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Neonatal Resuscitation Pp


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Neonatal Resuscitation Pp

  1. 1. Neonatal Resuscitation 4.0 CEU’S
  2. 2. Introduction <ul><li>Approximately 10 % of all newborns require some type of life support in the delivery room or nursery. In those less than 1500 grams the need rises to about 80%. 1% of all infants will require major resuscitative measures. </li></ul>
  3. 3. Transition <ul><li>The First Breath </li></ul><ul><li>Clamping of the Umbilical Cord </li></ul><ul><li>Pressure Changes </li></ul><ul><li>Closure of the Ductus/Foramen ovale </li></ul>
  4. 6. Factors Associated with Increased Risk for Resuscitation <ul><li>Antepartum </li></ul><ul><li>1. Maternal Age > 35 </li></ul><ul><li>2. Diabetes </li></ul><ul><li>3. SGA </li></ul><ul><li>4. Pre or Post Term </li></ul><ul><li>5. PROM </li></ul><ul><li>6. Drugs </li></ul>
  5. 7. <ul><li>Intrapartum </li></ul><ul><li>1. Breech Presentation </li></ul><ul><li>2. Infection </li></ul><ul><li>3. Prolonged Labor </li></ul><ul><li>4. Prolapsed Cord </li></ul><ul><li>5. Meconium–Stained Fluids </li></ul><ul><li>6. Operative Delivery </li></ul><ul><li>7. Fetal HR Abnormalities </li></ul>
  6. 8. Preparation for Delivery <ul><li>Anticipation </li></ul><ul><li>Adequate Planning and Preparation </li></ul><ul><li>Prompt Initiation of Resuscitation Steps </li></ul>
  7. 9. Initial Steps of Resuscitation <ul><li>1. Provide Warmth/Prevent Heat Loss </li></ul><ul><li>2. Position/Clear the Airway </li></ul><ul><li>3. Dry/Stimulate – Initiate Breathing </li></ul><ul><li>4. Evaluation </li></ul>
  8. 10. Meconium-Stained Infants <ul><li>* Vigorous </li></ul><ul><li>strong respirations, good muscle tone, HR>100 </li></ul><ul><li>* Not Vigorous </li></ul>
  9. 12. Thermoregulation <ul><li>1. Always preheat the radiant warmer </li></ul><ul><li>** Preterm babies are especially vulnerable to </li></ul><ul><li>cold stress. </li></ul><ul><li>2. Warm blankets to be used prior to birth. </li></ul><ul><li>*** baby cannot benefit from radiant heat if covered with blankets, or team members block the heat with their head or upper body. </li></ul>
  10. 14. Opening/Clearing the Airway <ul><li>Place infant of his back or side. </li></ul><ul><li>Place in a “sniffing” position </li></ul><ul><li>Suction mouth, then nose. </li></ul>
  11. 15. Dry/Stimulate <ul><li>Drying and removal of wet linen may be enough to initiate breathing. </li></ul><ul><li>Tactile Stimulation (if necessary) </li></ul>
  12. 18. Evaluation <ul><li>Respiratory Effort </li></ul><ul><li>Heart Rate </li></ul><ul><li>Color </li></ul>
  13. 19. Providing Free Flow Oxygen <ul><li>Give the baby free-flow oxygen if… </li></ul><ul><li>the newborn is breathing, Heart rate is above 100, but the baby is cyanotic. </li></ul>
  14. 20. <ul><li>** When after tactile stimulation and administration of free flow O2 baby remains… </li></ul><ul><li>Apneic </li></ul><ul><li>Gasping </li></ul><ul><li>Heart Rate < 100 </li></ul><ul><li>PPV is indicated </li></ul>
  15. 21. <ul><li>**Ventilation of the lungs is the most important and effective action of NRP </li></ul>
  16. 22. Positive Pressure Ventilation <ul><li>Bag and Mask </li></ul><ul><li>1. Self Inflating Bag </li></ul><ul><li>2. Flow Inflating/Anesthesia Bag </li></ul><ul><li>3. T-piece Resuscitator </li></ul>
  17. 23. Self Inflating Bag <ul><li>Fills spontaneously after squeezed and remains inflated at all times. </li></ul><ul><li>Can deliver PPV without a compressed air source </li></ul><ul><li>Requires an oxygen reservoir to deliver 90-100% oxygen </li></ul><ul><li>Cannot be used to deliver free-flow O2 through the mask. </li></ul><ul><li>***Pop-off valve should always be used to avoid delvivery of too much pressure. </li></ul>
