Download NEONATAL RESUSCITATION

NEONATAL
RESUSCITATION
PRESENTED BY
PHATTRAPONG TANSUPOL MD.
หลักการที่จะทาให้ การช่ วยฟื้ นชีวติ ประสบความสาเร็จ
1.ความพร้อมของบุคลากร
2.การฝึ กฝน
3.การทางานเป็ นทีม
4.ACTION/EVALUATION/DECISION CYCLE
5.อุปกรณ์ที่เพียงพอ และพร้อมใช้งาน
ACTION/EVALUATION/DECISION CYCLE
EVALUATION
ACTION
DECISION
ASPHYXIA – THE BASIC
1.Primary
Apnea: When asphyxiated,
the infant responds with a increased
RR. If the episode continues, the infant
becomes apnic, followed by a drop in HR
and a slight increase in BP.The infant will
respond to stimulation and therapy with
spontaneous respirations.
2. Secondary
apnea: after primary
apnea, the infant responds with a period
a gasping respirations, falling HR, and
falling BP.The infant takes a last breath
and then enters the secondary apnea
period.The infant will not respond to
stimulation and death will occur unless
resuscitation begins immediately.
* Because after delivery of an infant it is impossible to
differentiate between primary apnea and secondary
apnea, assume the infant is in secondary apnea and begin
resuscitation immediately.
ASPHYXIA CHANGE
APGAR SCORE
1.Antepartum and intrapartum history
Antepartum Factors
Maternal substance
abuse
No prenatal care
Previous stillbirth
Bleeding - 2nd/3rd
trimester
Hydramnios
Oligohydramnios
Multiple gestation
Post-term gestation
Small-for-dates fetus
Fetal malformations
CONT.
Intrapartum Factors
Maternal narcotics
(within 4 hrs of delivery)
General anaesthesia
Meconium-stained fluid
Prolapsed cord
Placental abruption
Placenta previa
Uterine tetany
Equipment
Equipment and medications should be checked
as a daily routine and then prior to
anticipated need. Used items should be
replenished as soon as possible after a
resuscitation.
The delivery room should be kept relatively
warm and the radiant heater should be
preheated when possible. Prewarming of
towels and blankets can also be helpful in
preventing excessive heat loss from the
neonate.
Equipment
SUCTION EQUIPMENT
BULB SYRINGE
SUCTION CATH NO 5 6 8 10 Fr
8 Fr FEEDING TUBE 20 ml SYRINGE
MECONIUM ASPIRATOR
BAG-MASK EQUIPMENT
FACE MASK
ORAL AIRWAY
OXYGEN
Equipment CONT.
INTUBATION EQUIPMENT
LARYNGOSCOPY-BLADE NO 0-1
BATTERY FOR LARYNGOSCOPE
ETT NO 2.5 3.0 3.5 4.0 mm
STYLET SCISSOR GLOVE
MISCELLANEOUS
RADIANT WARMER-STETHOSCOPE-TAPESYRINGE-NEEDLE-ALCOHOL-UMBILICAL CATH
Initial Steps for Neonatal
Resuscitation in Delivery Room
ANTICIPATION
ASSESSMENT OF ACTION
1.PREVENT HEAT LOSS
Place the infant under an overhead
radiant heater to minimize radiant and
convective heat loss.
Dry the body and head to remove
amniotic fluid and prevent evaporative
heat loss. This will also provide gentle
stimulation to initiate or help maintain
breathing.
Initial Steps for Neonatal
Resuscitation in Delivery Room
CONT.
2.ABCDE STEP
A-AIRWAY
POSITION
CLEAR AIRWAY-SUCTION MOUTH
THEN NOSE
Initial Steps for Neonatal
Resuscitation in Delivery Room
CONT.
B-BREATHING ADEQUACY
1.TACTILE STIMULATION
slapping or flicking the soles of
the feet
rubbing the back gently
Do not waste time continuing tactile stimulation
if there is no response after 10 - 15 seconds.
