2 concentration during CPR? Phrase used to time and coordinate CPR to ventilation? Time before HR check? Rate of CPR, rate of ventilation?

52 + The Bottom Line If HR <60 despite 30 secs of adequate ventilation, start chest compressions Once chest compressions; 100% O2 until oximeter working Two thumb technique preferred 1 and 2 and 3 and breathe cadence CPR 90/min and RR 30/min (3:1 ratio) HR check at sec, if HR < 60: intubate and epi

53 + Lesson 5: Endotracheal Intubation and LMA Insertion

54 + Intubation No RSI drugs needed No atropine pre treatment Miller blade 00 extreme preterm 0 preterm 1 term

55 +

56 + LMA Size 1 Contraindicated in: Meconium Preterm infants (<32 wks) or <2000g

57 + Quiz Blade size for term infant? ETT size for 2000g infant?

58 + The Bottom Line ETT sized by weight Blade by GA Depth: wt in kg +6 No LMA <32 wks mec Indications: Non-vigorous mec suctioning If BMV not effective or prolonged During chest compressions Special circumstances: Extreme prematurity Surfactant administration Diaphragmatic hernia

59 + Lesson 6: Medications Epi only if HR<60 after 30 sec adequate ventilation ETT epi only while IV being established only IO? Epi 1:10,000 1m1/kg by ET (max 3ml dose) 0.1m1/kg by IV Q3-5min

60 +

61 + Umbilical Vein Catheter Steps sterile field : antiseptic, gloves, PPE Loose tie at base 3.5F (<3.5 kg); 5 F (>3.5kg) 3 way stopcock and 3ml syringe Cut perpendicular at 1-2cm above skin Depth 2-4cm Withdrawal blood Epi, NS flush, and secure with tape

62 +

63 +

64 + NEJM UVC Video Emergent UVC JMvcm

65 + Fluid Replacement Fetal/maternal hemorrhage or fetal shock NS/Ringers/Whole blood 10ml/kg IV over 5-10mins

66 + Quiz What is the potential problem with ETT epi? Pulse check how often? If HR <60, how often for epi? Epi concentration? Epi by umbilical vein should be followed by what? Fluid resuscitation dose?

67 + The Bottom Line Epi only if HR<60 after 30 sec adequate ventilation ETT epi only while IV being established only Fluid Fetal/maternal hemorrhage or shock despite resuscitation NS/Ringers/whole blood 10ml/kg IV over 5-10 mins Epi 1:10,000 1m1/kg by ET x 1(max 3ml dose) 0.1m1/kg by IV Q

68 + Lesson 7: Special Considerations

69 + Choanal Atresia

70 + Pierre Robin Syndrome

71 + Congenital Diaphragmatic Hernia

72 + Pneumothorax (transillumination)

73 + Pleural effusions

74 + Hypoglycemia IV glucose: <4 and symptomatic <2.5 and asymptomatic for 0-4 hrs of age <3.5 and asymptomatic for 4-24 hrs of age D10W 2ml/kg then D10W infusion ml/kg/day Repeat Q10-20mins Avoid D25W as hyperosmolar

75 + Maternal Opioid Use Naloxone 0.1mg/kg Only after initial resuscitation Not for chronic/methadone maternal use Pulmonary hypertension Supp O2 or PPV Congenital Heart Disease Metabolic Acidosis No bicarb unless adequate ventilation

76 + Therapeutic Hypothermia >36 wks and perinatal asphyxia Seizures Altered LOC Hypotonia Hyporeflexia Can improve outcomes of severe hypoxic-ischemic encephalopathy Initiated within 6 hrs C for 72 hrs

77 + Quiz Baby with choanal atreasia. What do you do? A mec baby has been resuscitated and then develops acute respiratory deterioration. A? should be expected.

78 + The Bottom Line Diaphragmatic hernia: intubate and OG Choanal atresia: oral airway Pierre Robin: prone and NP airway Congenital cardiac disease rarely causes acute issues Naloxone only after resus in recent maternal opioid use babies Ongoing monitoring of temp, BG, O2 sat

79 + Lesson 8: Preterm Resuscitation Increased heat loss Weak chest muscles Immature immune systems Fragile intracranial capillaries Small blood volume Limited surfactant

80 + <29 wk: polyethylene bag wrap and warmer Monitor O2 sat from beginning; avoid hyperoxia Giving PEEP Don t give surfactant until fully resuscitated Handle baby gently No trendelenburg

81 + Quiz In addition to a warmer, what else can you use to keep a 27 week baby warm? A baby at 30 wk GA, required PPV for an initial HR of 80. She responds quickly with rising HR and spontaneous respirations. At 2 mins of age, she is breathing, has a HR of 140 and CPAP at 50% O2. Her sats are 95%. What should you do: Increase the O2 concentration? Decrease the O2 concentration? Leave the O2 concentration the same?

