trends in emergency care - emergency air medical ... · tunneled central venous catheters an iv...
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TRENDS IN EMERGENCY CARE PROVIDES FOUR (4) HOURS OF CONTINUING EDUCATION CREDIT
April 11, 2018 | Adventist Health Ukiah Valley
AGENDA 1200-1300 Controlled Substances Chris Awad Mendocino County Major Crimes Team Taskforce 1310-1410 Access Issues: Pediatric Peripheral and Central Lines Diana Priego, RN, CCRN, FN REACH Air Medical Services 1420-1520 Facial Trauma Amy Henry, RN, CFRN CALSTAR Air Medical Services 1530-1630 Neonatal and High Risk OB Emergencies Yvette Gonzalez, MS, RN, C-EFM, C-NPT REACH Air Medical Services 1630 Evaluation and Adjourn
Access Issues: Pediatric Peripheral and
Central Lines
Diana Priego, RN, CRN, FN
Access Issues; Pediatric Peripheral
and Central Lines
Diana Priego RN BSN CCRN CNP-T
Objectives
- Identify appropriate sites and securing for
pediatric IV's.
- Review strategies for positioning and calming
children while having peripheral IV's placed.
- Identify 3 different central lines that can be
found in pediatric patients receiving home care
and considerations for access in emergent
situations.
Remember to start with the basics...
• All children require the same priorities.
– Clear airway
– Adequate ventilation
– Adequate oxygenation
– Adequate cardiac output
• Perfusion indicators
• Good preparation is
key
• All equipment
prepared
• Sites evaluated
• Personnel available
So you need a line…
Sites
• Arms
– AC
– Hands
– Wrist
– Forearm
• Feet (consider if the
child ambulates or not)
• Scalp (direction?)
• EJ?
Preparing the Child
• Age appropriate time
to tell child about the
IV start and
description
• Poke vs Shot
• Lidocaine cream (30
min ahead)
• Warm packs to
hands/feet
Distraction Techniques
• Bubbles
• Tablet or
Smartphone
• Spinning toys
• Vibrating toys
Positioning the Child
• For babies and toddlers, safely
immobilize all other extremities.
• Minimum of 3 staff for younger
children, parent should not be the
person restraining child.
• Blanket wrapped with arm out,
superman fold for foot PIV
• Bear hug vs chest to chest
Helping Hands
• Vein finders
• Venoscopes
• Red flashlight (be aware
of temp, light cannot be halogen)
• All of these can be very
valuable but need practice
as depth perception is
limited.
Neonates
• They do feel pain!
• Sweet-ease along with a
pacifier or gloved finger
to suck on.
• May internalize pain
and demonstrate in
other ways such as
apnea or decreased
LOC.
During the Procedure
• Reassure child they are
doing a good job
• Acknowledge any
statements they are
making, eg “that hurts!”
• Do not promise it is the
last poke or will only be
one poke.
• Tell them when the
sharp part is removed
from the IV.
How many attempts?• CHANGE something if you
don’t get it…
position of child
catheter size
site
provider
- Consider alternatives for other
IV access or interventions in
the meantime.
- Is pt appropriate to wait for the
TT to attempt further? (Try at
least once, you may surprise
yourself!)
Securing the IV• What kind of tape?
• Anchor hub under
tegaderm
• Diaphoretic kids may
need skin prep/adhesive
• 2x2’s as needed
• Leave your site visible
please!!!!
(no coban/wraps)
• Armboard if needed
• Stockinette/Netting?
The Scary Scalp IV…
• Rubber band with a tab of
tape for a tourniquet
• Consider hair
• Arterial vs venous?
• Will need some sort of skin
prep to make tegaderm adhere
• “Party hat” support catheter
with cotton ball. Don’t need
cups/plastic covering it.
• Again, site should be visible
after securing.
I/O access
• Indications
• Manual vs EZ IO
• Appropriate size
• Prepare the family for
what it will sound/look
like
• Secure with dressing, no
circumferential tape
Interesting Information
• Special needs population is increasing out in our community.
• Many children have more than one special healthcare need.
• Children with special healthcare needs are over three times as likely as other children to require emergent ICU admission.
• Technology-dependent children are over 300 times more likely to require emergent ICU admission than other children with special health needs.
Schif, Jeff. Children with Special Health Needs in the EMS System.
Minnesota Department of Health. Spring 2002
Tunneled Central Venous Catheters
• An IV catheter that is
surgically inserted and
tunneled under the skin
into a large central vein.