  18. 25. Flow-Inflating Bag <ul><li>Also known as an anesthesia bag </li></ul><ul><li>Fills only when oxygen from a compressed source flows through it. </li></ul><ul><li>Depends on a compressed gas source. </li></ul><ul><li>Uses a flow-control valve to regulate pressure </li></ul><ul><li>(pressure manometer is required to avoid excess pressures) </li></ul><ul><li>Looks like a deflated balloon when not in use </li></ul><ul><li>Can be used to administer free-flow O2 </li></ul>
  19. 27. T-Piece Resuscitator <ul><li>Requires a gas source </li></ul><ul><li>Must have a tight face-mask seal to inflate the lungs </li></ul><ul><li>Pressures are set manually with adjustable controls </li></ul><ul><li>Operator sets maximum circuit pressure, PiP, and peep </li></ul><ul><li>PiP must be adjusted to achieve correct chest movement </li></ul><ul><li>Can be used to delivery free-flow O2 </li></ul><ul><li>**Postive Pressure is provided by occluding and releaseing the hole in the peep cap. </li></ul>
  20. 31. Bag and Mask Performance <ul><li>* Face Masks </li></ul><ul><li>1. size/shape </li></ul><ul><li>2. seal/correct position </li></ul><ul><li>* Rate </li></ul><ul><li>* Pressures </li></ul><ul><li>* NG/OGT placement </li></ul>
  21. 32. Supplemental Oxygen <ul><li>Term </li></ul><ul><li>Preterm </li></ul><ul><li>Heart Rate <100 </li></ul>
  22. 33. Chest Compressions <ul><li>Indicated when Heart Rate is less than 60 despite 30 seconds PPV. </li></ul><ul><li>Two acceptable techniques </li></ul><ul><li>a. two finger </li></ul><ul><li>b. thumb </li></ul><ul><li>Correct positioning </li></ul><ul><li>Rate/Depth/Coordination </li></ul><ul><li>Complications </li></ul>
  23. 35. Endotracheal Intubation <ul><li>Indications </li></ul><ul><li>1. Suctioning the trachea </li></ul><ul><li>2. When Bag & Mask is ineffective </li></ul><ul><li>3. Facilitate coordination with CC </li></ul><ul><li>4. Administer Epinephrine </li></ul>
  24. 36. Endotracheal Intubation <ul><li>Equipment </li></ul><ul><li>1. Laryngoscope </li></ul><ul><li>2. Endotracheal Tubes </li></ul><ul><li>3. Stylette </li></ul><ul><li>4. Suction </li></ul><ul><li>5. Ambu bag </li></ul><ul><li>6. Oxygen </li></ul>
  25. 37. Endotracheal Intubation <ul><li>Steps of Intubation </li></ul><ul><li>1. Position the Head </li></ul><ul><li>2. Inserting Laryngoscope </li></ul><ul><li>3. Landmarks </li></ul><ul><li>4. Suction/insertion of tube </li></ul>
  26. 39. Endotracheal Intubation <ul><li>* Correct Placement </li></ul><ul><li>1. Vital Signs </li></ul><ul><li>2. Breath Sounds </li></ul><ul><li>3. Vapor </li></ul><ul><li>4. Chest Movement </li></ul><ul><li>5. CO2 detectors </li></ul><ul><li>6. Lip to Tip </li></ul><ul><li>7. CXR </li></ul><ul><li>* Securing the Tube </li></ul>
  27. 40. Endotracheal Intubation <ul><li>Complications </li></ul><ul><li>1. Hypoxia </li></ul><ul><li>2. Bradycardia/Apnea </li></ul><ul><li>3. Pneumothorax </li></ul><ul><li>4. Contusions/Lacerations </li></ul><ul><li>5. Perforations </li></ul><ul><li>6. Infections </li></ul>
  28. 41. Laryngeal Mask <ul><li>What is it? </li></ul><ul><li>How does it work? </li></ul><ul><li>Indications for it? </li></ul><ul><li>Limitations </li></ul><ul><li>Complications </li></ul>
  29. 42. Medications <ul><li>Naloxone </li></ul><ul><li>Epinephrine </li></ul><ul><li>Volume Expanders </li></ul><ul><li>Sodium Bicarbonate </li></ul>
  30. 43. Premature Infants <ul><li>Additional Risks </li></ul><ul><li>Additional Equipment </li></ul><ul><li>Use of Oxygen </li></ul><ul><li>Brain Injury </li></ul><ul><li>Thermoregulation </li></ul>
  31. 44. Post Resuscitation Care <ul><li>Routine Care </li></ul><ul><li>Observational Care </li></ul><ul><li>Post-resuscitative Care </li></ul>
  32. 45. Routine care
  33. 46. Observational Care
  34. 47. Intensive Care
  35. 48. Ethics/Compassionate Care at the End of Life <ul><li>Ethical Principals </li></ul><ul><li>1. Autonomy </li></ul><ul><li>2. Benefits </li></ul><ul><li>3. Nonmalefience </li></ul><ul><li>4. Justice </li></ul><ul><li>* Parents Role </li></ul><ul><li>* Law </li></ul>
  36. 49. Support at Death <ul><li>Be clear and honest </li></ul><ul><li>What “not” to say </li></ul><ul><li>Provide humane and compassionate care </li></ul><ul><li>Follow-up </li></ul><ul><li>Care of the Staff </li></ul>