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MEDICATIONS

MEDICATIONS. Medications . Epinephrine Volume expanders Sodium bicarbonate Naloxone Dopamine . Neonatal Resuscitation. No role of Atropine Calcium Dexamethasone Dextrose . Epinephrine. Indications HR < 60 per minute despite 30 seconds of BMV plus chest compressions .

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MEDICATIONS

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  1. MEDICATIONS

  2. Medications • Epinephrine • Volume expanders • Sodium bicarbonate • Naloxone • Dopamine

  3. Neonatal Resuscitation No role of • Atropine • Calcium • Dexamethasone • Dextrose

  4. Epinephrine Indications • HR < 60 per minute despite 30 seconds of BMV plus chest compressions

  5. Epinephrine • Formulation 1:1000 • Dilution 1:10000 (Ten times) 0.2 ml in 1.8 ml • Load 1 ml (in 1ml syringe) • Dose 0.1-0.3 ml/kg • Route IV (preferable) • Rate Rapid bolus IT * - use only if IV access is not available; dose of up to1ml/kg to be used; Efficacy ?

  6. Epinephrine • Effect : Inotropic, chronotropic, peripheral vasoconstriction • Expect : HR > 60 within 30 seconds

  7. Epinephrine Follow up: if HR < 60 • Repeat epinephrine q 3-5 minutes • Ensure: effective ventilation effective chest compressions endotracheal intubation (if not done already) • Consider using volume expander • Consider using sodium bicarbonate

  8. Volume expanders Consider • Pallor persisting after oxygenation • Weak pulses, good heart • Tachy / bradycardia • No improvement despite effective ventilation, chest compressions & Epinephrine

  9. Volume expanders • Normal saline • Ringer’s lactate • Whole blood (O Neg cross matched with mother’s blood)

  10. Normal saline Indications • Evidence or suspicion of acute blood loss with signs of hypovolemia and/or baby responding poorly to resuscitation

  11. Normal saline • Dosage 10 ml/kg • 40 ml in syringe or infusion set • Route IV- umbilical is best • Rate over 5-10 minute

  12. Volume expanders • Effect : Volume expansion, correction of metabolic acidosis • Expectation : Better BP & pulses, less pallor • Follow up : If signs of hypoperfusion persist, repeat volume expander, consider sodium bicarbonate or dopamine

  13. Sodium bicarbonate Indications • Prolonged arrest that does not respond to other therapy • if ABG shows metabolic acidosis with normal PaCO2

  14. Sodium bicarbonate • Preparation 0.9 mEq (approx. 1mEq)/ml • Dilution 1:1 dilution • Load 10 ml of diluted solution • Dose 2 mEq/kg of diluted solution • Route IV; Never through ET tube • Rate Slow over 2 minutes or more @ not >1 mEq/kg/min

  15. Sodium bicarbonate • Effect : Control of metabolic acidosis; volume expansion • Expectation : HR > 100 within 30 seconds • Follow up : If persistent metabolic acidosis Use epinephrine and volume expansion, consider dopamine

  16. Naloxone hydrochloride Indications • Severe respiratory depression after BMV has restored a normal heart rate & color And • A history of maternal narcotic administration within the past 4 hours

  17. Naloxone Preparation 0.4 mg/ml Load 1 ml in syringe Dose 0.1 mg/kg (0.25 ml/kg) Route IV, IM; No intratracheal Rate Rapidly

  18. Naloxone • Effect : Narcotic antagonist • Expectation : Spontaneous respiration • Follow up : If no response, repeat dose

  19. Dopamine • Indication : Persisting evidence of shock • Effects : Increases cardiac output • Expectation : Better perfusion, better pulses

  20. Dopamine • Preparation : 40 mg/ml • Dose : 5 mcg/kg/min to 20 mcg/kg/min • Route : IV • Rate : Constant infusion for hours to days

  21. - Medications Begin Epinephrine • HR below 60/min after 30 seconds of Volume Expander PPV and chest compressions Sodium Bicarbonate Dopamine Give epinephrine May be repeated every 3-5 minutes if required HR above 60 Discontinue medications Prolonged arrest that does not Evidence or suspicion of acute May be repeated respond to other therapy blood loss with signs of if signs of hypovolvemia hypovolemia persist Give sodium bicarbondte Give volume expander Evidence of continuing depression

  22. Evidence of continuing depression • Consider other causes, eg: - Pneumothorax - Diaphragmatic hemia - Persistant pulmonary hypertension • Consider starting dopamine • Obtain consultation Naloxone Respiratory depression and history of narcotics administered in the mother within past 4 hours after 30 seconds of BMV

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