• Common insertion sites
include the chest and
arm. Also possible, but
not as common are
insertion sites in the
scalp, neck and groin.
Tunneled Central Venous Catheters
• Children may have a permanent central line in
place for:
- At-home intravenous medications or nutrition
- Frequent blood draws
- Administration of chemotherapy
- Chronic condition and history of poor IV
access.
Types of Tunneled Catheters
• Broviac-Hickman
catheter (also known as
Groshong catheter)
• Port-a-Cath
• PICC (Peripherally
Inserted Central
Catheter)
• Also referred to as
PVAD’s (pre-existing
vascular access device)
Accessing the Catheter
• Port-a-caths require insertion of a special
needle to use.
• Other catheters may be accessed by a
capped or luer-lock mechanism.
• Be aware of potential heparinized lines.
• When drawing labs, first draw should be
used for blood culture or waste and then
use another syringe to draw remaining labs.
Kids and their Lines
• Always let the child know what you are going
to do with the line.
eg. draw blood or infuse medication.
• Some children are sensitive to the sensation
when lines are flushed quickly.
• Some kids require pre-medication with
lidocaine cream to site before accessing
port-a-caths.
Line Emergencies
• Line dislodgement – apply pressure to site and above
insertion point.
• Save dislodged line to verify length to rule out
thrombi of line tip.
• Always ensure caps are snug as hemorrhage or air
emboli can occur in a short period of time from
disconnected catheters.
• If you are not sure about using the line you can
always place a PIV/ IO until the line has been
verified.
Questions?
Facial Trauma Amy Henry, RN, CFRN
Facial Trauma
Amy Henry, RN, CFRN
Objectives
• Discuss anatomy and assessment of the patient with facial trauma
• Discuss implications of caring for the patient with facial trauma
• Discuss facial injuries and treatment
• Discuss airway assessment and management in the patient with facial trauma
• Discuss anatomy and assessment of the patient with ocular trauma
• Discuss ocular injuries and treatment
Facial Anatomy
Facial Anatomy
Facial Vasculature
Facial Innervation
Facial Anatomy
Anatomy of the Midface
Anatomy of the Forehead
Anatomy of the Orbit
Anatomy of the Maxilla
Anatomy of the Nose
Anatomy of the Zygoma
Anatomy of the Mandible and Oral Cavity
Common Concurrent Injuries
• Hemorrhage
• Intracranial lesions
• Lacerations
• Tearing and shearing injuries
• Secondary injuries– Hypotension
– Hypoemia
– Hypercarbia
– Cerebral edema
– Changes in ICP
– Cerebral ischemia
GOAL OF TREATMENT IS TO PREVENT SECONDARY INJURIES!
Assessment of the Patient with Facial Injuries
Assessment of the Patient with Facial Injuries
Assess mental status
Assessment of the Patient with Facial Injuries
Circulation
Facial Lacerations
• Treatment includes:
– Control of bleeding
– Clean/irrigate wound
– Prepare patient for wound repair
– More complex wounds or wounds with concurrent injuries may require specialist consultation
Nasal Fracture
Treatment:
- Monitor airway
- Control bleeding
- May require nasal
packing
- ENT
- Definitive treatment
may be delayed
to allow swelling to
decrease
Facial Fractures
Frontal Bone Fracture
- usually from high velocity blunt trauma and frontal sinuses may be involved
- Lacerations, contusions, or hematoma should cause suspicion for fracture
Orbital Fracture
- can occur on the outer ring or orbital floor
- usually result from direct blunt trauma as from assault
- can cause nerve entrapment and/or injury
LeFort I
Horizontal fracture line
that runs along the maxilla
Upper gums and soft palate
are detached from the skull
LeFort II
Pyramidal maxillary fracture
The apex of the fracture is at
the bridge of the nose
The lateral fractures extend
through the lacrimal bone of
the face and ethmoid of the
skull into the medial orbits
The base of the fracture extends
above the level of the upper teeth
and into the maxilla
Most of the maxilla is free-floating
from the skull
LeFort III
Complete separation of the
midface from the skull
Fracture line travels horizontally
through the midface at the bridge
of the nose
Fracture traverses each orbit and
extends down into each zygomatic
arch
Midface is detachable from the
skull and the anterior face is mobile
