The document discusses neonatal resuscitation, including the physiology of fetal circulation and changes at delivery. It describes potential difficulties in transitioning including lack of respiratory effort and persistent pulmonary hypertension. Guidelines are provided for the initial steps and subsequent interventions in resuscitation based on the infant's condition, such as providing warmth, clearing the airway, positive pressure ventilation, and chest compressions if needed.
step by step description of resuscitation in newborn for clinical year 2 medical students easier to understand and help revise for exam and osce examinations
Pediatrics notes about "Neonatal Resuscitation". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Pediatric Triage
French verb “trier”, means to separate or select.
Triage is the process of rapid assessment of a patient with a view to define urgency of care & priorities in treatment.
It helps in rational allocation of limited resources, when demand exceeds availability.
Triage is the first step in the management of a sick child admitted to a hospital.
Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death.
step by step description of resuscitation in newborn for clinical year 2 medical students easier to understand and help revise for exam and osce examinations
Pediatrics notes about "Neonatal Resuscitation". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Pediatric Triage
French verb “trier”, means to separate or select.
Triage is the process of rapid assessment of a patient with a view to define urgency of care & priorities in treatment.
It helps in rational allocation of limited resources, when demand exceeds availability.
Triage is the first step in the management of a sick child admitted to a hospital.
Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death.
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
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R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
4. Physiology
• Fetal Circulation
– From the
placenta…
• Oxygenated
blood…
• Ductus
venosus into
IVC…
• Right atrium…
• Shunted thru
foramen
ovale…
• Into left atrium
2011 UpToDate, Inc.
5. Physiology
• Fetal Circulation
– From the SVC
and IVC…
• Minimal mixing
with oxygenated
blood…
• Right atrium to
right ventricle…
• Shunted through
ductus
arteriosus…
• Into distal aorta
2011 UpToDate, Inc.
9. Physiology
• Difficulties Transitioning
– Lack of respiratory effort
– Blockage of the airways
– Impaired lung function
– Persistent pulmonary hypertension
– Cardiac anomalies
10.
11. Neonatal Resuscitation
Introduction – Multiparous female to ED with severe
contractions; is preterm (28 weeks); precipitous delivery
of pre-term neonate as put into resuscitation bay.
PMH for mother –G6P6, Normal prenatal visits, estimate
gestational age 28 weeks currently, no other issues.
Exam for mother – Awake, alert, stable, can provide
appropriate history as needed
CASE 1
12. Neonatal Resuscitation
Initial Description of Neonate –
Placed in warmer; is not breathing
or crying; poor muscle tone;
cyanotic; note clear amniotic fluid.
Exam –
Cyanotic neonate, unresponsive,
floppy
No respiratory effort/apneic
Heart rate 50’s
APGAR = 1
CASE 1
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
13. Neonatal Resuscitation
• APGAR Score
– Performed at 1 and 5 minutes
– Evaluate condition after delivery and need for intervention
Component 0 1 2
Appearance Whole body
cyanotic
Cyanotic
extremities
Good color
Pulse No heart rate < 100 BPM > 100 BPM
Grimace No response to
stimulation
Grimace Grimace,
vigorous cry
Activity Limp, no
movement
Some muscle
tone
Active motion
Respiration Not breathing Slow, irregular Cries well
Quick Tangential Point
14. Neonatal Resuscitation
APGAR Score
“These scores should not be used to dictate appropriate
resuscitative actions, nor should interventions for
depressed newborns be delayed until the 1-minute
assessment.”
Textbook of Neonatal Resuscitation, 6th
Edition; Page 35.
Quick Tangential Point
15. Neonatal Resuscitation
Initial Description of Neonate –
Placed in warmer; is not
breathing or crying; poor
muscle tone; cyanotic; note
clear amniotic fluid.
Exam – Cyanotic neonate,
unresponsive, floppy
No respiratory effort/apneic
Heart rate 50’s
APGAR = 1
CASE 1
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
16. Neonatal Resuscitation
• What is the next step?
– “ABCDs”
• Initial steps – provide warmth, suction Airway as necessary,
dry, stimulate
• Reassess
• Positive pressure ventilation (Breathing)
• Reassess
• Ventilation corrective steps (Breathing)
• Reassess
• Chest compressions
• Reassess
• Give Drugs
17. Neonatal Resuscitation
• Initial steps
– Provide warmth
• Warm towels
• Radiant warmer
– Clear airway as
necessary
– Dry and
stimulate
– Reassess
Term Gestation?