82 + The Bottom Line Increased risk of resuscitation in preemies More vulnerable to hyperoxia: target 85-95% Increased heat loss bag wrap <29 weeks PEEP if intubated Decrease risk of brain injury Continuous monitoring

83 + Lesson 9: Ethics and Care at the End of Life Discontinuation of resuscitation: 10 mins of no HR

84 + Practicality

85 + The Very Bottom Line Vigorous: stay with mom (even if meconium) Warm, dry, stimulate Ventilation!!! No chest compressions until ventilation until adequate for 30 sec and HR <60 Umbilical vein catheter is not that hard

86 + Acknowledgements Kristyn Chatwin: RCH NRP Coordinator References: AHA. Textbook of Neonatal Resuscitation. 6 edition. Elk Grove Village, Dallas, Tex: American Academy of Pediatrics; Anon. Addendum to the NRP Provider Textbook 6th Edition; Recommendations for specific modifications in the Canadian context Lo MD, Mazor SS. Chapter 11 Neonatl Resuscitation. In: Rosen s Emergency Medicine-Concepts and Clinical Practice.Vol 1. 8th ed. Anon. CPS Medications for Neonatal Rsuscitation Program 2011 Canadian Adaptation. Kester-Greene N, Lee JS. Preparedness of urban, general emergency department staff for neonatal resuscitation in a Canadian setting. CJEM. 2013;15(0):1 7. Anderson J, Leonard D, Braner DAV, Lai S, Tegtmeyer K. Umbilical Vascular catheterization. New England Journal of Medicine

Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context

Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context A subcommittee of the Canadian Neonatal Resuscitation Program (NRP) Steering Committee

More information

AHA/AAP Neonatal Resuscitation Guidelines 2010: Summary of Major Changes and Comment on its Utility in Resource-Limited Settings

AHA/AAP Neonatal Resuscitation Guidelines 2010: Summary of Major Changes and Comment on its Utility in Resource-Limited Settings AHA/AAP Neonatal Resuscitation Guidelines 2010: Summary of Major Changes and Comment on its Utility in Resource-Limited Settings Resuscitation step Recommendations (2005) Recommendations (2010) Comments/LOE

More information

NRP 2012 Putting New Resuscitation Guidelines into Practice

NRP 2012 Putting New Resuscitation Guidelines into Practice Outreach Education Online Video Library for Healthcare Professionals NRP 2012 Putting New Resuscitation Guidelines into Practice. Jeanette Zaichkin, RN, MN, NNP-BC December 2, 2010 Program Handouts This

More information

Clear the Airway. Assess Breathing. Assess Heart Rate

Clear the Airway. Assess Breathing. Assess Heart Rate 200 CHAPTER 9: Emergency Delivery and Newborn Stabilization oxygen consumption. Thoroughly dry every infant, healthy, or depressed. Remove wet towels or blankets from around the baby after drying and replace

More information

Pediatric Newborn Assessment, Treatment and Resuscitation

Pediatric Newborn Assessment, Treatment and Resuscitation Date: May 31, 2012 Page 1 of 5 Pediatric Newborn Assessment, Treatment and Resuscitation This protocol should be followed for all newly born infants. Pre-Medical Control MFR/EMT/ 1. As the infant is being

More information

NRP Study Guide Bethanie Christopher, RN (626) fax (626) Revised 1/2012

NRP Study Guide Bethanie Christopher, RN (626) fax (626) Revised 1/2012 NRP Study Guide Bethanie Christopher, RN (626) 441-3406 fax (626) 441-2791 www.lifesavered.com Revised 1/2012 NRP 6 th Edition Need-to-Know Information 1. A baby who is breathing or crying, has good muscle

More information

Neonatal Resuscitation -Golden first minute. Dr Ameet Patki MD,DNB,FCPS,FICOG,FRCOG Chairperson FOGSI Perinatolgy Committee

Neonatal Resuscitation -Golden first minute. Dr Ameet Patki MD,DNB,FCPS,FICOG,FRCOG Chairperson FOGSI Perinatolgy Committee Neonatal Resuscitation -Golden first minute Guidelines Dr Ameet Patki MD,DNB,FCPS,FICOG,FRCOG Chairperson FOGSI Perinatolgy Committee On Behalf of the Committee FOGSI Statement for Neonatal Resuscitation:

More information

AHE: NRP AAP/AHA COURSE COMPONENTS

AHE: NRP AAP/AHA COURSE COMPONENTS ADVANCED HEALTHCARE EDUCATION 2011 6 TH EDITION - KEY POINT STUDY GUIDE IMPORTANT INFORMATION FOR STUDENTS REGISTERING FOR CLASSES AFTER 01/011/2012. AAP HAS RESTRUCTURED NRP TO NOW REQUIRE COMPLETION

More information

NEONATAL RESUSCITATION PROVIDER (NRP) RECERTIFICATION TABLE OF CONTENTS

NEONATAL RESUSCITATION PROVIDER (NRP) RECERTIFICATION TABLE OF CONTENTS NEONATAL RESUSCITATION PROVIDER (NRP) RECERTIFICATION TABLE OF CONTENTS NEONATAL FLOW ALGORITHM.2 INTRODUCTION 3 ANTICIPATION OF RESUSCITATION 4 TEMPERATURE CONTROL.4 CLEARING THE AIRWAY OF MECONIUM 5

More information

Neonatal Emergencies. Care of the Neonate. Care of the Neonate. Care of the Neonate. Student Objectives. Student Objectives continued.