2.FREE FLOW OXYGEN
3.PPV
Initial Steps for Neonatal
Resuscitation in Delivery Room
C-CARDIOVASCULAR
RESUSCITATION
D-DRUG
-DIAGNOSIS
E-ENVIRONMENT
-EXTENDED CARE
CONT.
Resuscitation in the delivery room
PPV
1.INDICATION FOR PPV
APNEA OR GASPING
HR < 100 bpm
CENTRAL CYANOSIS
2.BAG-Self inflating vs. flow dependent bag
3. Rate 40-60 bpm
4. Pressure used =
a. Initial breath after delivery = 30-40 cm
H2O
b. Normal delivery = 15-20 cm H2O
c. Diseased Lungs =20-40 cm H2O
PPV CONT.
5. Technique/Trouble shooting problems
of Bag mask ventilation
a. Check for a good seal
b. Check for a patent airway
c. Are you using enough pressure ?
6.Checking for chest movement
check mask position
head position-hyperflexion or
hyperextention
secretion obstruction
slighly open infant mount
checking for pressure
Chest compression
1. Indications:
If after 15-30 seconds of positive pressure
ventilation with 100% FIO2 the heart rate is
a. below 60 bpm
b.between 60-80 bpm and not increasing
2. Technique:
a. 1 fingers breadth below nipple line, using
2 fingers
b. 1/2 to 3/4 compression depth
c. accompanied by ventilations, ratio is 3:1
METHOD
ENDOTRACHEAL TUBE INTUBATION
1.Indications for intubation:
a. Prolonged bag and mask ventilation
b. Bag and mask is ineffective
c. Tracheal suctioning
2.Tube size
Tube size
Weight
Gestational Age
(ID mm)
(gm)
(weeks)
2.5
<1000
<28
3.0
1000-2000
28-34
3.5
2000-3000
34-38
3.5-4.0
>3000
>38
ดูวา่ ท่อหลอดลมอยูใ่ นตาแหน่ งทีเ่ หมาะสมโดย
1.ฟังปอดได้ยน
ิ เสียงเท่ากัน 2 ข้าง
2.ฟังทีก
่ ระเพาะอาหารไม่ได้ยน
ิ เสียงลม
3.ทรวงอกเคลือ
่ นไหวเท่ากัน 2 ข้าง
MEDITATION
1.Indication
HR < 80 bpm despite 100% O2 and
chest compression 30 sec
No heart rate
Drug
-adrenaline
-volume expander
-NaHCO3
-Dopamine
-Naloxone
hydrochloride
Drug dosage
Drug
Epinephrine
1:10,000
Volume Expanders
-NS or RL
-5% Albumin
-O-neg Blood
Preparation
1 ml
40 ml
Naloxone
0.4 mg/ml
1.0 mg/ml
1 ml
1 ml
Dosage
Rate/Precautions
Give rapidly IV or ET
0.01-0.03
mg/kg
Repeat q 3-5 min
0.1-0.3 ml/kg (ET: dilute to 1-2 ml with
NS)
10 ml/kg
Give IV over 5-10 min
0.1mg/kg
Give rapidly
IV or ET preferred
0.25ml/kg
0.1 ml/kg
Drug dosage cont.
Reserved for prolonged
resuscitations only
Sodium Bicarbonate
(0.5 mEq/ml = 4.2% soln)
20 ml
10 mlx2
Dopamine
(6 x weight in kg = mg of
dopamine diluted to 100 ml)
100 ml
2 mEq/kg Give slowly, over at least
(4ml/kg)
2 min, IV ONLY, Infant
must be ventilated
Continuous infusion by
pump
ทารกที่ไม่ ตอบสนองควรคิดถึง
1.inadequate ventilation: missplaced
ETT,inadequate pressure,air leak
syndrome
2.Shoke: asphyxia,hypovolumic,septic
3.Congenital anomalies: pulmonary
hypoplasia,severe cardiac disease
THE END
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