TRENDS IN EMERGENCY CARE - Emergency air medical ... · Tunneled Central Venous Catheters An IV...

TRENDS IN EMERGENCY CARE PROVIDES FOUR (4) HOURS OF CONTINUING EDUCATION CREDIT

April 11, 2018 | Adventist Health Ukiah Valley

AGENDA 1200-1300 Controlled Substances Chris Awad Mendocino County Major Crimes Team Taskforce 1310-1410 Access Issues: Pediatric Peripheral and Central Lines Diana Priego, RN, CCRN, FN REACH Air Medical Services 1420-1520 Facial Trauma Amy Henry, RN, CFRN CALSTAR Air Medical Services 1530-1630 Neonatal and High Risk OB Emergencies Yvette Gonzalez, MS, RN, C-EFM, C-NPT REACH Air Medical Services 1630 Evaluation and Adjourn

Access Issues: Pediatric Peripheral and

Central Lines

Diana Priego, RN, CRN, FN

Access Issues; Pediatric Peripheral

and Central Lines

Diana Priego RN BSN CCRN CNP-T

Objectives

- Identify appropriate sites and securing for

pediatric IV's.

- Review strategies for positioning and calming

children while having peripheral IV's placed.

- Identify 3 different central lines that can be

found in pediatric patients receiving home care

and considerations for access in emergent

situations.

Remember to start with the basics...

• All children require the same priorities.

– Clear airway

– Adequate ventilation

– Adequate oxygenation

– Adequate cardiac output

• Perfusion indicators

• Good preparation is

key

• All equipment

prepared

• Sites evaluated

• Personnel available

So you need a line…

Sites

• Arms

– AC

– Hands

– Wrist

– Forearm

• Feet (consider if the

child ambulates or not)

• Scalp (direction?)

• EJ?

Preparing the Child

• Age appropriate time

to tell child about the

IV start and

description

• Poke vs Shot

• Lidocaine cream (30

min ahead)

• Warm packs to

hands/feet

Distraction Techniques

• Bubbles

• Tablet or

Smartphone

• Spinning toys

• Vibrating toys

Positioning the Child

• For babies and toddlers, safely

immobilize all other extremities.

• Minimum of 3 staff for younger

children, parent should not be the

person restraining child.

• Blanket wrapped with arm out,

superman fold for foot PIV

• Bear hug vs chest to chest

Helping Hands

• Vein finders

• Venoscopes

• Red flashlight (be aware

of temp, light cannot be halogen)

• All of these can be very

valuable but need practice

as depth perception is

limited.

Neonates

• They do feel pain!

• Sweet-ease along with a

pacifier or gloved finger

to suck on.

• May internalize pain

and demonstrate in

other ways such as

apnea or decreased

LOC.

During the Procedure

• Reassure child they are

doing a good job

• Acknowledge any

statements they are

making, eg “that hurts!”

• Do not promise it is the

last poke or will only be

one poke.

• Tell them when the

sharp part is removed

from the IV.

How many attempts?• CHANGE something if you

don’t get it…

position of child

catheter size

site

provider

- Consider alternatives for other

IV access or interventions in

the meantime.

- Is pt appropriate to wait for the

TT to attempt further? (Try at

least once, you may surprise

yourself!)

Securing the IV• What kind of tape?

• Anchor hub under

tegaderm

• Diaphoretic kids may

need skin prep/adhesive

• 2x2’s as needed

• Leave your site visible

please!!!!

(no coban/wraps)

• Armboard if needed

• Stockinette/Netting?

The Scary Scalp IV…

• Rubber band with a tab of

tape for a tourniquet

• Consider hair

• Arterial vs venous?

• Will need some sort of skin

prep to make tegaderm adhere

• “Party hat” support catheter

with cotton ball. Don’t need

cups/plastic covering it.

• Again, site should be visible

after securing.

I/O access

• Indications

• Manual vs EZ IO

• Appropriate size

• Prepare the family for

what it will sound/look

like

• Secure with dressing, no

circumferential tape

Interesting Information

• Special needs population is increasing out in our community.

• Many children have more than one special healthcare need.

• Children with special healthcare needs are over three times as likely as other children to require emergent ICU admission.

• Technology-dependent children are over 300 times more likely to require emergent ICU admission than other children with special health needs.

Schif, Jeff. Children with Special Health Needs in the EMS System.

Minnesota Department of Health. Spring 2002

Tunneled Central Venous Catheters

• An IV catheter that is

surgically inserted and

tunneled under the skin

into a large central vein.