Neonatal Emergencies. Care of the Neonate. Care of the Neonate. Care of the Neonate. Student Objectives. Student Objectives continued. Student Objectives Neonatal Emergencies After completing this section the student will be able to: 1. Identify three physiologic and/or anatomic features unique to the newborn 2. List three perinatal factors

More information

NRP Study Guide. This packet is intended for review only. Requirements to successfully complete NRP:

NRP Study Guide. This packet is intended for review only. Requirements to successfully complete NRP: This packet is intended for review only Requirements to successfully complete NRP: Completed NRP Pretest is required for admission to the course. Score 84% on the multiplechoice posttest. You may be allowed

More information

Neonatal Transition! 11/8/2011. Neonatal Resuscitation Snapshot. NRP Update I: Temperature Stabilization and Airway Management:

Neonatal Transition! 11/8/2011. Neonatal Resuscitation Snapshot. NRP Update I: Temperature Stabilization and Airway Management: NRP Update I: Temperature Stabilization and Airway Management: Myra H. Wyckoff, MD Associate Professor of Pediatrics UT Southwestern Medical Center at Dallas Always Neonatal Resuscitation Snapshot Needed

More information

Lesson 4: CHEST COMPRESSIONS

Lesson 4: CHEST COMPRESSIONS Lesson 4: CHEST COMPRESSIONS Neonatal Resuscitation Program Slide Presentation Kit The American Academy of Pediatrics is not responsible for any changes or modifications to this program made by the Neonatal

More information

PedsCases Podcast Scripts

PedsCases Podcast Scripts PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Neonatal Resuscitation Part 2. These podcasts are designed to give medical students an overview of key topics in pediatrics.

More information

NEWBORN (birth to 24 hours)

NEWBORN (birth to 24 hours) NEWBORN (birth to 24 hours) 3kg ETT size: 3mm ETT length: 14cm AIRTRAQ: GREY LMA size: 1 or 1.5 IGT size: 5 FG SHOCK: 15 joules CPR: one third of chest depth rate 100/min 3:1 The emphases in resuscitation

More information

Neonatal Resuscitation Program 2011: Changes and Controversies

Neonatal Resuscitation Program 2011: Changes and Controversies Neonatal Resuscitation Program 2011: Changes and Controversies Myra H. Wyckoff, MD Associate Professor of Pediatrics UT Southwestern Medical Center at Dallas Disclosures I am not on any speakers bureaus

More information

Newborn Life Support. Resuscitation Council (UK) Introduction. Physiology

Newborn Life Support. Resuscitation Council (UK) Introduction. Physiology Newborn Life Support Introduction Passage through the birth canal is a hypoxic experience for the fetus, since significant respiratory exchange at the placenta is prevented for the 50-75 sec duration of

More information

(C) AMBULANCE VICTORIA

(C) AMBULANCE VICTORIA The Newborn Baby: Definitions and Contacts Newborn definition 'Newborn' refers to the first min to hours post birth. For the purpose of resuscitation, AV accepts up to the first 24 hours from birth in

More information

Neonatal Reference Guide

Neonatal Reference Guide Operated by REACH Air Medical Services Assessment Heart Rate (beats/min.) Age Rate

More information

Simulation Scenario. I. Title: Newborn with Apnea and Cyanosis. Target Audience: Emergency physicians, and ED nurses. Learning Objectives:

Simulation Scenario. I. Title: Newborn with Apnea and Cyanosis. Target Audience: Emergency physicians, and ED nurses. Learning Objectives: Simulation Scenario I. Title: Newborn with Apnea and Cyanosis II. III. Target Audience: Emergency physicians, and ED nurses. Learning Objectives: A. Primary Management of apnea in the newborn period and

More information

PEDIATRIC TREATMENT GUIDELINES

PEDIATRIC TREATMENT GUIDELINES P1 Pediatric Patient Care P2 Cardiac Arrest Initial Care and CPR P3 Neonatal Resuscitation P4 Ventricular Fibrillation / Ventricular Tachycardia P5 PEA / Asystole P6 Symptomatic Bradycardia P7 Tachycardia

More information

Neonatal Reference Guide

Neonatal Reference Guide Operated by REACH Air Medical Services Assessment Heart Rate (beats/min.) Rate

More information

A Guide for Completion of the British Columbia Newborn Resuscitation Record (PSBC 1583B)

A Guide for Completion of the British Columbia Newborn Resuscitation Record (PSBC 1583B) A Guide for Completion of the British Columbia Newborn Resuscitation Record (PSBC 1583B) January 2014 Table of Contents 1.0 Introduction.................................. 2 2.0 Abbreviations.................................

More information

Perinatal Services BC Provincial Perinatal Guidelines Standards for Neonatal Resuscitation

Perinatal Services BC Provincial Perinatal Guidelines Standards for Neonatal Resuscitation Perinatal Services BC Provincial Perinatal Guidelines Standards for Neonatal Resuscitation January 2014 Perinatal Services BC West Tower, Suite 350 555 West 12th Avenue Vancouver, BC Canada V5Z 3X7 Tel:

More information

Why is prematurity a concern?

