newborn care and resuscitation june 24, 2014 michael kim, md newborn care and resuscitation 2014...
TRANSCRIPT
Newborn care and resuscitation2014 Emergency Care Trauma Symposium
June 24, 2014
Michael Kim, MD
Topics
• Preparation• Initial assessment• Initial intervention and intervention• HR dependent interventions• Timing and use of O2• Use of pulse oximetry• Advanced care
Kattwinkel J et al. Circulation 2010;122:S909-S919Copyright © American Heart Association
Preparation• Gestational age• Multiple?• Pregnancy complications• Provider assignment• Equipments
– Warm towels– Mask, Bag, O2, Suction– Plastic wrap– Oxygen– Proper sized Laryngoscope, blade, ETT, (RT)– EZ IO– Medication– Advanced support
Initial assessment
• Crying • Breathing • Tone
Term, good cry and tone
Stay with mom, keep warm and transport
If not
• Warm, dry, and stimulate• Clear airway with suction bulb/catheter• Monitor and maintain temperature
• If vigorous, support only • If not vigorous, Suction mouth and nose Endotracheal suction
before PPV
Vigorous or not so vigorous?
Assessment of O2 need/administration
• Birth cyanosis: up to 10 min• Excess and/or deficit are harmful• POX: only when sustained resuscitation is anticipated
Assessment of O2 need/administration
• PPV and O2 administration– Goal: achieve target saturation/HR– Start with RA or blended O2– PPV if apnic, gasping or HR<100– increase O2 if HR < 60 after 90 sec of intervention
Definitive airway
• Endotracheal Intubation: – Initial suctioning of depressed meconium stained
baby– BMV is ineffective– Chest compression is needed
• Laryngeal Mask Airway: if mask or ETT unsuccessful
Chest compressions
• Indicated if HR < 60 after 30 sec of ventilation with O2
• 1/3 AP diameter on lower 1/3 of sternum• 2 thumbs encircling the chest• 2 finger method: not ideal• 90 compressions/ min (3:1)
Vascular access
Medications• Epinephrine if
– HR < 60 with adequate ventilation, 100% O2, and Chest compression
– IV: 0.01 -0.03 mg/kg (1:10,000)– ET: 0.05-0.1 mg/kg (1:10,000)
Approach
• Airway• Breathing• Circulation• Dextrose• Environment
Approach
• Airway• Breathing• Circulation• Dextrose (Don’t Ever Forget the Glucose)• Environment
Newborn care algorithm
Initial evaluation Term, cry, breathing, tone (Pox/perfusion not reliable)
Factors Resp effort, HR, tone , time(POx: later)
Initial intervention Warm, dry, sxn, stim
CPAP indication If resp distress with HR>100
PPV indication if gasping, apnic or HR<100
Oxygen indication If HR<60 after PPV x 90sec
Compression indication If HR<60 after PPV with O2 x 30 sec
IV Epi dose 0.01-0.03 mg/kg (1:10,000)
ET Epi dose 0.05-0.1 mg/kg (1:10,000)
Vascular access Umbilical catheter
Summary
• Preparation• Crying, breathing and tone• Warm, dry and stimulate• Pulse Ox reading misleading• ABCDEFG