Treatment of LeFort Fractures
• Monitor airway – retropharyngeal hematoma may obstruct airway
• Patient may have open fractures and/or pneumocephalus
• Maintain spinal precautions
• Analgesia, anxiolysis, and anti-emetic
• Patient will likely need surgery
• Consult neurology/neurosurgery, ophthalmology, oral and maxillofacial surgery
• Keep the head elevated and positioned midline to facilitate venous drainage
Mandibular Fracture
Can be open or closed
Almost always breaks in two places
Facial asymmetry will be noted
Painful
Patient may have malocclusion,
inability to open the mouth, edema
or hematoma formation, blood
behind or ruptured tympanic
membrane, CSF from the ear, or
anesthesia of the lower lip
Treatment of Mandibular Fractures
• Manage and maintain airway
• Control bleeding
• Monitor neuro status
• Analgesia
• Consider concurrent injuries
Anatomy of the Eye
Assessment of Ocular Injuries
• Look for symmetry, lacerations, foreign bodies, penetrating trauma, and any indications of fracture such as step-offs
• Assess visual acuity – get a description of the patient’s vision, Snellen chart
• Check extraocular movements
• Check pupils for shape, size, reactivity, and symmetry
Neonatal and High Risk
OB Emergencies Yvette Gonzalez, MS, RN, C-EFM, C-NPT
High Risk OB & Neonatal EmergenciesPre-Transport Stabilization & Transport Considerations
Yvette Gonzalez, MS, RN, C-NPT, C-EFM, High Risk Obstetric & Neonatal Transport Clinical Manager
This outreach education presentation is intended as an overview of basic concepts surrounding assessment of the
pregnant patient, OB complications and stabilization priorities for maternal and newborn patients.
Follow designated county protocols, policies and guidelines for actual care of obstetric and newborn patients.
Objectives• Review normal physiologic changes in pregnancy
• Review basic assessment of pregnant patients
• Review high risk obstetric clinical presentations, pretransport & transport clinical considerations
• Review postpartum hemorrhage and interventions
• Review high risk obstetric & neonatal transport stabilization priorities
• Review in-utero resuscitation measures for pre-transport and transport clinical application
Maternal Early Warming Criteria
US Maternal Morbidity & Mortality Leading Causes & Regions
Source: 1. National Vital Statistics Maternal Morbidity. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_04.pdf. Accessed March 2017. 2. Maternal Early Warning Criteria. http://safehealthcareforeverywoman.org/patient-safety-tools/maternal-early-warning-criteria/. Accessed March 2017.3. Image Source: World Health Organization, 2014
Causes of Arrest in OB Patients
Bleeding-DIC, Embolism, Anesthetic complications, Uterine atony,
Cardiac disease, Hypertensive disease, Other, Placental, Sepsis
Source:1. The American Heart Association 2010 Guidelines for the Management of Cardiac Arrest in Pregnancy: Consensus Recommendations on Implementation Strategies. http://www.jogc.com/article/S1701-2163(16)34991-X/pdf . 2. American Heart Association: AHA. Maternal Cardiac Arrest. http://circ.ahajournals.org/content/132/18/1747. Accessed March 20173. Direct Causes of Maternal Mortality. Dartmouth.edu. Countdown to 2015 Decade Report (2000-2010), World Health Organization (2010).
Cardiac Arrest In Pregnancy & Perimortum Cesarean Delivery
Recognition, Collaboration, & Teamwork• CRM: Prepare For 2 Patients: OB & Neonatal Teams
Positioning• Laterally to prevent aortocaval compression!
BLS & ACLS per AHA
CPR & Delivery• Every Minute Matters
Source: 1. Aortocaval Compression Conundrum in Obstetrics. https://journals.lww.com/anesthesia-analgesia/Citation/2017/12000/The_Aortocaval_Compression_Conundrum.7.aspx. Accessed March 2018.2. Cardiac Arrest In Pregnancy. AHA Scientific Statement. https://doi.org/10.1161/CIR.0000000000000300 Circulation. 2015;CIR.0000000000000300. Accessed March 2018Originally published October 6, 2015
Normal Physiologic Changes In Pregnancy
Cardiovascular • Hormones, Hemodynamics & Vital Signs
Hematologic • Circulating Blood Volume, Hct, & Coagulation
Respiratory• Compensated Respiratory Alkalosis: pH 7.4-7.45 & PaCO2 27-32
• O2 Consumption, minute ventilation, tidal volume:
• Delayed gastric emptying---risk for aspiration!