Why is prematurity a concern? Prematurity What is prematurity? A baby born before 37 weeks of pregnancy is considered premature. Approximately 12% of all babies are born prematurely. Terms that refer to premature babies are preterm

More information

RESUSCITATION OF THE NEWBORN BABY

RESUSCITATION OF THE NEWBORN BABY RESUSCITATION OF THE NEWBORN BABY This module is designed for education of nursing personnel in resuscitation of newborns in the delivery room. The same principles apply for resuscitation of sick newborns

More information

Newborn Transition to Extra-Uterine Life Janet Mendis, MSN, RNC-NIC, CNS Summer Morgan, MSN, RNC, CPNP UC San Diego Health System

Newborn Transition to Extra-Uterine Life Janet Mendis, MSN, RNC-NIC, CNS Summer Morgan, MSN, RNC, CPNP UC San Diego Health System Newborn Transition to Extra-Uterine Life Janet Mendis, MSN, RNC-NIC, CNS Summer Morgan, MSN, RNC, CPNP UC San Diego Health System OBJECTIVES: Understand fetal circulation and circulatory adjustments post

More information

Neonatal Resuscitation: History and Vital Updates

Neonatal Resuscitation: History and Vital Updates Neonatal Resuscitation: History and Vital Updates Two (2.0) contact hours Course expires: 6/27/2017 First published: 6/29/2011 Updated: 6/27/2014 Reproduction and distribution of these materials are prohibited

More information

Respiratory distress in the newborn

Respiratory distress in the newborn Respiratory distress in the newborn Respiratory distress is encountered frequently in newborns. respiratory distress in the newborn may be a potentially lifethreatening condition,. The key to successful

More information

Neonatal respiratory distress including CPAP

Neonatal respiratory distress including CPAP Department of Health Neonatal respiratory distress including CPAP Clinical Guideline Presentation v2.0 45 minutes Towards your CPD Hours Great state. Great opportunity. References: The Queensland Clinical

More information

Respiratory distress in a newborn baby

Respiratory distress in a newborn baby Respiratory distress in a newborn baby Slide RD-l Introduction Respiratory distress in a newborn is a challenging problem. It accounts for significant morbidity and mortality. It occurs in 4 to 6 percent

More information

Southern Stone County Fire Protection District Emergency Medical Protocols

Southern Stone County Fire Protection District Emergency Medical Protocols TITLE Pediatric Medical Assessment PM 2.4 Confirm scene safety Appropriate body substance isolation procedures Number of patients Nature of illness Evaluate the need for assistance B.L.S ABC s & LOC Focused

More information

11 Newborn Life Support

11 Newborn Life Support 11 Newborn Life Support Introduction Passage through the birth canal is a hypoxic experience for the fetus, since significant respiratory exchange at the placenta is prevented for the 50-75 s duration

More information

K: Maternal/ Newborn Care

K: Maternal/ Newborn Care K: Maternal/ Newborn Care College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 93 Competency: K-1 Maternal/Newborn Nursing K-1-1 K-1-2 K-1-3 Demonstrate knowledge and ability

More information

GUIDELINE 13.8 THE RESUSCITATION OF THE NEWBORN INFANT IN SPECIAL CIRCUMSTANCES

GUIDELINE 13.8 THE RESUSCITATION OF THE NEWBORN INFANT IN SPECIAL CIRCUMSTANCES AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 13.8 THE RESUSCITATION OF THE NEWBORN INFANT IN SPECIAL CIRCUMSTANCES PREMATURITY Temperature management Very premature infants are at particular risk of hypothermia.

More information

Obstetrical Emergencies

Obstetrical Emergencies Date: July 18, 2014 Page 1 of 5 Obstetrical Emergencies Purpose: To provide the process for the assessment and management of the patient with an obstetrical related emergency. Pre-Medical Control 1. Follow

More information

North Trent Neonatal Network Clinical Guideline

North Trent Neonatal Network Clinical Guideline North Trent Neonatal Network Clinical Guideline Title: Pulmonary Haemorrhage (neonatal) Author: Elizabeth Pilling (adapted from P Adiotomre and R Kacheroo) Date written: December 2012 Review date: April

More information

Update on Neonatal Resuscitation

Update on Neonatal Resuscitation Update on Neonatal Resuscitation Ola Didrik Saugstad MD, PhD, FRCPE Professor of Pediatrics Director Department of Pediatric Research Rikshospitalet, Faculty of Medicine University of Oslo NORWAY 1st.