• Common insertion sites

include the chest and

arm. Also possible, but

not as common are

insertion sites in the

scalp, neck and groin.

Tunneled Central Venous Catheters

• Children may have a permanent central line in

place for:

- At-home intravenous medications or nutrition

- Frequent blood draws

- Administration of chemotherapy

- Chronic condition and history of poor IV

access.

Types of Tunneled Catheters

• Broviac-Hickman

catheter (also known as

Groshong catheter)

• Port-a-Cath

• PICC (Peripherally

Inserted Central

Catheter)

• Also referred to as

PVAD’s (pre-existing

vascular access device)

Accessing the Catheter

• Port-a-caths require insertion of a special

needle to use.

• Other catheters may be accessed by a

capped or luer-lock mechanism.

• Be aware of potential heparinized lines.

• When drawing labs, first draw should be

used for blood culture or waste and then

use another syringe to draw remaining labs.

Kids and their Lines

• Always let the child know what you are going

to do with the line.

eg. draw blood or infuse medication.

• Some children are sensitive to the sensation

when lines are flushed quickly.

• Some kids require pre-medication with

lidocaine cream to site before accessing

port-a-caths.

Line Emergencies

• Line dislodgement – apply pressure to site and above

insertion point.

• Save dislodged line to verify length to rule out

thrombi of line tip.

• Always ensure caps are snug as hemorrhage or air

emboli can occur in a short period of time from

disconnected catheters.

• If you are not sure about using the line you can

always place a PIV/ IO until the line has been

verified.

Questions?

Facial Trauma Amy Henry, RN, CFRN

Facial Trauma

Amy Henry, RN, CFRN

Objectives

• Discuss anatomy and assessment of the patient with facial trauma

• Discuss implications of caring for the patient with facial trauma

• Discuss facial injuries and treatment

• Discuss airway assessment and management in the patient with facial trauma

• Discuss anatomy and assessment of the patient with ocular trauma

• Discuss ocular injuries and treatment

Facial Anatomy

Facial Anatomy

Facial Vasculature

Facial Innervation

Facial Anatomy

Anatomy of the Midface

Anatomy of the Forehead

Anatomy of the Orbit

Anatomy of the Maxilla

Anatomy of the Nose

Anatomy of the Zygoma

Anatomy of the Mandible and Oral Cavity

Common Concurrent Injuries

• Hemorrhage

• Intracranial lesions

• Lacerations

• Tearing and shearing injuries

• Secondary injuries– Hypotension

– Hypoemia

– Hypercarbia

– Cerebral edema

– Changes in ICP

– Cerebral ischemia

GOAL OF TREATMENT IS TO PREVENT SECONDARY INJURIES!

Assessment of the Patient with Facial Injuries

Assessment of the Patient with Facial Injuries

Assess mental status

Assessment of the Patient with Facial Injuries

Circulation

Facial Lacerations

• Treatment includes:

– Control of bleeding

– Clean/irrigate wound

– Prepare patient for wound repair

– More complex wounds or wounds with concurrent injuries may require specialist consultation

Nasal Fracture

Treatment:

- Monitor airway

- Control bleeding

- May require nasal

packing

- ENT

- Definitive treatment

may be delayed

to allow swelling to

decrease

Facial Fractures

Frontal Bone Fracture

- usually from high velocity blunt trauma and frontal sinuses may be involved

- Lacerations, contusions, or hematoma should cause suspicion for fracture

Orbital Fracture

- can occur on the outer ring or orbital floor

- usually result from direct blunt trauma as from assault

- can cause nerve entrapment and/or injury

LeFort I

Horizontal fracture line

that runs along the maxilla

Upper gums and soft palate

are detached from the skull

LeFort II

Pyramidal maxillary fracture

The apex of the fracture is at

the bridge of the nose

The lateral fractures extend

through the lacrimal bone of

the face and ethmoid of the

skull into the medial orbits

The base of the fracture extends

above the level of the upper teeth

and into the maxilla

Most of the maxilla is free-floating

from the skull

LeFort III

Complete separation of the

midface from the skull

Fracture line travels horizontally

through the midface at the bridge

of the nose

Fracture traverses each orbit and

extends down into each zygomatic

arch

Midface is detachable from the

skull and the anterior face is mobile

Treatment of LeFort Fractures

• Monitor airway – retropharyngeal hematoma may obstruct airway

• Patient may have open fractures and/or pneumocephalus

• Maintain spinal precautions

• Analgesia, anxiolysis, and anti-emetic

• Patient will likely need surgery

• Consult neurology/neurosurgery, ophthalmology, oral and maxillofacial surgery

• Keep the head elevated and positioned midline to facilitate venous drainage

Mandibular Fracture

Can be open or closed

Almost always breaks in two places

Facial asymmetry will be noted

Painful

Patient may have malocclusion,

inability to open the mouth, edema

or hematoma formation, blood

behind or ruptured tympanic

membrane, CSF from the ear, or

anesthesia of the lower lip

Treatment of Mandibular Fractures

• Manage and maintain airway

• Control bleeding

• Monitor neuro status

• Analgesia

• Consider concurrent injuries

Anatomy of the Eye

Assessment of Ocular Injuries

• Look for symmetry, lacerations, foreign bodies, penetrating trauma, and any indications of fracture such as step-offs

• Assess visual acuity – get a description of the patient’s vision, Snellen chart

• Check extraocular movements

• Check pupils for shape, size, reactivity, and symmetry

Neonatal and High Risk

OB Emergencies Yvette Gonzalez, MS, RN, C-EFM, C-NPT

High Risk OB & Neonatal EmergenciesPre-Transport Stabilization & Transport Considerations

Yvette Gonzalez, MS, RN, C-NPT, C-EFM, High Risk Obstetric & Neonatal Transport Clinical Manager

This outreach education presentation is intended as an overview of basic concepts surrounding assessment of the

pregnant patient, OB complications and stabilization priorities for maternal and newborn patients.

Follow designated county protocols, policies and guidelines for actual care of obstetric and newborn patients.

Objectives• Review normal physiologic changes in pregnancy

• Review basic assessment of pregnant patients

• Review high risk obstetric clinical presentations, pretransport & transport clinical considerations

• Review postpartum hemorrhage and interventions

• Review high risk obstetric & neonatal transport stabilization priorities

• Review in-utero resuscitation measures for pre-transport and transport clinical application

Maternal Early Warming Criteria

US Maternal Morbidity & Mortality Leading Causes & Regions

Source: 1. National Vital Statistics Maternal Morbidity. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_04.pdf. Accessed March 2017. 2. Maternal Early Warning Criteria. http://safehealthcareforeverywoman.org/patient-safety-tools/maternal-early-warning-criteria/. Accessed March 2017.3. Image Source: World Health Organization, 2014

Causes of Arrest in OB Patients

Bleeding-DIC, Embolism, Anesthetic complications, Uterine atony,

Cardiac disease, Hypertensive disease, Other, Placental, Sepsis

Source:1. The American Heart Association 2010 Guidelines for the Management of Cardiac Arrest in Pregnancy: Consensus Recommendations on Implementation Strategies. http://www.jogc.com/article/S1701-2163(16)34991-X/pdf . 2. American Heart Association: AHA. Maternal Cardiac Arrest. http://circ.ahajournals.org/content/132/18/1747. Accessed March 20173. Direct Causes of Maternal Mortality. Dartmouth.edu. Countdown to 2015 Decade Report (2000-2010), World Health Organization (2010).

Cardiac Arrest In Pregnancy & Perimortum Cesarean Delivery

Recognition, Collaboration, & Teamwork• CRM: Prepare For 2 Patients: OB & Neonatal Teams

Positioning• Laterally to prevent aortocaval compression!

BLS & ACLS per AHA

CPR & Delivery• Every Minute Matters

Source: 1. Aortocaval Compression Conundrum in Obstetrics. https://journals.lww.com/anesthesia-analgesia/Citation/2017/12000/The_Aortocaval_Compression_Conundrum.7.aspx. Accessed March 2018.2. Cardiac Arrest In Pregnancy. AHA Scientific Statement. https://doi.org/10.1161/CIR.0000000000000300 Circulation. 2015;CIR.0000000000000300. Accessed March 2018Originally published October 6, 2015

Normal Physiologic Changes In Pregnancy

Cardiovascular • Hormones, Hemodynamics & Vital Signs

Hematologic • Circulating Blood Volume, Hct, & Coagulation

Respiratory• Compensated Respiratory Alkalosis: pH 7.4-7.45 & PaCO2 27-32

• O2 Consumption, minute ventilation, tidal volume:

• Delayed gastric emptying---risk for aspiration!