Breathing or crying?
Good tone?
Routine
Care
Warm
Clear airway if needed
Dry
Stimulate
HR less than 100?
Gasping or
Apnea?
No
Yes
30 sec
19. Neonatal Resuscitation
• Subsequent steps
– Positive-pressure
ventilation (PPV)
• Self-inflating bag
• Position neck in
neutral position
• Suction mouth and
nose
• Ventilate at 40-60
bpm
– SpO2 monitoring
• Right hand or wrist
– Reassess
HR less than 100?
Gasping or
Apnea?
Labored
Breathing
Cyanosis
Positive-Pressure
Ventilation
SpO2 monitoring
HR below 100?
Yes
5-10 breaths
No
Clear airway
SpO2 monitor
CPAP?
Yes
20. Neonatal Resuscitation
Reassessment
Somewhat improved heart rate
and color
Heart rate increases to 90’s
with continued PPV
Oxygen saturation in the 80’s
CASE 1
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
21. Neonatal Resuscitation
• Pulse oximetry
– Attached to preductal location on right upper extremity
– Saturation may normally remain low for several minutes after
delivery
Targeted preductal SpO2 after
delivery
1 min 60-65 percent
2 min 65-70 percent
3 min 70-75 percent
4 min 75-80 percent
5 min 80-85 percent
10 min 85-95 percent
Quick Tangential Point
22. Neonatal Resuscitation
Reassessment
Somewhat improved heart rate
and color
Heart rate increases to 90’s
with continued PPV
Oxygen saturation in the 80’s
CASE 1
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
23. Neonatal Resuscitation
• Subsequent steps
– Heart rate less
than100 BPM
• Ventilation
corrective steps
• Continue BMV
ventilation
HR below 100? Postresus.
care
Ventilation corrective
steps
Yes
No
HR < 60?
No
Continue
ventilation
Yes
HR < 100 but > 60?
24. Neonatal Resuscitation
• Ventilation Corrective Steps – 3 possible reasons for ineffective
ventilation
– Inadequate mask seal
– Airway is blocked
– Not enough pressure used
Measures to improve positive-pressure ventilation
M Mask adjustment
R Reposition airway
S Suction mouth and nose
O Open mouth
P Pressure increase
A Airway alternative
Quick Tangential Point
25. Neonatal Resuscitation
Reassessment
Heart rate increases to > 100
with continued PPV
Attempts to provide
supplemental oxygen result in
decreasing oxygen saturation
and decreasing heart rate
Obvious inadequate
respiratory effort
CASE 1
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
26. Neonatal Resuscitation
Your kind of stuck
here aren’t you…
HR below 100? Postresus.
care
Ventilation corrective
steps
Yes
No
HR < 60?
No
Continue
ventilation
Yes
HR < 100 but > 60?
27. Neonatal Resuscitation
• Consider placing an
orogastric tube to…
– Suction gastric contents
– Serve as vent for air in
stomach
• Consider endotracheal
intubation for…
– PPV beyond a few minutes
– Meconium and floppy
– Chest compressions
– PPV with inadequate
improvement
– Special circumstances
What to do if positive-pressure ventilation is to be
continued…
28. Neonatal Resuscitation
Reassessment
Heart rate with PPV remains
above 100
Color improved
Continue to provide respiratory
support (oxygen saturation in
low 90’s)
NICU team present with
warmer
CASE 1
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
29.
30. Neonatal Resuscitation
Introduction – Multiparous female to ED in labor; precipitous delivery as
put into resuscitation bay of term neonate. Meconium stained
amniotic fluid.
PMH for mother –G6P6, Normal prenatal visits, due date 2 days from
now, no other issues.
Exam for mother – Awake, alert, stable, can provide appropriate history
as needed
CASE 2
31. Neonatal Resuscitation
Initial Description of Neonate –
Placed in warmer; is not
breathing or crying; poor
muscle tone; cyanotic;
meconium stained.
Exam – Cyanotic neonate,
unresponsive, floppy
No respiratory effort/apneic
Heart rate 50’s (< 60)
APGAR = 1
CASE 2
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
32. Neonatal Resuscitation
• Initial steps
– Provide warmth
• Warm towels
• Radiant warmer
– Clear airway as
necessary
– Dry and
stimulate
– Reassess
Term Gestation?
Breathing or crying?
Good tone?