More information

5/30/2014 OBJECTIVES THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM. Disclosure

5/30/2014 OBJECTIVES THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM. Disclosure THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM Ona Fofah, MD FAAP Assistant Professor of Pediatrics Director, Division of Neonatology Department of Pediatrics Rutgers- NJMS, Newark OBJECTIVES

More information

Neonatal Respiratory Care Julia Petty

Neonatal Respiratory Care Julia Petty Neonatal Respiratory Care Julia Petty Respiratory conditions EXAMPLES.. Respiratory Distress Syndrome (RDS) Chronic lung disease Transient Tachypnoea of the Newborn Meconium Aspiration Pneumonia Apnoea

More information

Neonatal resuscitation

Neonatal resuscitation Neonatal resuscitation Document title: Neonatal resuscitation Publication date: October 2011 Document number: Document supplement Replaces document: Author: Audience: MN11.5-V2-R16 The document supplement

More information

RMH Scenario: Cyanosed Newborn_with respiratory distress

RMH Scenario: Cyanosed Newborn_with respiratory distress Set Up: RMH Scenario: Cyanosed Newborn_with respiratory distress Mannequin Moulage Equipment available Drugs available SimNewbi Cord attached resuscitaire adrenaline Mother IV available for mother neopuff

More information

Hummi Micro Draw Blood Transfer Device. The Next Generation System for Closed Micro Blood Sampling in the Neonate

Hummi Micro Draw Blood Transfer Device. The Next Generation System for Closed Micro Blood Sampling in the Neonate Hummi Micro Draw Blood Transfer Device The Next Generation System for Closed Micro Blood Sampling in the Neonate Current Methods for Umbilical Blood Sampling Current Methods for Umbilical Blood Sampling

More information

EMBARGOED FOR RELEASE

EMBARGOED FOR RELEASE Systems of Care and Continuous Quality Improvement Universal elements of a system of care have been identified to provide stakeholders with a common framework with which to assemble an integrated resuscitation

More information

Community Ambulance Service of Minot ALS Standing Orders Legend

Community Ambulance Service of Minot ALS Standing Orders Legend Legend Indicates General Information and Guidelines Indicates Procedures Indicates Medication Administration Indicates Referral to Other Protocol Indicates Referral to Online Medical Direction Pediatric

More information

Safe Zone: CV PIP < 26; HFOV: MAP < 16; HFJV: MAP < 16 Dopamine infusion up to 20 mcg/kg/min Epinephrine infusion up to 0.1 mcg /kg/min.

Safe Zone: CV PIP < 26; HFOV: MAP < 16; HFJV: MAP < 16 Dopamine infusion up to 20 mcg/kg/min Epinephrine infusion up to 0.1 mcg /kg/min. Congenital Diaphragmatic Hernia: Management Guidelines 5-2006 Issued By: Division of Neonatology Reviewed: Effective Date: Categories: Chronicity Document Congenital Diaphragmatic Hernia: Management Guidelines

More information

More detailed background information and references can be found at the end of this guideline

More detailed background information and references can be found at the end of this guideline Neonatal Intensive Care Unit Clinical Guideline Oxygen Over the past few years there have been significant changes, based on high quality research, in our understanding of how to give the right amount

More information

Persistent Pulmonary Hypertension of the Newborn (PPHN)

Persistent Pulmonary Hypertension of the Newborn (PPHN) Persistent Pulmonary Hypertension of the Newborn (PPHN) Information for families Great Ormond Street Hospital for Children NHS Foundation Trust 2 This information sheet from Great Ormond Street Hospital

More information

Neonatal resuscitation

Neonatal resuscitation Queensland Health Maternity and Neonatal Clinical Guideline Neonatal resuscitation Document title: Publication date: July 2016 Document number: Neonatal resuscitation MN16.5-V4-R21 Document supplement:

More information

High-Frequency Oscillatory Ventilation

High-Frequency Oscillatory Ventilation High-Frequency Oscillatory Ventilation Arthur Jones EdD, RRT Learning Objectives Describe the indications and rationale and monitoring for HFOV. Identify HFOV settings and describe the effects of their

More information

Blood glucose homeostasis in the neonate. Julia Petty

Blood glucose homeostasis in the neonate. Julia Petty Blood glucose homeostasis in the neonate Julia Petty Glucose homeostasis in the neonate Constant supply is vital Requirements are high in utero and in the neonatal period compared with adult Rate of glucose

More information

CPT Pediatric Coding Updates 2009. The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009.

CPT Pediatric Coding Updates 2009. The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009. CPT Pediatric Coding Updates 2009 The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009. NEW CODES Evaluation and Management Services Normal Newborn Care Codes 99431-99440

More information

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Method of maintaining low pressure distension of lungs during inspiration and expiration when infant breathing spontaneously Benefits Improves oxygenation

More information

ROC CONTINUOUS CHEST COMPRESSIONS STUDY (CCC): MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE

ROC CONTINUOUS CHEST COMPRESSIONS STUDY (CCC): MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE ROC CONTINUOUS CHEST COMPRESSIONS STUDY (CCC): MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE An Advanced Care Paramedic will provide the treatment based on the randomization scheme and as prescribed in this

More information

Ventilation 101. Bag-Valve Device. Bag-Valve Device. Self-inflating bag. Flow-inflating bag

Ventilation 101. Bag-Valve Device. Bag-Valve Device. Self-inflating bag. Flow-inflating bag Ventilation 101 Bag-Valve Device Self-inflating bag Simple to use Doesn t need a gas source Inflate just until chest rises Doesn t provide CPAP Bag-Valve Device Flow-inflating bag Takes more training/practice

More information

Premature Infant Care

Premature Infant Care Premature Infant Care Introduction A premature baby is born before the 37th week of pregnancy. Premature babies are also called preemies. Premature babies may have health problems because their organs

