2. Basic Pediatrics Emergency Training
Learning objectives basic pediatrics emergency:
By the end of this session, participants will be able:
• How to triage
• How to assess and manage Pediatrics Air way
• Management of Pediatrics respiratory Emergency
• Identifying Pediatrics circulatory problem
• Over view of basic life support in infant and children
• How to do Neonatal resuscitation
4. Objective
At the end of the attachment, the trainee will be able to:
• Outline the principle of triaging
• Identify the three steps of triaging
• Recognize the importance of re-triaging
5. What is triage?
• Triage is the sorting of patients into priority groups according to their need and
the resources available
• The aim of triage is to identify very sick children quickly so they may be treated
without delay
• Many children die within the first 24 hours of admission to hospital and many of
these deaths are preventable.
6. Triage Process
• How long does it take?
Not long! Experienced staff can triage in 20 seconds
• When does it happen?
As soon as the child arrives in hospital
• Where does it take place?
Anywhere children are first seen – under 5 clinic, emergency
room, ward
Emergency treatment area should be close by but some
treatments can be started anywhere
• Who should triage?
All staff involved in care of sick children should be able to
triage and ideally be able to give emergency treatment
Non-medical staff who may meet children on arrival should
also be trained in basic triage
7. HOW TO TRIAGE?
• There are three level of triaging by use of ABC(3)DO concept
- Emergency has ABC(3)DO problem – who needs immediate
management
- Priority has 3TPR MOB – needs management without delay
- None urgent has none emergency or priority signs - needs to wait
until the above seen
8. • A Airway
• B Breathing
• C Circulation, Convulsion, Coma
• D Dehydration
• O Other (bleeding child, trauma with open fracture, Acute poisoning
and Exposing the child after poly trauma also is an emergency
assessment)
9. How to triage
• Assess for each group of emergency signs in turn: ABC(3)DO
• As soon as an emergency sign is found, emergency treatment must be started
• Do not wait to assess other ‘E’ signs before starting treatment
• Once treatment is given continue to look for other ‘E’ signs
• If no ‘E’ signs are found move on to Priority signs
• If ‘P’ signs are found child must be given priority for full assessment and treatment
• If no ‘E’ or ‘P’ signs are found child is a non-urgent case and should be directed to queue
10. Airway or Breathing Problems
• To assess for airway or breathing problems you need to know:
• Is the child breathing?
• Is the airway obstructed?
• Is the child blue (centrally cyanosed)?
• Does the child have severe respiratory distress?
• Look, listen and feel for breathing
• Listen for sounds of obstruction (noisy breathing)
• Look for severe chest in drawing, accessory muscle use, very fast breathing
• Is the child too breathless to talk or feed?
NB: If any of air way and breathing problem found child is classified as Emergency
11. Circulation
To assess for circulation problems you need to know:
• Does the child have warm hands?
• If yes move on to assess for coma
• If not, is the capillary refill time longer than 3 seconds?
Is the pulse weak and fast?
NB: If any of circulatory problem is found child classified as Emergency
12. Coma and convulsions
• To assess for coma make a rapid assessment of conscious level:
• A = ALERT
• V = responds to VOICE
• P = responds to PAIN
• U = UNRESPONSIVE
• A child who responds only to pain or is unresponsive is classified as coma
• GCS can also be used, usually used to assess the progress
Look for repetitive, abnormal movements or twitching (signs of convulsion)
NB: If any of coma or convulsion is found child classified as Emergency
13. Dehydration
• To assess for severe dehydration you need to know:
• If the child is lethargic or unconscious
• If the child has sunken eyes
• If the skin pinch goes back slowly
NB: If any of the dehydration signs is found child classified as
Emergency
14. Others
• To assess for other emergency conditions you need to know:
• If the child is bleeding
• If the child is poisoned (with in an hour of acute poisoning)
• If the child has major trauma with compound fracture/poly trauma may need
exposure
NB: If any of others signs is found child classified as Emergency
15. ABCDO Emergency Signs
• If the child has any sign of the ABCDO, it means the child has an
emergency ‘E’ sign and emergency treatment should start
immediately
• When ABCDO has been completed and there are no emergency signs,
continue to assess Priority signs
16. Priority
• These children need prompt, but not emergency, assessment and
treatment
• These signs can be remembered with the symbols: 3 TPR MOB
• T Tiny
18. 3TPR MOB
• Tiny baby: any sick baby under 2 months
Small babies difficult to assess, more prone to infection, more likely to deteriorate