Source: 1. Hayes, Meghan; Larson, Lucia (2012). "Chapter 220. Overview of Physiologic Changes of Pregnancy". Principles and Practice of Hospital Medicine The McGraw-Hill Companies. https://accessmedicine.mhmedical.com/content.aspx?bookid=496§ionid=41304210 March 20182. Cardiac Arrest In Pregnancy. AHA Scientific Statement. https://doi.org/10.1161/CIR.0000000000000300 Circulation. 2015;CIR.0000000000000300. Accessed March 2018Originally published October 6, 2015
Vital Signs & Labs During Pregnancy
Pregnant
• HR: 85
• SBP: 114
• DBP: 70
• Goal: vital organ perfusion
• MAP > 70
• Ensure adequate preload before initiating vasoactive drugs
Labs
• Hct 34
• Platelets > 150
• AST/ALT ~ 35
• Creatinine < 1.0
• WBC < 16
Source: Hayes, Meghan; Larson, Lucia (2012). "Chapter 220. Overview of Physiologic Changes of Pregnancy". Principles and Practice of Hospital Medicine The McGraw-Hill Companies. https://accessmedicine.mhmedical.com/content.aspx?bookid=496§ionid=41304210 Accessed March 2018
OB Care Priorities: Stabilization & TransportABCs
Lateral Positioning
Vascular Access & Fluid Bolus • If indicated: LR or NS
Treat Mom To Treat Fetus!!• Uteroplacental Unit-New “End-Organ”
At Sending Facility: • Ensure stability of mother and fetus prior to transport• Obtain Frequent maternal vital signs & fetal assessment• Decision To Transport for Higher Level of Care ?
Source: Trauma in the Obstetric Patient. American College of Emergency Physicians. https://www.acep.org/Clinical---Practice-Management/Trauma-in-the-Obstetric-Patient--A-Bedside-Tool/. Accessed March 2018.
Determinants Of Fetal Oxygen Delivery
Source:http://www.obstetanesthesia.com/article/S0959-289X(01)90933-1/pdf. Accessed December 2017Clinical Obstetrics and Gynecology. 54(1):28–39, MAR 2011. DOI: 10.1097/GRF.0b013e31820a062b. Accessed December 2017Source: Macones, Hankins, Spong, Hauth, & Moore (2008). The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring. Obstetrics & Gynecology, 112, pg 665.
Intrauterine Resuscitation Measures
Lateral Positioning• Optimize perfusion to uteroplacental unit
IV Fluid Bolus: Based on clinical condition
• Correction of maternal hypotension is essential!!
Oxygen Supplementation :• May optimize maternal oxygenation status and fetal oxygen delivery.
Reduction of Uterine Activity: Tocolysis
Source: Maternal Oxygen Administration As An IntraUterine Resuscitation Measure During Labor. Simpson, Kathleen Rice. MCN: The American Journal of Maternal/Child Nursing: March/April 2015 - Volume 40 - Issue 2 - p 136http://www.sfnmjournal.com/article/S1744-165X(08)00061-9/abstract. Accessed March 2018.
Bleeding During Pregnancy
Source: 1. ACOG. Bleeding During Pregnancy. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy. Accessed March 2017.2. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/he-06b-AF-140516-HemChecklist-Binder.pdf?dmc=1&ts=20171212T2152159656. Accessed March 2017.
OB TraumaStabilization, Assessment & Transport Considerations
Primary & Secondary Survey
LUD & Fetal Assessment
KB
Source: 1. ACOG. Bleeding During Pregnancy. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy. Accessed March 2017
Ectopic Pregnancy: 11% Of Maternal Deaths
Pregnancy implantation outside the uterus
Suspect with childbearing age and abdominal pain
Leading cause of 1st trimester maternal death---risk of hemorrhage!!
Source: Tubal Ectopic Pregnancy. ACOG. https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Tubal-Ectopic-Pregnancy. Accessed March 2018
OB Trauma: #1 Cause of Maternal Death
Causes: MVA, Abuse, & Falls• Risk of abdominal trauma & hemorrhage
Physiologic Changes of Pregnancy Can Mask Signs of Shock• Increased blood volume, cardiac output, mild tachycardia
Uteroplacental Unit—Perfusion Redistribution• Fetal compromise can occurs before shock is apparent in mother
Source: Trauma In The Obstetric Patient. American College of Emergency Physicians. https://www.acep.org/Clinical---Practice-Management/Trauma-in-the-Obstetric-Patient--A-Bedside-Tool/. Accessed March 2018
Placenta Previa: Bleeding Risk• Bright red, painless bleeding with or without UC’s
•Must have rapid surgical capability for C/S
Source: Placenta Previa-Obstetric Risk Factors & Pregnancy Outcome. https://www.ncbi.nlm.nih.gov/pubmed/11798453. Accessed March 2018
Placental Abruption: Bleeding RiskRisk Factors?