More information

Resuscitation of the baby at birth

Resuscitation of the baby at birth Chapter 8 Resuscitation of the baby at birth Objectives On successfully completing this topic, you will be able to: understand the important physiological differences in the newly born baby understand

More information

Chapter 26. Care of the Newborn

Chapter 26. Care of the Newborn Care of the Newborn Chapter 26 Care of the Newborn Routine Resuscitation When called to the delivery of a newborn, first learn the basic maternal history (time permitting), including the following: The

More information

Cardiac Arrest VF/Pulseless VT Learning Station Checklist

Cardiac Arrest VF/Pulseless VT Learning Station Checklist Cardiac Arrest VF/Pulseless VT Learning Station Checklist VF/VT 00 American Heart Association Adult Cardiac Arrest Shout for Help/Activate Emergency Response Epinephrine every - min Amiodarone Start CPR

More information

ACLS Study Guide BLS Overview CAB

ACLS Study Guide BLS Overview CAB ACLS Study Guide The ACLS Provider exam is 50-mutiple choice questions. Passing score is 84%. Student may miss 8 questions. For students taking ACLS for the first time or renewing students with a current

More information

NCPR; Neonatal Cardiopulmonary Resuscitation

NCPR; Neonatal Cardiopulmonary Resuscitation Chapter 4 NCPR; Neonatal Cardiopulmonary Resuscitation NCPR Task Force Chairmen Masanori Tamura, Masaki Wada NCPR Task Force Members Gen Ishikawa, Isao Kusakawa, Keishi Goishi, Takahiro Sugiura, Hisanori

More information

Extracorporeal Life Support Organization (ELSO) Guidelines for Neonatal Respiratory Failure

Extracorporeal Life Support Organization (ELSO) Guidelines for Neonatal Respiratory Failure Extracorporeal Life Support Organization (ELSO) Guidelines for Neonatal Respiratory Failure Introduction This neonatal respiratory failure guideline is a supplement to ELSO s General Guidelines for all

More information

DEBRIEFING GUIDE. The key components of an optimal code response: 1. Early recognition that the patient is deteriorating or has become unresponsive.

DEBRIEFING GUIDE. The key components of an optimal code response: 1. Early recognition that the patient is deteriorating or has become unresponsive. DEBRIEFING GUIDE I N T R O D U C T I O N Debriefing has been shown to improve clinical behavior during cardiac resuscitation and, as such, has become a recommended procedure in the 2010 American Heart

More information

S.T.A.B.L.E. Program Pre-Assessment

S.T.A.B.L.E. Program Pre-Assessment S.T.A.B.L.E. Program Pre-Assessment S.T.A.B.L.E. Pre-Assessment 1 Please write your name and answers on the answer sheet. For the following multiple-choice questions, choose the one best answer. 1. The

More information

RESPONDING TO ANESTHETIC COMPLICATIONS

RESPONDING TO ANESTHETIC COMPLICATIONS RESPONDING TO ANESTHETIC COMPLICATIONS General anesthesia poses minimal risk to most patients when performed by a capable anesthetist using appropriate protocols and proper monitoring. However, it is vitally

More information

Crash Cart Drugs Drugs used in CPR. Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University

Crash Cart Drugs Drugs used in CPR. Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Crash Cart Drugs Drugs used in CPR Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Introduction A list of the drugs kept in the crash carts. This list has been approved by the

More information

ACLS PRE-TEST ANNOTATED ANSWER KEY

ACLS PRE-TEST ANNOTATED ANSWER KEY ACLS PRE-TEST ANNOTATED ANSWER KEY June, 2011 Question 1: Question 2: There is no pulse with this rhythm. Question 3: Question 4: Question 5: Question 6: Question 7: Question 8: Question 9: Question 10:

More information

FETAL CIRCULATION LEARNING OBJECTIVES

FETAL CIRCULATION LEARNING OBJECTIVES FETAL CIRCULATION LEARNING OBJECTIVES At the end the lecture the student should know the following: Components of fetal circulation Foramen ovale Ductusarteriosus Path of Fetal circulation Changes in circulation

More information

Wilson County Emergency Management Agency Protocol Manual Protocols

Wilson County Emergency Management Agency Protocol Manual Protocols Asystole No pulse or respirations Confirm cardiac rhythm with combo pads or electrodes Record in two leads to confirm Asystole and to rule out fine V-Fib. Basic assessment and management (up to your scope

More information

It is recommended that the reader review each medical directive presented in this presentation along with the actual PCP Core medical directive.