quickly
• Temperature: child is very hot
High fever may need prompt treatment and investigation e.g paracetamol, MPS
• Trauma or other urgent surgical condition(not included as other emergency condition)
Includes acute abdomen, fractures, head injury
19. 3TPR MOB
• Pallor
- Severe pallor may indicate severe anaemia needing urgent transfusion
• Poisoning
- Those who arrived after an hour of history of swallowing drugs or poison but still s/he
may deteriorate rapidly and may need specific urgent treatment
• Pain
- Severe pain requires early full assessment and pain relief
20. 3TPR MOB
• Restless, lethargy, irritable
- Child who is conscious but cries constantly and will not settle. May have serious
illness such as meningitis
• Respiratory distress
- Moderate respiratory distress (chest in drawing or difficulty breathing that is not
severe) requires urgent but not emergency treatment. If in doubt class as ‘E’
• Referral
- Any urgent referral from another hospital or clinic should be seen as a priority
21. 3TPR MOB
• Malnutrition/ marasmus
- Severe wasting may indicate severe malnutrition ( marasmus)
• Oedema
- Oedema of both feet may indicate another form of severe malnutrition, Kwashiorkor
• Burn
- Major burns are very painful and children can deteriorate rapidly
22. None urgent
• Once assessment is complete if no emergency or priority signs are
found the child is classed ‘non-urgent’ and should wait their turn in
the queue
• However, if there is any change in the child’s condition, the child will
need to be triaged again and treated appropriately
23. • Emergency management
- Treatment must be started as soon as possible
- Ideally should be directed by senior health worker
- Needs good team work
- Needs frequent reassessment of ABCD
• Priority cases
- Can receive some treatments while waiting eg pain relief, anti-pyretics
24. Re-triaging
• Patient who is priority may go to emergency while they are waiting
• Non urgent can go to priority
• At the end of triaging the patient has to have to be again re triaged
• While the patent is waiting area if patient has fever or pain anti pain
has to be give
• If patient is malnourished glucose has to be given
26. Airway and Breathing
Objective:
• Assessment of airway
• Assessment of breathing
• Management of the airway
• Positioning of the child to open the airway
• Neck stabilisation
• Log roll
• Management of the choking child
• Ventilation with bag and mask
• Management of severe respiratory distress
27. Assessment of Airway
• Is the child breathing?
• Is the breathing obstructed?
• Tongue flopping back
• Foreign body
• Croup
• Anaphylaxis
• If there are signs of obstruction, respiratory distress and history of
choking, proceed immediately to clear airway
28. Management of the Choking Child
• History of aspiration of foreign body plus increasing
respiratory distress requires immediate management
• Techniques are based on forced expiration rather than
mechanical means
• Techniques such as blind finger sweep of mouth should
be avoided in children as they may result in trauma and
are likely to push object further down into airway
29. Management of the choking infant
• Lay infant on your arm in head down position
• Give 5 blows to the infants back with heel of hand
• If obstruction persists turn over and give 5 chest thrusts with 2
fingers, 1 finger breadth below nipple level in midline
• If obstruction persists check infants mouth for any object which can
be easily removed
• If necessary repeat sequence with back slaps again
31. Management of Choking Child
• Give 5 blows to the child’s back with heel of hand with child sitting,
kneeling or lying
• If obstruction persists, go behind the child and pass your arms around the
child’s body: form a fist with one hand immediately below the child’s
sternum; place the other hand over the fist and pull upwards into the
abdomen; repeat this Heimlich manoeuvre 5 times
• If the obstruction persists, check the child’s mouth for any obstruction
which can be removed
• If necessary repeat sequence with back slaps again
33. Management of Airway
• Airway must be opened using chin lift with head tilted to appropriate
position
• Airway positions
Infant <12 months – NEUTRAL (nose up)
Child >12 months – SNIFFING (chin up)
35. Management of Airway in suspected head/neck trauma
• Avoid moving the head or neck
• may make spinal injury worse
• Use JAW THRUST to open airway
• Place 2-3 fingers under angle of jaw on both side
• Lift the jaw upwards
• Stabilise the neck
• Keep lying on back with neck stabilised
• Tape forehead to sides of a firm board to secure position
• Support head on either side to prevent movement
• Place strap over chin
• If vomiting, turn on side keeping head in line with body
(LOG ROLL)
37. Log Roll
• Move carefully keeping head in line with body
• Leader controls head, others help to turn
38. Assessment of Breathing
• Is the child breathing?