Source: 1. Hayes, Meghan; Larson, Lucia (2012). "Chapter 220. Overview of Physiologic Changes of Pregnancy". Principles and Practice of Hospital Medicine The McGraw-Hill Companies. https://accessmedicine.mhmedical.com/content.aspx?bookid=496&sectionid=41304210 March 20182. Cardiac Arrest In Pregnancy. AHA Scientific Statement. https://doi.org/10.1161/CIR.0000000000000300 Circulation. 2015;CIR.0000000000000300. Accessed March 2018Originally published October 6, 2015

Vital Signs & Labs During Pregnancy

Pregnant

• HR: 85

• SBP: 114

• DBP: 70

• Goal: vital organ perfusion

• MAP > 70

• Ensure adequate preload before initiating vasoactive drugs

Labs

• Hct 34

• Platelets > 150

• AST/ALT ~ 35

• Creatinine < 1.0

• WBC < 16

Source: Hayes, Meghan; Larson, Lucia (2012). "Chapter 220. Overview of Physiologic Changes of Pregnancy". Principles and Practice of Hospital Medicine The McGraw-Hill Companies. https://accessmedicine.mhmedical.com/content.aspx?bookid=496&sectionid=41304210 Accessed March 2018

OB Care Priorities: Stabilization & TransportABCs

Lateral Positioning

Vascular Access & Fluid Bolus • If indicated: LR or NS

Treat Mom To Treat Fetus!!• Uteroplacental Unit-New “End-Organ”

At Sending Facility: • Ensure stability of mother and fetus prior to transport• Obtain Frequent maternal vital signs & fetal assessment• Decision To Transport for Higher Level of Care ?

Source: Trauma in the Obstetric Patient. American College of Emergency Physicians. https://www.acep.org/Clinical---Practice-Management/Trauma-in-the-Obstetric-Patient--A-Bedside-Tool/. Accessed March 2018.

Determinants Of Fetal Oxygen Delivery

Source:http://www.obstetanesthesia.com/article/S0959-289X(01)90933-1/pdf. Accessed December 2017Clinical Obstetrics and Gynecology. 54(1):28–39, MAR 2011. DOI: 10.1097/GRF.0b013e31820a062b. Accessed December 2017Source: Macones, Hankins, Spong, Hauth, & Moore (2008). The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring. Obstetrics & Gynecology, 112, pg 665.

Intrauterine Resuscitation Measures

Lateral Positioning• Optimize perfusion to uteroplacental unit

IV Fluid Bolus: Based on clinical condition

• Correction of maternal hypotension is essential!!

Oxygen Supplementation :• May optimize maternal oxygenation status and fetal oxygen delivery.

Reduction of Uterine Activity: Tocolysis

Source: Maternal Oxygen Administration As An IntraUterine Resuscitation Measure During Labor. Simpson, Kathleen Rice. MCN: The American Journal of Maternal/Child Nursing: March/April 2015 - Volume 40 - Issue 2 - p 136http://www.sfnmjournal.com/article/S1744-165X(08)00061-9/abstract. Accessed March 2018.

Bleeding During Pregnancy

Source: 1. ACOG. Bleeding During Pregnancy. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy. Accessed March 2017.2. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/he-06b-AF-140516-HemChecklist-Binder.pdf?dmc=1&ts=20171212T2152159656. Accessed March 2017.

OB TraumaStabilization, Assessment & Transport Considerations

Primary & Secondary Survey

LUD & Fetal Assessment

KB

Source: 1. ACOG. Bleeding During Pregnancy. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy. Accessed March 2017

Ectopic Pregnancy: 11% Of Maternal Deaths

Pregnancy implantation outside the uterus

Suspect with childbearing age and abdominal pain

Leading cause of 1st trimester maternal death---risk of hemorrhage!!

Source: Tubal Ectopic Pregnancy. ACOG. https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Tubal-Ectopic-Pregnancy. Accessed March 2018

OB Trauma: #1 Cause of Maternal Death

Causes: MVA, Abuse, & Falls• Risk of abdominal trauma & hemorrhage

Physiologic Changes of Pregnancy Can Mask Signs of Shock• Increased blood volume, cardiac output, mild tachycardia

Uteroplacental Unit—Perfusion Redistribution• Fetal compromise can occurs before shock is apparent in mother

Source: Trauma In The Obstetric Patient. American College of Emergency Physicians. https://www.acep.org/Clinical---Practice-Management/Trauma-in-the-Obstetric-Patient--A-Bedside-Tool/. Accessed March 2018

Placenta Previa: Bleeding Risk• Bright red, painless bleeding with or without UC’s

•Must have rapid surgical capability for C/S

Source: Placenta Previa-Obstetric Risk Factors & Pregnancy Outcome. https://www.ncbi.nlm.nih.gov/pubmed/11798453. Accessed March 2018

Placental Abruption: Bleeding RiskRisk Factors?