It is recommended that the reader review each medical directive presented in this presentation along with the actual PCP Core medical directive. It is recommended that the reader review each medical directive presented in this presentation along with the actual PCP Core medical directive. This presentation will highlight the changes and any new

More information

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble In contrast to cardiac arrest in adults, cardiopulmonary arrest in pediatric

More information

A8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References

A8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References A8b Resuscitation of a Term Infant with Meconium Staining Karen Wright, PhD, NNP-BC Assistant Professor and Coordinator, Neonatal Nurse Practitioner Program Dept. of Women, Children, and Family Nursing,

More information

changes in BLS, ACLS & PALS from By the end of this program, the

changes in BLS, ACLS & PALS from By the end of this program, the 2010 AHA BLS, ACLS & PALS Changes: What s New? Jennifer Murray MSN, RN Critical Care Educator AHA Training i Center Coordinator PALS Regional Faculty ACLS Training Center Faculty Objectives This module

More information

Pediatric Pharmacotherapy A Monthly Newsletter for Health Care Professionals Children s Medical Center at the University of Virginia

Pediatric Pharmacotherapy A Monthly Newsletter for Health Care Professionals Children s Medical Center at the University of Virginia Pediatric Pharmacotherapy A Monthly Newsletter for Health Care Professionals Children s Medical Center at the University of Virginia Volume 2 Number 12 December 1996 Medications for Neonatal and Pediatric

More information

Resuscitation 81 (2010) 1389 1399. Contents lists available at ScienceDirect. Resuscitation. journal homepage: www.elsevier.com/locate/resuscitation

Resuscitation 81 (2010) 1389 1399. Contents lists available at ScienceDirect. Resuscitation. journal homepage: www.elsevier.com/locate/resuscitation Resuscitation 81 (2010) 1389 1399 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation European Resuscitation Council Guidelines for Resuscitation

More information

Objectives: Identify the changes that have been made to the Code Blue Record ( for pilot at the BGH site) Discuss the importance of documentation

Objectives: Identify the changes that have been made to the Code Blue Record ( for pilot at the BGH site) Discuss the importance of documentation Objectives: Identify the changes that have been made to the Code Blue Record ( for pilot at the BGH site) Discuss the importance of documentation during a Code Blue Event from a risk management as well

More information

NEONATAL RESUSCITATION; THE USE OF LARYNGEAL MASK AIRWAY

NEONATAL RESUSCITATION; THE USE OF LARYNGEAL MASK AIRWAY NEONATAL RESUSCITATION 8 ORIGINAL PROF-1326 NEONATAL RESUSCITATION; THE USE OF LARYNGEAL MASK AIRWAY DR. FAHEEM FEROZE, MBBS, FCPS PAC Hospital Kamra DR. NAVEED MASOOD, MBBS, FCPS Classified Anaesthetist

More information

Pediatric Shock Recognition / Resuscitation. Edward J. Cullen Jr., D.O. Pediatric Critical Care Medicine

Pediatric Shock Recognition / Resuscitation. Edward J. Cullen Jr., D.O. Pediatric Critical Care Medicine Pediatric Shock Recognition / Resuscitation Edward J. Cullen Jr., D.O. Pediatric Critical Care Medicine 2003 Shock Oxygen Delivery can not support Metabolic Demands of the Body Is the child in shock? Mental

More information

Neonatal Intubation. Purpose. Scope. Indications. Equipment Cardiorespiratory monitor SaO 2 monitor. Anatomic Considerations.

Neonatal Intubation. Purpose. Scope. Indications. Equipment Cardiorespiratory monitor SaO 2 monitor. Anatomic Considerations. Page 1 of 5 Purpose Scope Indications Neonatal Intubation To assure proper placement of endotracheal tubes for maximum ventilation using proper intubation procedures. The policy applies to all Respiratory

More information

PRE-HOSPITAL CARE MEDICAL CONTROL PROTOCOLS AND PROCEDURES

PRE-HOSPITAL CARE MEDICAL CONTROL PROTOCOLS AND PROCEDURES EMS Services PRE-HOSPITAL CARE MEDICAL CONTROL PROTOCOLS AND PROCEDURES TABLE OF CONTENTS 9. CHILDBIRTH / OBSTETRICAL EMERGENCIES pages Uncomplicated / Imminent Delivery 1-1A Neonatal Delivery 2-2A Abnormal

More information

Approved and Funded Neonatal Resuscitation Program (NRP) Research Grants and Young Investigator Awards

Approved and Funded Neonatal Resuscitation Program (NRP) Research Grants and Young Investigator Awards Approved and Funded Neonatal Resuscitation Program (NRP) Research Grants and Young Investigator Awards 2015 Meconium aspiration syndrome and non vigorous neonates pilot study, St Louis, MO TM Identification

More information

What do we mean by birth asphyxia

What do we mean by birth asphyxia Neonatal Medicine and brain injury in the Infant at term Andrew Whitelaw Professor of Neonatal Medicine University of Bristol What do we mean by birth asphyxia Interruption in oxygen delivery to the fetus

More information

BLS TREATMENT GUIDELINES - CARDIAC

BLS TREATMENT GUIDELINES - CARDIAC BLS TREATMENT GUIDELINES - CARDIAC CARDIOPULMONARY ARREST - NON-TRAUMATIC (SJ-B101) effective 07/01/99 Defibrillation CPR Apply S-AED and assess rhythm as trained. Defib as indicated Simultaneous OXYGEN:

More information

LIFE SUPPORT TRAINING CENTER

LIFE SUPPORT TRAINING CENTER LIFE SUPPORT TRAINING CENTER (LSTC) For more information and booking, please contact Zulekha Hospital Life Support Training Center (LSTC) Phone: +971 6 506 9247 Email: LSTC@ Web: www. Use of American Heart

More information

Resuscitation of the baby at birth

Resuscitation of the baby at birth APPENDIX I Resuscitation of the baby at birth I.1 OBJECTIVES This will teach you: I.2 INTRODUCTION the important physiological differences in the newly born baby the equipment used for resuscitation at

More information

Co-organized by. Neonatal Resuscitation Program (NRP) Provider Course

Co-organized by. Neonatal Resuscitation Program (NRP) Provider Course Neonatal resuscitation program (NRP) is an evidence-based simulation training to improve the resuscitation of the newborn. The causes, prevention, and management of mild to severe neonatal asphyxia are

More information

If you do not wish to print the entire pre-test you may print Page 2 only to write your answers, score your test, and turn in to your instructor.