• LOOK
• Active, talking, crying = breathing
• Chest moving?
• LISTEN
• Listen for breath sounds
• Are they normal or is breathing noisy/ obstructed?
• FEEL
• Can you feel breath at the nose/ mouth of the child
39. Assessment of Breathing
• If the child airway is open
and the child is not
breathing, start ventilation
with bag and mask
immediately
40. Assessment of Breathing
• Does the child show central
cyanosis?
• Cyanosis occurs when there is a
low level of oxygen in the blood
• Results in blue/purple
discolouration of tongue, inside
mouth and skin/nails
• NB: Cyanosis may be absent in
severe anaemia
41. Assessment of Breathing
• Does the child have severe respiratory distress?
• Is the child able to talk, drink, feed?
• Is the child exhausted with laboured breathing?
• Signs of severe respiratory distress
• Very fast breathing
• Severe chest wall indrawing
• Using accessory muscles/ head bobbing
42. Assessment of Breathing
• Is there noisy breathing?
• Stridor – harsh noise on inspiration
• Grunting – short noise on expiration
• Both are signs of severe respiratory problems
• (other noises)
• Bubbling/ snoring – airway obstruction from secretions/ tongue
• Wheeze – bronchiolitis or asthma
43. Management of Breathing Problems
• Ventilate with Bag and Mask
• Consider Oro-pharyngeal (Guedel) airway
• Give oxygen
44. Ventilate with Bag and Mask
• Essential treatment in child who is not breathing or is gasping
• Check bags are in good working order regularly and before use
• Choose correct mask size
• Ensure good seal around mouth/nose and open airway (may need
two people)
• Squeeze bag slowly and evenly
• Watch chest rise and allow to fall before giving next breath
46. Insertion of an oropharyngeal (Guedel) Airway
• Can be used in unconscious patient to improve airway opening
• Not tolerated in patients who are awake (gag reflex)
• Size–from centre of teeth to angle of jaw (convex side up)
• Infants– insert convex side (right way) up
• Children- insert concave side up (upside down) then turn
• Check airway opening before and after insertion
• Give Oxygen
48. Giving Oxygen
• Oxygen should be given to any child with an airway or breathing ‘E’
sign
• Children with cyanosis need urgent oxygen treatmen
• Severely ill children with shock, acidosis or other problems may also
benefit from oxygen
49. Oxygen delivery
• Sources of oxygen
• Oxygen concentrator
• Oxygen cylinders
• Delivery of oxygen
• Nasal prongs
• Nasal catheter
• Face Mask
• Flow rates
• Infant – 0.5-1litres/min
• Child – 1-2 liters/min
• Use flow rate of 5-10 lits/min for Face Mask
50. Oxygen delivery
• Nasal prongs
• Keep clear of mucus
• Secure with tape
• Use correct size or cut to fit
• Nasal catheter
• 6-8 FG tubing
• Insert to a distance= nostril to
inner eyebrow
• Should not be visible below
uvula
• Avoid in pertussis or croup
51. Airway and Breathing Problems
Summary
• To assess the airway and breathing you need to know:
• Is the airway obstructed?
• Is the child breathing?
• Is the child cyanosed?
• Are there any signs of respiratory distress?
• If the patient is not breathing you need to:
• Open the airway
• Remove any foreign body
• Ventilate with bag and mask
• In all cases of airway and breathing problems give oxygen
• 0.5-1 l/min in infants
• 1-2l/min in older children
53. Objectives
At the end of this chapter the students expected to
- Identify When and how to initiate CPR
- Describe the difference between infant and child CPR
- choosing appropriate size of face mask
- How to do proper ventilation
- How to do effective cardiac compression
- Has to know proper way of coordination ventilation and cardiac
compression
54. Basic life support sequence
Introduction
• Initial patient assessment, activation of effective cardiopulmonary
resuscitation (CPR) include adequate ventilation and chest
compressions.
• Before beginning basic life support (BLS), rescuers must ensure that
the sight is safe for them and the victim
55. Initiate CPR –The actions that constitute cardiopulmonary resuscitation
(CPR) are opening the airway providing ventilations and performing chest
compression.
• The sequence in which the actions of CPR for infants and children should
be performed as follow: C-A-B-D
• Assess the circulation and breathing at the same time.
