Neonatal/Pediatric Cardiopulmonary Care - PowerPoint PPT Presentation

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Neonatal/Pediatric Cardiopulmonary Care

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Neonatal/Pediatric Cardiopulmonary Care Resuscitation When To Resuscitate Need usually related Combination of Can occur in Causes of Fetal Asphyxia Apnea Effect ... – PowerPoint PPT presentation

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Title: Neonatal/Pediatric Cardiopulmonary Care


1
Neonatal/Pediatric Cardiopulmonary Care
  • Resuscitation

2
When To Resuscitate
  • Need usually related
  • Combination of
  • Can occur in

3
Causes of Fetal Asphyxia

4
Apnea
5
Effect of Asphyxia on Lungs
  • Initial adaption to extra-uterine life requires 2
    steps

6
Effect of Asphyxia on Lungs
Asphyxia
Blood flow continues through d.a.
f.o. (by-passing lungs)
Apneic or ineffective respirations
Negative pressure not generated to open Alveo li
to push fluid out
Pulmonary hypertension
Pulmonary vasoconstriction
PaO2 ?, PaCO2 ?, ? pH
7
Effect of Asphyxia on Lungs
  • If asphyxia severe with lactic acidosis
  • ?
  • Ventilation alone will not change
  • acid-base imbalance
  • ?

8
Effect of Asphyxia on Lungs
  • In severe cases - might be beneficial to give
    HCO3- to

9
Effect of Asphyxia on Lungs
  • NOTE
  • Adequate ventilation must be maintained when
    bicarb given!!!
  • Why??

10
Effect of Asphyxia on Lungs
11
Preparation For Resuscitation

12
Basics of Neonatal Resuscitation
3 steps
  • A -
  • B -
  • C -

13
Resuscitation Cycle
Evaluation
Decision
Action
14
Steps in Resuscitation
  • 1st step

15
Mechanisms of Heat Loss
  • Radiation
  • Loss to
  • Conduction
  • Loss to
  • Evaporation
  • Loss when
  • Convection
  • Loss to

16
Causes of Heat Loss

17
ColdStress
18
Steps in Resuscitation
Next Step Open airway

19
Steps in Resuscitation
20
Evaluate Respiratory Effort
Evaluate
respirations
None or
Spontaneous
gasping
Evaluate
PPV with
heart rate
100 O2
Below 100
15 - 30 sec.
21
Evaluate Heart Rate
Evaluate
heart rate
Above 100
Evaluate
color
Blue
Pink or
peripheral cyanosis
Provide oxygen
Observe and
monitor
22
Indications for PPV

23
Positive Pressure Ventilation
  • Flow-inflating bag
  • Self-inflating bag
  • Pressure gauge
  • Oxygen flow 5-8 lpm
  • Pop-off at 30-40 cmH2O

24
PPV Technique
  • Slightly extend neck
  • Mask held with thumb forefinger
  • Bag squeezed with fingertips
  • Initial rate -
  • Done for 15-30 sec., then re-evaluate
  • May require -

25
Re-evaluate Heart Rate
26
Chest Compressions
  • 2 fingers or thumbs
  • Lower 1/3 of sternum
  • Sternum depressed
    1/2-3/4 inches
  • 31 compression-to-ventilation ratio
  • Continue for 30 sec., stop for 6 sec. to
    re-evaluate HR
  • DCd when HR gt 80, then re-evaluate RR

27
Indications for Intubation
  • Bag/mask ventilation is difficult or ineffective
  • Prolonged PPV is required
  • Thick meconium is present in amniotic fluid
  • Suspicion of diaphragmatic hernia

28
ETT Sizes
29
Laryngoscope Blades
  • Size 1 for
  • Size 0 for

30
Intubation Technique
  • Same as adult
  • Limit attempts to -
  • Provide blow-by oxygen at -
  • ETT tip midway between carina clavicles
  • Cut ETT to leave -

31
Medications - Uses

32
Medications - Routes

33
Instillation Into ETT
N A V E L O2
34
Medications - Indications
  • HR lt 80 despite PPV and chest compressions for at
    least 30 sec.
  • HR is 0

35
Epinephrine
  • Powerful sympathomimetic
  • 1st drug given
  • IV or ETT, delivered rapidly
  • Repeated q3-5 until HR -

36
Volume Expanders
  • Given if hypovolemic
  • ? BP
  • Pallor with adequate oxygenation
  • HR gt 100 with weak pulses
  • Failure to respond to resuscitation
  • Whole blood, 5 albumin, plasma expanders, NS
  • IV, may be repeated as needed

37
Sodium Bicarbonate
  • Prolonged arrest not responding
  • Alkaline to buffer metabolic acidosis
  • Only given when ventilation is adequate
  • IV

38
Narcan (naloxone)
  • Reversal of narcotic depression
  • Demerol (meperidine)
  • Morphine sulfate
  • Fentanyl (Sublimaze)
  • IV, IM, sub-q, ETT
  • Given rapidly

39
Dopamine

40
APGAR Scoring

41
APGAR Scoring
42
Serum Glucose
Sources
  • Nutritional needs of fetus supplied by Mom
    regulated by placenta
  • Fetus prepares for postnatal life by ? energy
    stores developing enzyme-dependant processes
    for usage of stored energy

43
Serum Glucose
Energy Storage
  • Glycogen
  • Triglycerides (brown fat)

44
Serum Glucose
Post-delivery
  • At 2 hours -
  • By 3 days -

45
Serum Glucose
Hypoglycemia
  • Term -
  • Preterm -

46
Hypoglycemia - Signs
  • Tremors
  • Irritability
  • ?or?Moro reflex
  • Apnea/tachypnea
  • Cyanosis
  • Seizures
  • Lethargy
  • Hypothermia
  • Weak/high-pitched cry
  • Poor feeding
  • Vomiting
  • CV failure

47
Hypoglycemia
48
Hypoglycemia - Causes
  • Hyperinsulinism
  • Prematurity
  • IUGR
  • Starvation
  • Sepsis
  • Shock
  • Asphyxia
  • Hypothermia
  • Glucogen Storage Disease
  • Galactosemia
  • Adrenal insufficiency
  • Polycythemia
  • Congenital heart defects
  • Iatrogenic causes

49
Hyperinsulinism
  • Fetus of diabetic Mom
  • Rh incompatibility
  • Insulin-producing tumors
  • Maternal tocolytic therapy (ritodrine,
    terbutaline)

50
Glucose Measurement
  • Glucose Test Strip Dextrostik
  • One Touch
  • Lab sample (blood glucose)

51
Hypoglycemia Treatment
  • Early feeding (oral)
  • D10W
  • 200 mg/kg bolus over 1-3 minutes
  • Cont IV, 4-8 mg/kg/min. until feedings started
  • Treat cause

52
Umbilical Blood Sampling

53
Umbilical Vein Catheter (UVC)
  • Usually placed in -
  • Drug administration during -

54
Umbilical Artery Catheter (UAC)
Indications

55
Umbilical Artery Catheter (UAC)
Placement
  • 5 Fr. catheter (gt1250 g), 3.5 Fr. catheter (lt1250
    g)
  • Sterile procedure
  • Heparinized-filled catheter
  • Tip L3-4 for low catheter, T8 for high catheter
    (in aorta below renal a., above bifurcation of
    femoral a.)

56
UAC
57
Umbilical Artery Catheter
Complications

58
Umbilical Artery Catheter
Sampling Technique
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