Placental Detachment• May present with dark red & painful bleeding, OR
• Bleeding may be occult, rigid abdomen with severe pain !!
Source: Bleeding During Pregnancy. ACOG. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy. Accessed March 2018
Tick Tock...Every Minute Matters
Preterm Labor
Preterm Premature Rupture of Membranes
• Primary Impression, Consult, & Pre-transport Stabilization
• Optimize Tocolysis
• Fetal Protection: Magnesium Sulfate, Antenatal Steroids & Antibiotics
• Transfer To Higher Level Of OB & Neonatal Care Source:1. Society For Maternal Fetal Medicine. Implementation of the Use of Antenatal Corticosteroids in the Late Preterm Birth Period in Women at Risk for Preterm Delivery. August 2016. Accessed March 2017. 2. ACOG. Management of Preterm Labor. https://www.acog.org/Womens-Health/Preterm-Premature-Labor-and-Birth. October 2016. Accessed March 2017 3. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Magnesium Sulfate In Obstetrics. January 2016. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co652.pdf?dmc=1&ts=20171212T2253317113. Accessed August 2017.
Viability Considerations23 weeks (some centers 22 weeks)
Estimated Fetal Weight Based On Weeks of Pregnancy
0.5kg 1Kg 2Kg 3Kg 4Kg
Source:1. NEJM. Survival and Neurodevelopmental Outcomes among Periviable Infants. February 2017. Accessed May 2017. 2. ACOG & Society For Maternal-Fetal Medicine. Periviable Birth. https://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Periviable-Birth. October 2017. Accessed November 2017.
The Pressure Is On…..OB Hypertensive Emergencies
Defined: SBP >160mmHg, or DBP > 100mmHg, acute-onset, & persistent (>15 min)
Severe systolic hypertension--most important predictor of cerebral hemorrhage in OB patients• Goal B/P: Range of 140-160/90-100 mmHg to preserve fetal perfusion!!• Severe hypertension can occur antepartum, intrapartum or post-partum
Stabilization Considerations: • Magnesium Sulfate, Antihypertensives, Delivery, Transport, Anticonvulsants
Source:1. California Maternal Quality Care Collaborative: CMQCC. https://www.cmqcc.org/. Accessed August 20172. ACOG. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period. April 2017. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co692.pdf?dmc=1&ts=20171212T2343034025.
Accessed May 2017
Image Source: https://www.thirdstopontheright.com/may-is-preeclampsia-awareness-month-do-you-know-the-signs-and-symptoms/. Accessed April 2018
Preeclampsia, HELLP & Eclampsia
Cerebral Effects Cardiac/Vascular
Pulmonary Liver Renal Fetal
Labs: Obtain Hct, Platelets, LFT’s, Cr, Coags
Preeclampsia Assessment Is Vital!!
Treatment-Stabilization: Magnesium Sulfate, Antihypertensives, Anticonvulsants, DeliverySource: 1. California Maternal Quality Care Collaborative: CMQCC. https://www.cmqcc.org/. Accessed August 20172. https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system. Accessed December 2017
Delivery Outside Of OB Unit : Now What??• Place infant on mothers abdomen after birth
• Clamp cord 8-10 inches from baby• Use 2 clamps several inches apart: cut between clamps
• Delayed Cord Clamping X 30-60 seconds IF VIGOROUS
• Immediate Cord Clamping IF NONVIGOROUS
• Provide basic newborn care• Clear Airway & Optimal Airway Positioning
• Dry Thoroughly & Provide Warmth
• Continuous assessment of ABC’s
• Thermoregulation & Blood Glucose
Source: Neonatal Resuscitation Program. AAP. 7th Edition
Tiny Ones: Preterm Delivery Delayed Cord Clamping (DCC): IF newborn is vigorous. DCC and reduction of IVH
• IF NONVIGOROUS---immediate umbilical cord clamping, initate NRP
Thermoregulation & Handling: Warming Mattress, isolation bag, nesting, gentle handling
Follow NRP Guidelines: Sp02, application of mask/nasal CPAP, careful (slow) fluid
administration, glycemic control, airway & perfusion support, early activation of transport team!
Source:1. AAP. Neonatal Resuscitation Program. 7th Edition.