• If there is no pulse or pulse is <60 bpm, begin ventilation and chest
Compressions
• Coordination of compression and ventilation may be facilitated by counting
• If the child is having gasping type of breath, we have to start CPR.
56. chest compressions —Essential elements for effective chest
compressions:
•Hard
•fast chest compression
•with full chest recoil
• Minimal interruptions
• If you are one rescuer two fingers, if you are two rescuer use thumb
encircling
• Older children on hand
60. VENTILATION
• Ventilations can be provided with mouth-to-mouth, mouth-to-nose,
or with a bag and mask.
• Each rescue breath should be delivered over one second.
• The volume of each breath should be sufficient to see the chest wall
rise.
62. • A child with a pulse 60 bpm who is not breathing should receive one
breath every 3 to 5 seconds (12 to 20 breaths per minute).
• Infants and children who require chest compressions should receive 2
breaths per 30 chest compressions for a lone rescuer2 breaths per 15
chest compressions.
65. CHEST COMPRESSIONS
• Essential elements for effective chest compressions:
• Hard
• fast chest compression
• with full chest recoil
• minimal interruptions
• Chest compressions should be performed over the lower half of the
sternum
• Compression of the xiphoid process can cause trauma to the liver,
spleen, or stomach, and must be avoided.
66. • Infants — Chest compressions for infants (under one year) may be
performed with either two fingers or with the two thumb-encircling
hands technique.
• Two fingers — this technique is recommended when there is a
single rescuer.
67. • Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 1/3-1/2 of chest diameter
Equal compression : relaxation
• When possible change CPR
operator every 2 min
CHEST COMPRESSIONS
71. Foreign-Body Airway Obstruction (Choking)
• More than 90% of deaths from foreign-body aspiration occur in children <5
years of age
• Signs of FBAO include a sudden onset of respiratory distress with coughing,
gagging, stridor (noise breathing) , wheezing
• For a child, perform abdominal thrusts (Heimlich maneuver) until the
object is expelled or the injured party becomes unresponsive
• For an infant, deliver 5 back blows (slaps) followed by 5 chest thrusts
repeatedly until the object is expelled or the victim becomes unresponsive
• If the victim becomes unresponsive, lay should perform CPR but should
look into the mouth before giving breaths
74. 1 Rescuer CPR for Children 1 to Age of Puberty
• 1 – Check for scene safety.
• 2 – Check for responsiveness.
• 3 – If no response SHOUT for help, send someone to ACTIVATE EMS and get an AED.
• A – Open the Airway (head-tilt-chin-lift or jaw thrust) Look, Listen, Feel for breath (5 – 10
secs).
• B – Give 2 breaths (give enough breath to make the chest rise).***remember to pinch the
nose.
• Start CPR 30 compressions and 2 breaths at a rate of 100 compressions per min.
• Compression is different than adult. One hand on chest and one hand on forehead.
• After 5 cycles of 30:2 if alone ACTIVATE the EMS and get the AED.
77. Management of Burn
Objective:
At the end of the attachment the trainees are expected to:
• Describe Initial assessment of a major burn
• Classify burn
• Describe burn management
78. • Definition- burn is defined as a traumatic injury to the skin or other
organic tissue caused by thermal or other acute exposures
• Burns occur when some or all of the cells in the skin or other tissues
are destroyed by heat, cold, electricity, radiation, or caustic chemicals
79. Types of Burn
The most common type of burn in children is from a scald injury
• Thermal
• Chemical burns
• Cold exposure (frostbite)
• Inhalation
• Electrical current
• Radiation burns
80. CLASSIFICATION
Cutaneous burns are classified according to the depth of tissue injury:
1. Superficial or epidermal (first-degree)
2. Partial-thickness (second degree)
3. Full thickness (third degree)
4. Burns extending beneath the subcutaneous tissues and involving
fascia, muscle and/or bone are considered (fourth degree)
81. 1. Superficial — Superficial or epidermal burns involve only the
epidermal layer of skin
They do not blister but are painful, dry, red, and blanch with pressure
healed in six days without scarring.
