Resuscitation enc-3


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  • Newborn Resuscitation Algorithm.
  • Resuscitation enc-3

    2. 2. Why we need to resuscitate: pH 7.30 pH 7.00 pH 6.80
    3. 3. How often do we use our resuscitation skills?
    4. 4. PREPARING FOR BIRTH Wash your hands  Draught free, warm room - temperature >250C  Clean, dry and warm delivery surface  Radiant heater  Two clean, warm towels/clothes  A folded piece of cloth  Self inflating bag - newborn size  Infant masks in two sizes - normal and small newborn  Suction device  Oxygen (if available)  Clock Check if all equipments are in working order
    5. 5. ASSESSMENT AT BIRTH  Deliver the baby on to mother’s abdomen  Note and call out time of birth  Thoroughly dry the baby  Use a warm towel  Discard wet towel after drying  Wrap the baby in another warm cloth Keep the baby warm Assess breathing while drying 5
    6. 6. CARE OF THE BABY AT BIRTH Assess breathing: Assessment Baby is crying Decision Baby is not crying, but breathing at 30 to 60 times per minute Baby is gasping No need for resuscitation or suctioning; Start skin-to-skin contact and breastfeeding No need for resuscitation or suctioning Start resuscitation immediately Baby is not breathing Start resuscitation immediately H- 6
    7. 7. Newborn Resuscitation Algorithm. Kattwinkel J et al. Pediatrics 2010;126:e1400-e1413 ©2010 by American Academy of Pediatrics
    8. 8. Dry the baby immediately after birth Immediate skin-to-skin Contact & Breastfeeding (routine care) 8
    9. 9. Steps of resuscitation If the baby is not breathing or gasping ◦ Call for help! ◦ Cut cord quickly, transfer to a firm, warm surface [under a radiant heater] ◦ Inform the mother that baby has difficulty breathing and you will help the baby to breathe ◦ Start newborn resuscitation 9
    10. 10. Suction Equipment Warmer & Blankets Bag, Mask, & Oxygen Laryngoscope and ETT Tube
    11. 11. Steps of resuscitation Position 11
    12. 12. Steps of resuscitation Position, clear airways (if needed) Suction: Do not exceed duration of 20 sec 12
    13. 13. Steps of resuscitation Dry, stimulate, reposition 13
    14. 14. Steps of resuscitation Dry, stimulate, reposition 14
    15. 15. Steps of resuscitation Ventilate (if still not breathing) Selecting Bag & Mask equipment • Size of bag: 240-750 ml • Oxygen capability: Oxygen source, reservoir • Safety feature: Pop off valve, pressure gauge (optional) 15
    16. 16. Steps of resuscitation Ventilate Use the CORRECT size face mask that covers:  The nose  The mouth  The tip of the chin but not the eyes 16
    17. 17. Steps of resuscitation Fitting a face mask: • A face mask that is too LARGE – Covers the eyes – Extends over the tip of the chin • A face mask that is too SMALL – Does not cover the nose – Does not cover the mouth effectively 17
    18. 18. Steps of resuscitation Ventilate  Squeeze bag with 2 fingers or whole hand, 2-3 times  Observe for rise of chest  IF CHEST IS NOT RISING: ◦ Check seal ◦ Reposition the head ◦ Squeeze harder  Once good seal and chest rising, ventilate at 40 squeezes per minute  Observe chest rise  Check heart rate after 30 seconds 18
    19. 19. Steps of resuscitation When to stop ventilating? If baby is crying; If breathing >30/min, and NO chest in-drawing: ◦ If the skin between the ribs is ‘sucked’ inwards and the ribs are prominent, the baby has chest ‘in-drawing’ 19
    20. 20. Steps of resuscitation After stopping ventilation  Put the baby in skin-to-skin contact on mother’s chest  Monitor every 15 minutes for breathing and warmth  Tell the mother the baby will probably be well  Encourage the mother to start breastfeeding as soon as possible NEVER leave the baby alone 20
    21. 21. Steps of resuscitation When to continue ventilating? If the baby – is breathing at a rate of <30/min, – is gasping – has severe chest in-drawing • Arrange for immediate referral 21
    22. 22. MECONIUM STAINED AMNIOTIC FLUID No need for intrapartum suction Birth: assess HR, breathing and tone Vigorous: HR>100 good breathing Nonvigorous: any parameter abnormal Good tone Initial steps Tracheal suction 23
    23. 23. Steps of resuscitation Special considerations for preterm • Be gentle • Use small size resuscitation bag and give small tidal volumes to move chest • Avoid 100% oxygen , use blenders and oxygen saturation monitors • Avoid rapid fluid bolus • May need intubation, chest compression, medications 24
    24. 24. Post resuscitation management Principles 1. Keeping normal temperature 2. Maintaining oxygenation 3. Maintaining physiological milieu- fluids , glucose 4. Maintaining perfusion 5. Treating seizures 6. Monitoring organ function 25
    25. 25. Care after resuscitation • • • • • Place baby in skin-to-skin contact with mother Keep the baby warm Monitor every 15 minutes Start breastfeeding as soon as possible Discuss what has happened with the parents be positive! • Do not separate the mother and baby unless the baby has difficult breathing 26