Neonatal Resuscitation - PowerPoint

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					Neonatal Resuscitation
   Mary P. Martinasek, BS, RRT
   Director of Clinical Education
  Hillsborough Community College
                   Asphyxia
• Hypoxia + Hypercapnia + Acidosis
• May lead to irreversible brain damage
• The necessity to resuscitate is related to the
  degree of asphyxia
         Causes of fetal asphyxia
•   Maternal hypoxia
•   Insufficient placental blood flow
•   Blockage of umbilical blood flow
•   Fetal disorders
   Primary vs. Secondary Apnea
• Primary
  – Initial asphyxia
  – Signs
     •   Initial period of rapid breathing
     •   Respiratory movements cease
     •   Heart rate and bp drop
     •   Neuromuscular tone diminishes
              Secondary Apnea
• If no resuscitation and apnea continues
• Signs
  –   Deep gasping respirations
  –   Heart rate continues to decrease
  –   Blood pressure begins to fall
  –   Infant flaccid
• Primary                    • Secondary
  – Stimulation and oxygen     – Infant unresponsive to
    will usually induce          stimulation – must be
    respirations                 resuscitated
 Effects of asphyxia on the lungs
• Ineffective respirations cannot open alveoli
• Pulmonary Hypertension
• Pulmonary vasoconstriction
  – Hypoxia, hypercarbia, acidosis
    Persistent Fetal Circulation
         known as PPHN
• Leads to further asphyxia
• Blood shunted
• CO2 remains high despite ventilation
  – Indocin
  – Ligation of PDA
   Preparation for Resuscitation
• Anticipation of high risk delivery
• Proper equipment
• Trained personnel
      Purpose of Resuscitation
• Reverse asphyxia before irreparable damage has
  occurred
         ABC’s of Resuscitation
• A – Establish an open airway
   – Position infant
   – Suction mouth then nose
• B – initiate breathing
   – Use tactile stimulation
   – Use PPV if necessary
                Resuscitation
• C – Maintain circulation
  – Stimulate and maintain circulation
     • Chest compressions
     • drugs
                  Initial steps
•   Dry the infant
•   Warm the infant
•   Position the infant
•   Suction the infant
•   Stimulate the infant
                  Next step
• Evaluate respirations
  – If none or gasping , provide PPV with 100% O2 for
    15-30 seconds
  – If spontaneous respirations then evaluate HR
                     Next
• After 15-30 seconds of PPV or evaluation of
  spontaneous respirations then:
• EVALUATE HEART RATE
• If HR is above 100 then reevaluate respirations
  and color
• If HR is less than 60 continue/start PPV and
  start compressions
                      Reassess
•   After 30 seconds reassess
•   HR greater than 60 stop compressions
•   HR greater than 100 and breathing stop PPV
•   Evaluate infant’s color
    – Peripheral vs. central cyanosis
    – What is acrocyanosis?
             Thermoregulation
• Maintain a neutral thermal environment
• Possible causes of heat loss
  –   Radiant
  –   Evaporative
  –   Convective
  –   Conductive

				
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posted:11/17/2011
language:English
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