82. 2.Partial-thickness — Partial thickness burns involve the epidermis
and portions of the dermis
• These burns form blisters within 24 hours between the epidermis and
dermis
• Painful, red, and weeping, and blanch with pressure . These burns
generally heal in 7 to 21 days
83. 3. Full-thickness — These burns extend through and destroy all layers
of the dermis and often injure the underlying subcutaneous tissue
• These wounds heal by wound contracture with epithelialization
around the wound edges
• Scarring is severe with contractures; complete spontaneous healing is
not possible
84. 4.Fourth degree burns — Fourth degree burns are deep and
potentially life-threatening injuries that extend through the skin into
underlying tissues such as fascia, muscle, and/or bone
85. Indications for admission
• Burns covering >10–15% of total BSA, smoke inhalation, burns due to
high-tension (voltage) electrical injuries, and burns associated with
suspected child abuse or neglect
• Small 1st- and 2nd-degree burns of the hands, feet, face, perineum,
and joint surfaces also require admission
86. • Initial assessment of a major burn
• Perform an ABCDEF primary survey
A—Airway with cervical spine control,
B—Breathing,
C—Circulation,
D—Neurological disability,
E—Exposure with environmental control,
F—Fluid resuscitation
87. Management
• Assess burn size and depth
• Establish good intravenous access and give fluids
• Give analgesia
• Catheterize patient or establish fluid balance monitoring
• Take baseline blood samples for investigation
• Dress wound
• Perform secondary survey, reassess, and exclude or treat associated
injuries
• Arrange safe transfer to specialist burns facility
88. F—Fluid resuscitation
• Total fluid requirement for first 24 hours
• 4 ml×( total burn surface area)×(wt in kg)/24hours
• Half to be given in first 8 hours, half over the next 16 hours
• Subtract any fluid already received from amount required for first8
hours
• Calculate hourly infusion rate for first 8 hours
• Calculate hourly infusion rate for next 16 hours
89. Maintenance fluid required for a child
• A 24 kg child with a resuscitation burn will need the following
maintenance fluid: Children receive maintenance fluid in addition, at
hourly rate of
4 ml/kg for first 10 kg of body weight plus
2 ml/kg for second 10 kg of body weight plus
1 ml/kg for > 20 kg of body weight
End point
• Urine output of 1.0-1.5 ml/kg/hour in children
90. Follow up investigations
• The amount of investigations will vary with the type of burn
Hematocrit /Hct/, Total Serum Protein/TSP/
92. Management of snake bite
• At the end of the attachment the trainees are expected to:
• Identify snake bite
• Assess and initiate immediate management
93. Snakes Bites: Several different types of snakes must be differentiated
due to the varying effects of their venoms
• Many snake bites are provoked and thus involve the upper
extremities some the snake’s venom is voluntarily injected by venom
gland contraction
• Snakes type has a neurotoxin which may lead to paralysis and
respiratory arrest
• There may be varying hemotoxins which profoundly decrease platelet
and clotting factors
94. Treatment
• Initiate BLS as necessary (ABCs) - Move the patient to a health care facility as rapidly as possible
• Minimize movement of an affected extremity and keep the extremity below the level of
the heart
• Avoid ice, aspirin (coagulopathies possible), alcohol or sedatives
Incision and Suction these should be considered only if:
• Patient is more than one hour from a medical facility
• The only incisions to be made are extensions of not more than 1 cm long and 0.5 cm deep.
• DO NOT MAKE AN X SHAPED CROSS INCISION, and always keep in mind underlying structures.
Tourniquets
• A varying portion of venom may be absorbed via the lymphatic system.
• Given this, if a medical facility is not nearby wide constricting band may be placed around an
extremity not tight.
96. Objective:
• At the end of the attachment the trainees are expected to:
• Describe Initial assessment of poisoning
• Demonstrate immediate management of poisoning
97. Def: A poison is any substance that causes harm if it gets into the body
Harm can be mild or severe, and severely poisoned people may die
Type of exposure:
• Acute exposure is a single contact that lasts for seconds, minutes or
hours, or several exposures over about a day or less.
• Chronic exposure is contact that lasts for many days, months or years.
98. Routes of Exposure
• Through the mouth by swallowing (ingestion)
• Through the lungs by breathing into the mouth or nose (inhalation)
• Through the skin by contact with liquids, sprays or mists
• By injection through the skin
99. General Principles of Poisoning Assessment
and Management
• Standard Toxicologic Emergency Procedures
• Recognize a poisoning promptly.
• Assess the patient thoroughly to identify the toxin and measures required to
control it.
• Initiate standard treatment procedures.
• Protect rescuer safety.
• Remove the patient from the toxic environment.
