1. Neonatal Resuscitation -BLS- RC 290

2. Equipment Needed Overhead radiant warmer Bulb syringe BVM with heated & humidified O2 De Lee suction device Size 5 Fr suction catheters and wall suction Laryngoscope with proper sized blades Proper sized ET tubes Crash cart/Drug box

3. Normal Delivery Procedures Place under warmer and towel dry Use bulb syringe to clear mouth, than nose Tactile stimulation if not breathing yet Auscultate heart and lungs & assess color Prophylactic silver nitrate or erythromycin drops in eyes Vitamin K injection Examine umbilical cord Free flow O2 as needed

4. Free Flow O2 Hold O2 connecting tubing ½ inch from infants face. Run flow at 5 LPM

5. Resuscitation Maternal causes: –Drugs –Cardiopulmonary problems –Infection –Dystocia –Utero-Placental problems Fetal Causes –Cord compression –Prematurity –Congenital anomalies –Multiple pregnancy –Meconium aspiration –Hypothermia –shock

6. NRP Resuscitation Algorithm

7. Meconium Baby Airway is aggressively cleared prior to drying if infant is meconium stained AND baby is NOT vigorous! –Use ET tube as a suction device May need PD & P after heart rate, respirations, and color stabilize If baby is meconium stained but vigorous, proceed with normal resuscitation

8. Bagging a Neonate

9. BVM Devices

10. Flow-dependent anesthesia bag

11. Bagging Technique Place infant in “sniffing” position by placing a small towel under the shoulders Do not hyperextend neck!

12. Bagging technique ( cont.) Apply correctly sized mask over infants mouth and nose with apex of mask over bridge of nose

13. Run either type of bag at 5-8 LPM to get 100% FIO2 –If self-inflating bag, use reservoir also Watch for slight rise of chest (Vt ~ 20-30 ml) Rate is 40-60 Pressure –First breath may require 30-40 cmH2O –Then, with normal lungs, 15-20 cmH2O –Poor lung compliance may require sustained 20-40 cmH2O

14. If BVM ventilation lasts over 2 minutes… Than an orogastric tube has to be inserted

15. Neonatal PD & P Meconium babies and/or C section babies No more than 20 degrees of Trendelenberg or ICP will increase Percuss anterior and lateral surfaces 1-2 minutes Maintain airway throughout using one hand on head Suction PRN Besides suction, need BVM and O2 Monitor heart rate, respirations and color throughout

16. Neonatal PD & P Percussors

17. Neonatal Chest Compressions Asystole or bradycardia less than 60 that is not increasing with airway and ventilation Use thumbs on lower half of sternum (one finger’s width below nipple line) Compress ½ to ¾ of an inch, 120 times per minute Compression ventilation ratio is 3:1 (pause to give breath)

18. The End Result