If you do not wish to print the entire pre-test you may print Page 2 only to write your answers, score your test, and turn in to your instructor. This is a SAMPLE of the pretest you can access with your AHA PALS Course Manual at Heart.org/Eccstudent using your personal code that comes with your PALS Course Manual The American Heart Association strongly

More information

MINI - COURSE On TEMPERATURE CONTROL IN THE NEWBORN

MINI - COURSE On TEMPERATURE CONTROL IN THE NEWBORN MINI - COURSE On TEMPERATURE CONTROL IN THE NEWBORN Instructions: Read each sheet and answer any questions as honestly as possible The first sheets have four questions to allow you to give your thoughts

More information

Ketamine in Anaesthetic Practice

Ketamine in Anaesthetic Practice Ketamine in Anaesthetic Practice Rachael Craven, Bristol Royal Infirmary, UK and Medecins sans Frontieres. rmcraven@hotmail.com Raad Alkhafaji, Kirkuk Hospital, Iraq Consider the following real life cases

More information

Respiratory Distress. National Pediatric Nighttime Curriculum Written by Liane Campbell, MD Lucile Packard Children s Hospital, Stanford University

Respiratory Distress. National Pediatric Nighttime Curriculum Written by Liane Campbell, MD Lucile Packard Children s Hospital, Stanford University Respiratory Distress National Pediatric Nighttime Curriculum Written by Liane Campbell, MD Lucile Packard Children s Hospital, Stanford University Learning Objectives Review the initial assessment of patient

More information

Cardiac Arrest Scenarios

Cardiac Arrest Scenarios Cardiac Arrest Scenarios William Lewis AEMCA, ACP, CCP(F) Regional Paramedic Educator Objectives To review multiple reasons for cardiac arrests To review the best practices for treatment in these arrests

More information

GUIDELINES FOR HOSPITALS WITH NEONATAL INTENSIVE CARE SERVICE : REGULATION 4 OF THE PRIVATE HOSPITALS AND MEDICAL CLINICS REGULATIONS [CAP 248, Rg 1] I Introduction 1. These Guidelines serve as a guide

More information

Neonatal Post-Resuscitation Stabilization and. Preparation for Transport

Neonatal Post-Resuscitation Stabilization and. Preparation for Transport Neonatal Post-Resuscitation Stabilization and February, 2006 Preparation for Transport During the transition from fetus to neonate some babies will need active intervention and resuscitation. Neonatal

More information

Trust Guideline for Neonatal Volume Guarantee Ventilation (VGV)

Trust Guideline for Neonatal Volume Guarantee Ventilation (VGV) (VGV) A Clinical Guideline For Use in: By: For: Division responsible for document: Key words: Name of document author: Job title of document author: Name of document author s Line Manager: Job title of

More information

How to Treat Bradycardia s

How to Treat Bradycardia s How to Treat Bradycardia s Table of Contents How to Treat Bradycardia s... 1 Introduction... 3 Sinus Bradycardia... 3 Symptomatic Bradycardia... 3 Bradycardia Algorithm... 3 Transcutaneous pacing (TCP)...

More information

Firefighter Pre-Hospital Care Program Module 18. Chest Assessment And Injuries

Firefighter Pre-Hospital Care Program Module 18. Chest Assessment And Injuries Firefighter Pre-Hospital Care Program Module 18 Chest Assessment And Injuries Firefighter Pre-Hospital Care Program Module 18 At the end of the lesson and upon completion of the post test quiz, the participant

More information

April 30, 2014. BronchoPulmonary Dysplasia. Respiratory Distress Syndrome. Multifactorial Etiology of BPD. Clinical O 2 Use Comparison

April 30, 2014. BronchoPulmonary Dysplasia. Respiratory Distress Syndrome. Multifactorial Etiology of BPD. Clinical O 2 Use Comparison Lunch & Learn March 26, 2014 Kevin Coughlin MD Brooke Read RRT Donna Pletsch RN Respiratory Distress Syndrome Disease of prematurity Significant decrease in incidence and severity of RDS Antenatal Corticosteroids

More information

Common Ventilator Management Issues

Common Ventilator Management Issues Common Ventilator Management Issues William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center You have just admitted a 28 year-old

More information

Nasal CPAP (Paediatric)

Nasal CPAP (Paediatric) CLINICAL PRACTICE GUIDELINE SCOPE (Area): SCOPE (Staff): Nasal CPAP (Paediatric) Paediatrics & Special Care Nursery (SCN) Nursing & Medical Staff BACKGROUND Nasal CPAP is a management option for treatment

More information