• Support ABCs.
• Decontaminate the patient.
• Administer antidote if one exists
100. • History, Physical Exam, and Ongoing Assessment
• Identify the toxin and length of exposure
• Contact poison control and medical direction according to local policy
• Complete appropriate physical exams
• Monitor vital signs closely
101. • Assessment
• History
• What was ingested?
• When was it ingested?
• How much was ingested?
• Did you drink any alcohol?
• Have you attempted to treat yourself?
• Have you been under psychiatric care? Why?
• What is your weight?
103. • Assessment
• History and Physical Exam
• Evaluate the scene
• Central nervous system effects include dizziness, headache, confusion, seizure,
hallucinations, coma
• Respiratory effects include cough, hoarseness, stridor, dyspnea, retractions, wheezing,
chest pain or tightness, crackles, rhonchi
• Cardiac effects include dysrhythmias
104. • Antidotes
• Useful only if the substance is known.
• Rarely 100% effective.
• Must be used in conjunction with other therapies to ensure effectiveness.
105.
106. Initiate supportive treatment.
• Decontamination
• Reduce intake of the toxin
• Remove the individual from the toxic environment
• Reduce absorption of toxins in the body
• Use gastric lavage and activated charcoal
• Enhance elimination of the toxin
• Use cathartics
107. Management
• The management of the poisoned child is at two levels; at home
where first aid is administered and, in the hospital, where specific
treatment is given.
First aid at home
• Care should be taken so that the first aid treatment does not cause
severe complications that may be worse than the original poisoning.
108. Treatment in hospital
• Ensure a clear airway and support respiration.
• Treat shock if present.
• Remove poison from the body before it is absorbed, doing a gastric lavage if
victims comes within one hour except when kerosene or a corrosive has been
ingested.
• Reduce absorption by administering activated charcoal which absorbs many
toxins and prevents subsequent absorption. ( 0.5-1gm/kg of activated charcoal)
• Anti-dotes should be used but these are available for very poisons.
• General supportive measures are important to ensure adequate hydration,
temperature control, fluid and electrolyte balance, nutrition intake and control of
convulsions
110. Objective
• At the end of this chapter the participants are expected to:
• Handle new born immediately after delivery
• Recognize air way obstruction and their management
• Identify the peculiarity of new born resuscitation
111. • Resuscitation efforts should focus on improving respiratory status and
maintaining body temperature.
Evaluation and Treatment Priorities
• During delivery, suction mouth then noses before delivery of body.
• This is especially important if there is meconium in the amniotic fluid.
• Dry infant and maintain warm environment.
• Wrap the baby in a thermal blanket.
• Cover the infant’s head to preserve warmth.
112. Open and position the airway in the “sniffing” position.
• Suction airway again using bulb syringe, mouth first then
nasopharynx.
• Avoid hyperextension of the neck.
113. If thick meconium is present in apneic and/or hypotonic infant:
• Initiate suctioning before the infant takes first breath.
• Suction the airway while withdrawing the suction tube
• Repeat suction only if meconium is not cleared and infant remains
apneic and/or hypotonic, then ventilate infant with BVM
• If infant becomes bradycardic (<60), discontinue suctioning and
provide ventilation immediately.
• Assess Breathing and adequacy of ventilation.
• Stimulate the infant by rubbing the back or flicking the soles of the
feet.
114. If infant is apneic:
• BVM at 40-60 breaths/minute with 100% oxygen.
• Assess Heart Rate – Auscultation or palpation of brachial artery or
umbilical cord stump.
• If heart rate is <60 and signs of poor perfusion are persistent after 30
seconds of assisted ventilation with 100% oxygen initiate the
following
115. Continue ventilation
• Begin chest compressions and CPR: ratio of 1 to 3 rate of 100
compressions per minute (hard and fast)
• Stop CPR when heart rate >60 with signs of improved perfusion
• If heart rate is 60 – 100/ minute
116. • Continue ventilation
• Assess skin color – If cyanosis use blow-by oxygen
• If heart rate is >100/minute Continue assisted ventilation until patient
is breathing adequately on own and is vigorous.
117. Reassess the infant frequently
• Pulse, respiratory rate, tone, color, and response.
• Contact direct medical control for additional instructions
• Continued care of mother.
• Place two clamps 6 and 8 inches from baby, cut umbilical cord
between clamps.
• Transport delivered placenta to hospital with the baby
