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Paediatric Series An Introduction to Newborn Resusitation Presented by Dr James MackintoshOverview What to expect tonight Recap of fantastic teaching session I recieved in the ED from a Paediatric Consultant. S I T A Dray & Warm I E A Initial Assessment P | Airway P E L Breathing B H Circulation T D I Drugs M Wooly hat STAT! Dry / Warm / Stimulate Term and near-term infants > 32 weeks gestation - Dry and stimulate the newborn with a towel - Get rid of the damp towel - Wrap the newborn with a new towel S I R - Keep the head warm with a hat T I - Place them on a thermal mattress E A P | P E Preterm infants ≤ 32 weeks gestation L E H - Do NOT dry T N - Cover neck down with polythene wrap I M Initial Assessment Tone / Colour / Breathing / Heart Rate Floppy baby will likely need respiratory support. Cyanosis / Pallor S Breathing - rate, work, symmetry I T A D E A Heart Rate | E > 100 bpm E B E 60 - 100 bpm H D < 60 bpm N I M Delay cord clamping 60s vs immediatelyAirway Different to adults / children Is the airway patent? Neutral position Jaw lift can help in floppy babies Laryngeal mask S I R 2 person > 1 person T I D A P Orophargeal / Nasopharengeal | P Intubation E L B E T D Suction I M Direct visulisation, do not delay ventillation Breathing Look / Listen / Feel If not breathing, gasping or not breathing effectively give 5 inflation breaths in air. Use positive pressure ventilation using bag S valve mask - 3 second breaths I T A D E A Check HR - if < 100 likely not effective | E ventilation. E B E H D If no improvement to HR, check chest N I M movement and reassess. Breathing Ventilate If there is a HR response to the inflation breaths then continue to ventilate the newborn until they are breathing on their own. S I Aim for 30 breaths / min with 1 sec inflation R T I D E P Reassess HR and breathing every 30 secs | E E L E H T D I MCirculation Different to adults / children Help should have arrived by now Sats probe on right arm so can titrate oxygen to pre-ductal measurement C I T 3 to 1 chest compressions to ventilations A I E A P | Give oxygen and consider intubation P E L B E H D N I M Vascular Access & Drugs Who backs themselves to put a cannula in? Umbilical Venous Access Using clean technique Use scalpel to cut 1.5cm from skin S C Identify vessels R T I Insert catheter D E Must aspirate blood before using P | P E L B Intraosseous access can be useful 2nd option E T D I M Vascular Access & Drugs There's only four? Adrenaline - if HR < 60 despite previous steps Subsequent doses every 3-5 mins Glucose - hypoglycaemia, consider in prolonged C resuscitation I T A D E A Blood / Fluids - suspected volume loss or shock P | P E L B Sodium bicarbonate - intracardiac acidosis H T D I M Recap You are working in ED. You have seen a 25yr old lady with abdominal pain, she is unsure if she could be pregnant. You had back to the computer to request investigations including a pregnancy test. The emergency buzzer goes her room and you attend. The nurse tells you that your patient has just given birth and the baby isn't breathing...ResourcesFEEDBACK & QUESTIONS PLEASE TAKE 5 MINS AND GIVE US USEFUL INFO FOR RESEARCH AND IMPROVEMENT C I R T A I E A P | P E E L B E H T D I M