Routine
Care
Warm
Clear airway if needed
Dry
Stimulate
HR less than 100?
Gasping or
Apnea?
No
Yes
30 sec
Hold On!!!
33. Neonatal Resuscitation
• Meconium is present and
baby is NOT vigorous
– Provide warmth
• Warm towels
• Radiant warmer
– Before drying (!!!)
• Oropharynx and
hypopharynx suctioned
• Trachea suctioned under
direct visualization
– Dry and stimulate
– Reassess
Term Gestation?
Breathing or crying?
Good tone?
Routine
Care
Warm
Direct suctioning of trachea
Dry
Stimulate
HR less than 100?
Gasping or
Apnea?
No
Yes
30 sec
34. Neonatal Resuscitation
• To suction the
trachea
– Insert a laryngoscope
– Suction mouth and
posterior pharynx
– Insert endotracheal
tube
– Attach to meconium
aspirator
– Suction
Quick Tangential Point
37. Neonatal Resuscitation
• Subsequent steps
– Positive-pressure
ventilation (PPV)
• Self-inflating bag
• Position neck in
neutral position
• Suction mouth and
nose
• Ventilate at 40-60
bpm
– Reassess
HR less than 100?
Gasping or
Apnea?
Labored
Breathing
Cyanosis
Positive-Pressure
Ventilation
SpO2 monitoring
HR below 100?
Yes
5-10 breaths
No
Clear airway
SpO2 monitor
CPAP?
Yes
38. Neonatal Resuscitation
Reassessment
Neonate with no
improvement (apneic,
heart rate in 50’s, poor
color and tone)
CASE 2
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
39. Neonatal Resuscitation
• Subsequent steps
– Heart rate less
than100 BPM
• Ventilation
corrective steps
• Continue BMV
ventilation
HR below 100? Postresus.
care
Ventilation corrective
steps
Yes
No
HR < 60?
No
Continue
ventilation
Yes
HR < 100 but > 60?
40. Neonatal Resuscitation
Reassessment
Neonate with no
improvement (apneic,
heart rate in 50’s, poor
color and tone)
CASE 2
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
45. Neonatal Resuscitation
• Subsequent steps
– Heart rate less
than100 BPM
• Continue positive
pressure ventilation
HR below 100? Postresus.
care
Ventilation corrective
steps
Yes
No
HR < 60?
No
Continue
ventilation
Yes
HR < 100 but > 60?
46. Neonatal Resuscitation
Reassessment
Heart rate improves with
PPV to 100’s
NICU team present with
warmer
CASE 2
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
47.
48. Neonatal Resuscitation
Introduction – Young female with history of drug abuse (prescription
pain medications) to ED in labor; precipitous delivery as put into
resuscitation bay of near-term neonate.
PMH for mother – G2P1, drug abuse (prescription pain medications –
is currently abusing), 1 prenatal visit, thinks due date is “a couple
weeks from now.”
Exam for mother – post-partum, speech somewhat slurred
CASE 3
49. Neonatal Resuscitation
Initial Description of Neonate –
Placed in warmer; is not
breathing or crying; poor
muscle tone; cyanotic; note
clear amniotic fluid.
Exam – Cyanotic neonate,
unresponsive, floppy
No respiratory effort/apneic
Heart rate 50’s
APGAR = 1
CASE 3
Copyright: Author: Jules Atkins, RM, Supplied by: Brandi Catt, 2006-01-27
50. Neonatal Resuscitation
• Initial steps
– Provide warmth
• Warm towels
• Radiant warmer
– Clear airway as
necessary
– Dry and
stimulate
– Reassess
Term Gestation?
Breathing or crying?
Good tone?
Routine
Care
Warm
Clear airway if needed
Dry
Stimulate
HR less than 100?
Gasping or
Apnea?
No
Yes
30 sec
62. Neonatal Resuscitation
• Summary of resuscitation steps
– Initially provide warmth, clear airway, dry and stimulate infant
– If meconium staining and non-vigorous infant, suction before
stimulation
– If infant continues with poor respiratory effort or HR < 100, start
PPV with BMV, initiate pulse oximetry
– If not improving take ventilation corrective steps
– Intubate if BMV is ineffective or prolonged, or chest
compressions are being performed
– If HR < 60 despite adequate ventilation, start chest
compressions at 90 per minute
– If HR rate < 60 despite adequate ventilation and chest
compressions, administer IV epinephrine