Placental Detachment• May present with dark red & painful bleeding, OR

• Bleeding may be occult, rigid abdomen with severe pain !!

Source: Bleeding During Pregnancy. ACOG. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy. Accessed March 2018

Tick Tock...Every Minute Matters

Preterm Labor

Preterm Premature Rupture of Membranes

• Primary Impression, Consult, & Pre-transport Stabilization

• Optimize Tocolysis

• Fetal Protection: Magnesium Sulfate, Antenatal Steroids & Antibiotics

• Transfer To Higher Level Of OB & Neonatal Care Source:1. Society For Maternal Fetal Medicine. Implementation of the Use of Antenatal Corticosteroids in the Late Preterm Birth Period in Women at Risk for Preterm Delivery. August 2016. Accessed March 2017. 2. ACOG. Management of Preterm Labor. https://www.acog.org/Womens-Health/Preterm-Premature-Labor-and-Birth. October 2016. Accessed March 2017 3. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Magnesium Sulfate In Obstetrics. January 2016. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co652.pdf?dmc=1&ts=20171212T2253317113. Accessed August 2017.

Viability Considerations23 weeks (some centers 22 weeks)

Estimated Fetal Weight Based On Weeks of Pregnancy

0.5kg 1Kg 2Kg 3Kg 4Kg

Source:1. NEJM. Survival and Neurodevelopmental Outcomes among Periviable Infants. February 2017. Accessed May 2017. 2. ACOG & Society For Maternal-Fetal Medicine. Periviable Birth. https://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Periviable-Birth. October 2017. Accessed November 2017.

The Pressure Is On…..OB Hypertensive Emergencies

Defined: SBP >160mmHg, or DBP > 100mmHg, acute-onset, & persistent (>15 min)

Severe systolic hypertension--most important predictor of cerebral hemorrhage in OB patients• Goal B/P: Range of 140-160/90-100 mmHg to preserve fetal perfusion!!• Severe hypertension can occur antepartum, intrapartum or post-partum

Stabilization Considerations: • Magnesium Sulfate, Antihypertensives, Delivery, Transport, Anticonvulsants

Source:1. California Maternal Quality Care Collaborative: CMQCC. https://www.cmqcc.org/. Accessed August 20172. ACOG. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period. April 2017. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co692.pdf?dmc=1&ts=20171212T2343034025.

Accessed May 2017

Image Source: https://www.thirdstopontheright.com/may-is-preeclampsia-awareness-month-do-you-know-the-signs-and-symptoms/. Accessed April 2018

Preeclampsia, HELLP & Eclampsia

Cerebral Effects Cardiac/Vascular

Pulmonary Liver Renal Fetal

Labs: Obtain Hct, Platelets, LFT’s, Cr, Coags

Preeclampsia Assessment Is Vital!!

Treatment-Stabilization: Magnesium Sulfate, Antihypertensives, Anticonvulsants, DeliverySource: 1. California Maternal Quality Care Collaborative: CMQCC. https://www.cmqcc.org/. Accessed August 20172. https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system. Accessed December 2017

Delivery Outside Of OB Unit : Now What??• Place infant on mothers abdomen after birth

• Clamp cord 8-10 inches from baby• Use 2 clamps several inches apart: cut between clamps

• Delayed Cord Clamping X 30-60 seconds IF VIGOROUS

• Immediate Cord Clamping IF NONVIGOROUS

• Provide basic newborn care• Clear Airway & Optimal Airway Positioning

• Dry Thoroughly & Provide Warmth

• Continuous assessment of ABC’s

• Thermoregulation & Blood Glucose

Source: Neonatal Resuscitation Program. AAP. 7th Edition

Tiny Ones: Preterm Delivery Delayed Cord Clamping (DCC): IF newborn is vigorous. DCC and reduction of IVH

• IF NONVIGOROUS---immediate umbilical cord clamping, initate NRP

Thermoregulation & Handling: Warming Mattress, isolation bag, nesting, gentle handling

Follow NRP Guidelines: Sp02, application of mask/nasal CPAP, careful (slow) fluid

administration, glycemic control, airway & perfusion support, early activation of transport team!

Source:1. AAP. Neonatal Resuscitation Program. 7th Edition.

Delivery of Placenta: Now What?

