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NEONATAL RESUSCITATION

NEONATAL RESUSCITATION

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NEONATAL RESUSCITATION

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  1. NEONATAL RESUSCITATION PRESENTED BY PHATTRAPONG TANSUPOL MD.

  2. หลักการที่จะทำให้การช่วยฟื้นชีวิตประสบความสำเร็จหลักการที่จะทำให้การช่วยฟื้นชีวิตประสบความสำเร็จ 1.ความพร้อมของบุคลากร 2.การฝึกฝน 3.การทำงานเป็นทีม 4.ACTION/EVALUATION/DECISION CYCLE 5.อุปกรณ์ที่เพียงพอ และพร้อมใช้งาน

  3. ACTION/EVALUATION/DECISION CYCLE EVALUATION ACTION DECISION

  4. 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.

  5. 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.

  6. ASPHYXIA CHANGE

  7. APGAR SCORE

  8. 1.Antepartum and intrapartum history CONT.

  9. 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.

  10. 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

  11. 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-TAPE- SYRINGE-NEEDLE-ALCOHOL-UMBILICAL CATH

  12. 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.

  13. Initial Steps for Neonatal Resuscitation in Delivery Room CONT. 2.ABCDE STEP • A-AIRWAY POSITION CLEAR AIRWAY-SUCTION MOUTH THEN NOSE

  14. 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

  15. Initial Steps for Neonatal Resuscitation in Delivery Room CONT. • C-CARDIOVASCULAR RESUSCITATION • D-DRUG -DIAGNOSIS • E-ENVIRONMENT -EXTENDED CARE

  16. Resuscitation in the delivery room

  17. 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 H2Ob. Normal delivery = 15-20 cm H2Oc. Diseased Lungs =20-40 cm H2O

  18. 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

  19. 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

  20. METHOD

  21. 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 3.01000-2000 28-34 3.5 2000-3000 34-38 3.5-4.0 >3000 >38

  22. ดูว่าท่อหลอดลมอยู่ในตำแหน่งที่เหมาะสมโดยดูว่าท่อหลอดลมอยู่ในตำแหน่งที่เหมาะสมโดย • 1.ฟังปอดได้ยินเสียงเท่ากัน 2 ข้าง • 2.ฟังที่กระเพาะอาหารไม่ได้ยินเสียงลม • 3.ทรวงอกเคลื่อนไหวเท่ากัน 2 ข้าง

  23. MEDITATION • 1.Indication • HR < 80 bpm despite 100% O2 and chest compression 30 sec • No heart rate

  24. Drug -adrenaline -volume expander -NaHCO3 -Dopamine -Naloxone hydrochloride

  25. Drug dosage

  26. Drug dosage cont.

  27. ทารกที่ไม่ตอบสนองควรคิดถึงทารกที่ไม่ตอบสนองควรคิดถึง • 1.inadequate ventilation: missplaced ETT,inadequate pressure,air leak syndrome • 2.Shoke: asphyxia,hypovolumic,septic • 3.Congenital anomalies: pulmonary hypoplasia,severe cardiac disease

  28. THE END Thank you