Professional Documents
Culture Documents
Resuscitation
Resuscitation
• If BMV is ineffective/prolonged
• When chest compressions are performed
• Initial endotracheal suctioning of non vigorous
meconium stained newborn
Endotracheal tube
LMA(Laryngeal mask airway)
• Soft mask, fits over laryngeal inlet when
inflated, occludes the oesophageal opening
• Done when BMV is unsuccessful & tracheal
intubation is unsuccessful or not feasible
LMA(Laryngeal mask airway)
Targeted SPO2 after birth
1 minute 60-65%
2 minutes 65-70%
3 minutes 70-75%
4 minutes 75-80%
5 minutes 80-85%
10 minutes 85-90%
1. Initial steps in resuscitation
2. PPV
AAP
Algorithm
Chest compressions
• Started when HR<60 per minute despite adequate
ventilation with 100% oxygen for 30 sec
• Delivered at lower third of sternum, to depth 1/3 of
AP diameter of chest
• 2 techniques:
– 2 thumb-encircling hands technique
– Compression with 2 fingers ,second hand
supporting the back
– 3:1 ratio::[ 90 comp:30 ventilations]
1. Initial steps of resuscitation
2. PPV(ET)
3. CHEST COMPRESSIONS
AAP
Algorithm
Medications
• Rarely indicated
• Most important step to treat bradycardia is
establishing adequate ventilation
• HR remains <60bpm,despite adequate
ventilation(ET) with 100% Oxygen & chest
compressions
• Epinephrine or volume expansion or both
Epinephrine
• Route of administration: intravenous(IV),ideal
• Recommended dose: 0.01-0.03 mg/kg per
dose
• Desired concentration: 1:10,000
0.1 mg/ml
Volume expansion
• Suspected or known blood loss
• Isotonic crystalloid solution ; normal saline
• Blood
• Dose calculation: 10 ml/kg
The golden minute
• <30 seconds: complete initial steps
• Warmth
• Drying
• Clear airway if necessary
• Stimulate
• 30-60 seconds: assess 2 vital characteristics
• Respiration (apnea/gasping/labored/unlabored)
• Heart rate (<100/>100bpm)
• Golden Minute Project: skill based training
AAP
Algorithm
Post resuscitation care
• Needed for those who required PPV
• At risk of deterioration
– Hypo/hyperthermia ,hypoglycemia, CNS
complications(apnea, HIE), pulmonary
complications(TTN, Pneumonia), hypotension
• Need monitoring ,evaluation
• NICU may be necessary
NNR : not indicated
• Conditions with certainly early death
• Extreme prematurity(GA<23 weeks)
• Birth weight<400g
• Anencephaly
• Chromosomal abnormality: Trisomy 13
NNR: nearly always indicated
• High rate of survival
• Acceptable morbidity
• GA≥ 25 weeks
• Those with most congenital malformations
NNR?
• Conditions associated with uncertain
prognosis
• Survival borderline