Title: Neonatal/Pediatric Cardiopulmonary Care
1Neonatal/Pediatric Cardiopulmonary Care
2When To Resuscitate
- Need usually related
- Combination of
- Can occur in
3Causes of Fetal Asphyxia
4Apnea
5Effect of Asphyxia on Lungs
- Initial adaption to extra-uterine life requires 2
steps -
-
6Effect 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
7Effect of Asphyxia on Lungs
- If asphyxia severe with lactic acidosis
- ?
- Ventilation alone will not change
- acid-base imbalance
- ?
-
8Effect of Asphyxia on Lungs
- In severe cases - might be beneficial to give
HCO3- to -
-
-
9Effect of Asphyxia on Lungs
- NOTE
- Adequate ventilation must be maintained when
bicarb given!!! - Why??
10Effect of Asphyxia on Lungs
11Preparation For Resuscitation
12Basics of Neonatal Resuscitation
3 steps
13Resuscitation Cycle
Evaluation
Decision
Action
14Steps in Resuscitation
15Mechanisms of Heat Loss
- Radiation
- Loss to
- Conduction
- Loss to
- Evaporation
- Loss when
- Convection
- Loss to
16Causes of Heat Loss
17ColdStress
18Steps in Resuscitation
Next Step Open airway
19Steps in Resuscitation
20Evaluate Respiratory Effort
Evaluate
respirations
None or
Spontaneous
gasping
Evaluate
PPV with
heart rate
100 O2
Below 100
15 - 30 sec.
21Evaluate Heart Rate
Evaluate
heart rate
Above 100
Evaluate
color
Blue
Pink or
peripheral cyanosis
Provide oxygen
Observe and
monitor
22Indications for PPV
23Positive Pressure Ventilation
- Flow-inflating bag
- Self-inflating bag
- Pressure gauge
- Oxygen flow 5-8 lpm
- Pop-off at 30-40 cmH2O
24PPV 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 -
25Re-evaluate Heart Rate
26Chest 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
27Indications for Intubation
- Bag/mask ventilation is difficult or ineffective
- Prolonged PPV is required
- Thick meconium is present in amniotic fluid
- Suspicion of diaphragmatic hernia
28ETT Sizes
29Laryngoscope Blades
30Intubation Technique
- Same as adult
- Limit attempts to -
- Provide blow-by oxygen at -
- ETT tip midway between carina clavicles
- Cut ETT to leave -
31Medications - Uses
32Medications - Routes
33Instillation Into ETT
N A V E L O2
34Medications - Indications
- HR lt 80 despite PPV and chest compressions for at
least 30 sec. - HR is 0
35Epinephrine
- Powerful sympathomimetic
-
-
-
- 1st drug given
- IV or ETT, delivered rapidly
- Repeated q3-5 until HR -
36Volume 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
37Sodium Bicarbonate
- Prolonged arrest not responding
- Alkaline to buffer metabolic acidosis
- Only given when ventilation is adequate
- IV
38Narcan (naloxone)
- Reversal of narcotic depression
- Demerol (meperidine)
- Morphine sulfate
- Fentanyl (Sublimaze)
- IV, IM, sub-q, ETT
- Given rapidly
39Dopamine
40APGAR Scoring
41APGAR Scoring
42Serum 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
43Serum Glucose
Energy Storage
- Glycogen
-
-
- Triglycerides (brown fat)
-
-
44Serum Glucose
Post-delivery
45Serum Glucose
Hypoglycemia
46Hypoglycemia - Signs
- Tremors
- Irritability
- ?or?Moro reflex
- Apnea/tachypnea
- Cyanosis
- Seizures
- Lethargy
- Hypothermia
- Weak/high-pitched cry
- Poor feeding
- Vomiting
- CV failure
47Hypoglycemia
48Hypoglycemia - Causes
- Hyperinsulinism
- Prematurity
- IUGR
- Starvation
- Sepsis
- Shock
- Asphyxia
- Hypothermia
- Glucogen Storage Disease
- Galactosemia
- Adrenal insufficiency
- Polycythemia
- Congenital heart defects
- Iatrogenic causes
49Hyperinsulinism
- Fetus of diabetic Mom
- Rh incompatibility
- Insulin-producing tumors
- Maternal tocolytic therapy (ritodrine,
terbutaline)
50Glucose Measurement
- Glucose Test Strip Dextrostik
- One Touch
- Lab sample (blood glucose)
51Hypoglycemia 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
52Umbilical Blood Sampling
53Umbilical Vein Catheter (UVC)
- Usually placed in -
- Drug administration during -
54Umbilical Artery Catheter (UAC)
Indications
55Umbilical 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.)
56UAC
57Umbilical Artery Catheter
Complications
58Umbilical Artery Catheter
Sampling Technique