Neonatal Resuscitation for undergraduates 2022.pptx

NRP for Undergraduates

1. NEONATAL RESUSCITATION UNDERGRADUATE

2. ABCs of resuscitation T emperature A irway (position and clear) B reathing (stimulate to breathe) C irculation (assess heart rate and color) D rugs (Medications)

3. Fetal circulation

4. Fluid filled alveoli and constricted blood vessels in the lungs before birth

5. Prebirth questions: 4 What is the expected gestational age? Is the amniotic fluid clear? Are there any additional risk factors? What is our umbilical cord management plan?

6. High Risk factors

7. Antenatal Risk Assessment and Team Briefing Normal delivery: single person trained in basic NRP to attend Assemble team accordingly: High risk : two skilled personnel should attend How to call for additional help and whom Counsel parents depending on risk ID team leader and designate tasks Perform equipment check

8. NRP Key Behavioral Skills • Know your environment. • Use available information. • Anticipate and plan. • Clearly identify a team leader. • Communicate effectively. • Delegate the workload optimally. • Allocate attention wisely. • Use available resources. • Call for additional help when needed. • Maintain professional behavior.

9. Equipment Radiant warmer On Three linen spread out under it Manual mode 100% heater output Room free of draft and temperature 23-25 C Food grade plastic cling film or bag, caps for < 32wks Blender/ T piece resuscitator preferred device

10. Post birth questions: 3 Assess whether: TERM? Good Tone? Breathing / crying? If answer to all three is yes, then give -  Routine care

11. Routine Care Temperature: Place prone on mothers abdomen Dry the baby, remove wet linen Position with head turned to one side Clear airway by wiping with guaze if secretions Delay cord clamp and cut cord at 1 minute Cover M-B dyad with single pre-warmed linen Ongoing evaluation: breathing, color, activity, tone  breast feed

12. Initial Steps: TDSPA Routine Care

13. Post birth: Term gestation? Crying or breathing? Good muscle tone? Immediate cord clamping and take to radiant warmer for Initial Steps: 5 initial steps: TDSPA (memonic) Temperature Dry Stimulate Position to open airway Airway clear if needed NO

14. Initial Steps: Within 30 seconds

15. Initial Steps T: Provide warmth D: Dry S: stimulate Position Airway : clear or suction only if secretions present

16. Provide warmth Placed under radiant warmer Leave the baby uncovered under warmer: - to allow full visualization - to permit radiant heat to reach the baby

17. Position by slightly extending the neck Shoulder Roll Sniffing Position

18. Position by slightly extending the neck

19. Clear Airway Secretions removed from airway with a towel/ bulb syringe/ suction catheter Copious secretions- turn face to side Gentle suction- Pressure < 100 mm Hg Mouth before Nose (M before N) Stimulation of posterior pharynx causes Vagal stimulation and bradycardia- stop

20. Further Evaluation Respiration Heart Rate Count aloud for 6 seconds and multiply by 10 auscultate

21. Term Gestation? Breathing or crying? Good tone Warm, clear airway if necessary, dry, stimulate No HR below 100, gasping or apnea PPV, SpO 2 monitoring Routine care Provide warmth Clear airway if necessary Dry Ongoing evaluation Labored breathing? Persistent cyanosis Clear airway, SpO 2 monitoring, Consider CPAP Post resuscitation care Yes, stay with the mother Yes No No Yes Birth 30 Seconds 60 Seconds

22. Supplemental oxygen/CPAP T-piece

23. CPAP

24. Positive Pressure Ventilation

25. Indications of Bag & Mask Ventilation After 30 seconds of Initial steps if Baby is not breathing or is gasping Heart rate is less than 100 bpm and /or Is Cyanotic despite supplemental oxygen

26. Self Inflating Bag Advantages Will always refill after being squeezed even with no compressed gas source Pressure-release valve makes over-inflation less likely

27. Self Inflating Resuscitation Bag 2. Oxygen inlet 7.Pressure manometer site 3. Patient outlet

28. SELF INFLATING BAG https://youtu.be/ZPJQRogximU for ambu parts and functioning https://youtu.be/-o1CGStQr4k for bag and mask

29. T Piece resuscitator

30. T piece resuscitator

31. Flow inflating bag

32. PPV

33. Face mask positions Correct

34. PPV

35. PPV After 15 seconds of PPV start, check Heart rate If rising continue PPV for 30 seconds before next assessment If HR not rising, check chest rise If no chest rise, take ventilation corrective measures MRSOPA

36. Ventilation correction steps (MRSOPA)

37. Alternative airway: Intubate or Laryngeal mask airway

38. Alternative airway

39. Next Step If after 30 seconds of effective PPV with supplemental oxygen check HR: If heart rate <60 – Chest compression Heart rate >60 but <100 – Continue PPV as long as baby shows steady improvement consider intubation / consider other complications – pnuemothorax, hypovolemia

40. Orogastric Infant feeding tube tube placement

41. Chest Compressions

42. Term Gestation? Breathing or crying? Good tone Warm, clear airway if necessary, dry, stimulate No HR below 100, gasping or apnea PPV, SpO 2 monitoring HR below 100? Take ventilation corrective steps HR below 60? Consider intubation, chest compression, Coordinate with PPV HR below 60 IV Epinephrine Take ventilation corrective steps, Intubate if no chest rise Consider hypovolemia, pneumothorax Routine care Provide warmth Clear airway if necessary Dry Ongoing evaluation Labored breathing? Persistent cyanosis Clear airway, SpO 2 monitoring, Consider CPAP Post resuscitation care Yes, stay with the mother Yes Yes Yes Yes No No No Yes No No Birth 30 Seconds 60 Seconds Targeted Preductal SpO2 After Birth 1min 60% - 65% 2min 65% - 70% 3min 70% - 75% 4min 75% - 80% 5min 80% - 85% 10min 85% - 95%

43. Indications Heart rate less than 60 bpm despite 30 sec of effective positive-pressure ventilation

44. Chest compression

45. Chest compression Check HR after 60 seconds of compressions If HR > 60/min and stop CC and continue PPV If not improving check Memonic: ” CARDIO” C: Chest rise with each breath Airway: ET in place R: Rote 90:30 total 120 events in a minute D: Depth of compression 1/3 rd AP diameter IO: Inspired oxygen 100%?

46. How to prepare and give Epinephrine Indication: 60 seconds of effective PPV coordinated with good quality chest compressions with 100% O2, if HR < 60 /minute Dilute it 10 times to make it 1:10,000 1ml of 1:1000 with 9 ml of water for injection Dose: 0.2 ml/kg (range 0.1 – 0.3 ml/kg) of 1:10,000 Preferred Route: ( Intravenously: UVC) Followed by flush of Normal saline: 3 ml While IV access is being obtained may give endotracheally dose 0.5-1 ml/kg

47. Recommended solutions Normal Saline O-negative blood cross-matched with mother’s blood Dose – 10ml/kg Route – Umbilical vein Rate of administration – 5-10 minutes In premature babies: Rapid boluses may induce ICH

48. Post resuscitation care Team debriefing 20 minutes of zero HR and check H and T’s Parental counseling Ethics at end of life

49. Questions?? Thank you