Typically within a few minutes of delivery• Do not pull on cord

Normal blood loss ~ 500ml

Provide vigorous fundal massage!!

• Support lower uterine segment

• Ensure uterus stays contracted-firm

• Uterotonics: Pitocin as needed

Source: ACOG Guidelines For Management Of Hemorrage. https://www.aafp.org/afp/2007/0401/p1101.html. Accessed 3/2018.

Postpartum Hemorrhage: >500ml Blood Loss #1 Priority: Provide Vigorous Continuous Fundal Massage• Leading cause: uterine atony after birth•Goal: uterus remains contracted & firm

Adequate Vascular AccessContinuous Fundal MassageUterotonicsConsider TXAD&C -- Removal of Placental PartsOR --- Looking For BleedersActivate Massive Hemorrhage Protocol

Source: OB Hemorrhage V2 Toolkithttps://www.cmqcc.org/resources-tool-kits/toolkits/ob-hemorrhage-toolkit. CMQCC. California Maternal Quality Care Collaborative. Accessed 3/20/2018

Image Source: dailymom.com

Neonatal Emergencies

Neonatal Resuscitation & Stabilization Priorities

NRP versus PALS: Differences

Stabilization Measures: The S.T.A.B.L.E. Program

• Glycemic Control• Thermoregulation• Perfusion Support• Consider Antibiotics• Preparation For Transport • Transfer to Higher Level of Care

Source: AAP. Neonatal Resuscitation Program. 7th EditionThe S.T.A.B.L.E. Program. 6th Editionhttp://www.abclawcenters.com/wp-content/uploads/2014/11/original_resuscitation_with_bagging_and_chest_compressions.jpg. Accessed August 2017.

Neonatal Airway ManagementBabies Are Different…

•Anatomical Challenges

•Ventilation Devices

•Establishing Effective Ventilation

•Oxygenation

•Ongoing Airway Support

•Alternative AirwaySource1. AAP. Neonatal Resuscitation Program. 7th Edition2. The S.T.A.B.L.E. Program. 6th Edition

Neonatal Vascular AccessEmergent UVC: o18-20 gauge IV catheter: Prep—Tie—Cut--Cannulateo Single lumen UVC catheter 3-5 cm, obtain blood return o < 1500 Grams/30 weeks 3.5 F and > 1500 Grams/30 weeks 5.0

F

PIV Placement

• 24g

IO Placement

• EZ IO >3kg

Fluid Resuscitation

• NRP versus PALSSource1. AAP. Neonatal Resuscitation Program. 7th Edition2. The S.T.A.B.L.E. Program. 6th Edition

Neonatal Hypothermia Treatment: Protecting Babies BrainsHypoxic Ischemic Encephalopathy (HIE)

Inclusion CriteriaoPost criteria in L & D - Nursery

Time SensitiveoEarly Recognition is Vital

oTarget Initiation by 6 hours

Early ConsultationoRegional Neonatal Cooling Center

Source:Hypothermia and Neonatal Encephalopathy. AAP (2014). http://pediatrics.aappublications.org/content/pediatrics/133/6/1146.full.pdf. Accessed May 2017https://i.pinimg.com/236x/ef/50/f3/ef50f3f7f9ee2fdfc533270415471c1e.jpg. Accessed December 2017. http://www.rchsd.org/wp-content/uploads/2014/05/Neonatal-cooling-blanket.png. Accessed December 2017 http://jlgh.org/JLGH/media/Journal-LGH-Media-Library/Past%20Issues/Volume%206%20-%20Issue%203/Larsonfig3.jpg. Accessed December 2017

Bowel Obstruction: Clinical Priorities

• Rapid Consult, Stabilization & Transport to Pediatric Surgical Center

• Airway & Perfusion Support

• Decompression of abdomen continuous: Orogastric Tube 8F or 10F

• IV Fluids, Glycemic Control, ThermoregulationSource1. AAP. Neonatal Resuscitation Program. 7th Edition2. The S.T.A.B.L.E. Program. 6th Edition

3. Journal of Obstetric Gynecologic and Neonatal Nursing. JOGNN. Lockridge, Caldwell, Jason (2003). Neonatal Surgical Emergencies: Stabilization & Management. Volume 31, Number 3.

Free Air On Xray Is A Surgical Emergency

Questions?

For Additional Information Contact: Yvette Gonzalez, RN, MS, High Risk OB & Neonatal Clinical Manager @

Yvette.Gonzalez@REACHAir.com