Delivery of Placenta: Now What?
Typically within a few minutes of delivery• Do not pull on cord
Normal blood loss ~ 500ml
Provide vigorous fundal massage!!
• Support lower uterine segment
• Ensure uterus stays contracted-firm
• Uterotonics: Pitocin as needed
Source: ACOG Guidelines For Management Of Hemorrage. https://www.aafp.org/afp/2007/0401/p1101.html. Accessed 3/2018.
Postpartum Hemorrhage: >500ml Blood Loss #1 Priority: Provide Vigorous Continuous Fundal Massage• Leading cause: uterine atony after birth•Goal: uterus remains contracted & firm
Adequate Vascular AccessContinuous Fundal MassageUterotonicsConsider TXAD&C -- Removal of Placental PartsOR --- Looking For BleedersActivate Massive Hemorrhage Protocol
Source: OB Hemorrhage V2 Toolkithttps://www.cmqcc.org/resources-tool-kits/toolkits/ob-hemorrhage-toolkit. CMQCC. California Maternal Quality Care Collaborative. Accessed 3/20/2018
Image Source: dailymom.com
Neonatal Emergencies
Neonatal Resuscitation & Stabilization Priorities
NRP versus PALS: Differences
Stabilization Measures: The S.T.A.B.L.E. Program
• Glycemic Control• Thermoregulation• Perfusion Support• Consider Antibiotics• Preparation For Transport • Transfer to Higher Level of Care
Source: AAP. Neonatal Resuscitation Program. 7th EditionThe S.T.A.B.L.E. Program. 6th Editionhttp://www.abclawcenters.com/wp-content/uploads/2014/11/original_resuscitation_with_bagging_and_chest_compressions.jpg. Accessed August 2017.
Neonatal Airway ManagementBabies Are Different…
•Anatomical Challenges
•Ventilation Devices
•Establishing Effective Ventilation
•Oxygenation
•Ongoing Airway Support
•Alternative AirwaySource1. AAP. Neonatal Resuscitation Program. 7th Edition2. The S.T.A.B.L.E. Program. 6th Edition
Neonatal Vascular AccessEmergent UVC: o18-20 gauge IV catheter: Prep—Tie—Cut--Cannulateo Single lumen UVC catheter 3-5 cm, obtain blood return o < 1500 Grams/30 weeks 3.5 F and > 1500 Grams/30 weeks 5.0
F
PIV Placement
• 24g
IO Placement
• EZ IO >3kg
Fluid Resuscitation
• NRP versus PALSSource1. AAP. Neonatal Resuscitation Program. 7th Edition2. The S.T.A.B.L.E. Program. 6th Edition
Neonatal Hypothermia Treatment: Protecting Babies BrainsHypoxic Ischemic Encephalopathy (HIE)
Inclusion CriteriaoPost criteria in L & D - Nursery
Time SensitiveoEarly Recognition is Vital
oTarget Initiation by 6 hours
Early ConsultationoRegional Neonatal Cooling Center
Source:Hypothermia and Neonatal Encephalopathy. AAP (2014). http://pediatrics.aappublications.org/content/pediatrics/133/6/1146.full.pdf. Accessed May 2017https://i.pinimg.com/236x/ef/50/f3/ef50f3f7f9ee2fdfc533270415471c1e.jpg. Accessed December 2017. http://www.rchsd.org/wp-content/uploads/2014/05/Neonatal-cooling-blanket.png. Accessed December 2017 http://jlgh.org/JLGH/media/Journal-LGH-Media-Library/Past%20Issues/Volume%206%20-%20Issue%203/Larsonfig3.jpg. Accessed December 2017
Bowel Obstruction: Clinical Priorities
• Rapid Consult, Stabilization & Transport to Pediatric Surgical Center
• Airway & Perfusion Support
• Decompression of abdomen continuous: Orogastric Tube 8F or 10F
• IV Fluids, Glycemic Control, ThermoregulationSource1. AAP. Neonatal Resuscitation Program. 7th Edition2. The S.T.A.B.L.E. Program. 6th Edition
3. Journal of Obstetric Gynecologic and Neonatal Nursing. JOGNN. Lockridge, Caldwell, Jason (2003). Neonatal Surgical Emergencies: Stabilization & Management. Volume 31, Number 3.
Free Air On Xray Is A Surgical Emergency
Questions?
For Additional Information Contact: Yvette Gonzalez, RN, MS, High Risk OB & Neonatal Clinical Manager @