Oxigen n Flux Liber administrat cu un Balon de Anstestezie i
Masc2-19A p. 56
**Lesson 2 presents the initial steps in resuscitation.In Lesson
2 you will learn how to Decide if a newborn needs to be
resuscitated. Open the airway, and provide the initial steps of
resuscitation. Resuscitate a newborn when meconium is present.
Provide free-flow oxygen when needed.
*If the answer to all of the initial questions is Yes, and the
newborn is term, the newborn may receive routine care to continue
transition. If the answer to any one of these questions is No, the
newborn will require some form of resuscitation.
Instructor Tip: Assess these criteria simultaneously. The
decision to provide routine care or proceed with initial steps
takes only a few seconds.
*If the newborn is term and vigorous, the initial steps, such as
thermoregulation and clearing the upper airway, may be provided in
modified form, as described in Lesson 1.
Babies born preterm are more likely to have difficulty with
transition and should be evaluated carefully under a radiant warmer
while the initial steps are performed.*Once the newborn has been
placed under a preheated radiant warmer and dried, the next step is
to ensure A of the ABCsestablishment of an open airway. Correct
positioning of the newborn will bring the posterior pharynx,
larynx, and trachea in line, which will facilitate unrestricted air
entry.
Instructor Tip: Although positioning before suctioning is
suggested, if meconium is not present, you may position the newborn
before or after suctioning. The important point is that opening the
airway consists of both suctioning and positioning.*The newborn
should be placed on his or her back, with the neck slightly
extended.
Care should be taken to prevent hyperextension or flexion of the
neck, since either may decrease air entry.
To help maintain correct position, you may place a rolled
blanket or towel under the shoulders, elevating them three fourths
of an inch to 1 inch off the mattress. This roll may be
particularly useful if the newborn has a large occiput.
Correct positioning allows an open airway to be maintained. In
addition, the newborn will be in the optimal position if assisted
ventilation becomes necessary.*If meconium is present and the
newborn is not vigorous, suction the babys trachea before
proceeding with any other steps. If the baby is vigorous, suction
the mouth and nose only, and proceed with resuscitation as
required.Vigorous is defined as a newborn who has strong
respiratory efforts, good muscle tone, and a heart rate greater
than 100 beats per minute.*If the newborn has depressed
respirations, depressed muscle tone, and/or a heart rate less than
100 beats per minute, direct suctioning of the trachea soon after
delivery is indicated before many spontaneous respirations or
assisted ventilation has occurred.
The procedure for suctioning should be repeated as necessary
until little additional meconium is recovered, or until the
newborns heart rate indicates that resuscitation must proceed
without delay.*Visualizing the glottis and suctioning meconium from
the trachea using a laryngoscope and endotracheal tube are
demonstrated in this video. Lesson 5 provides details on
endotracheal intubation. When using suction from the wall or from a
pump, the suction pressure should be set so that, when the suction
tubing is blocked, the negative pressure (vacuum) reads
approximately 100 mm Hg. Monitor heart rate during this
procedure.*A vigorous newborn is defined as one who has strong
respiratory efforts, good muscle tone, and a heart rate greater
than 100 beats per minute. Then simply use a bulb syringe or
large-bore suction catheter (12F or 14F) to clear secretions and
any meconium from the mouth and nose. When you suction,
particularly when using a catheter, be careful not to suction
vigorously or deeply. Stimulation of the posterior pharynx during
the first few minutes after birth can produce a vagal response that
causes severe bradycardia or apnea.
Instructor Tip: Routine gastric suction is unnecessary and
invasive. *If no meconium is present, simply suction the mouth,
then nose, with a bulb syringe. The mouth is suctioned before the
nose to ensure that there is nothing for the newborn to aspirate if
he or she should gasp when the nose is suctioned. If the newborn
has copious secretions coming from the mouth, turn the head to the
side so that secretions will collect in the cheek and be easily
removed.
When you suction, particularly when using a catheter, be careful
ot to suction vigorously or deeply. Stimulation of the posterior
pharynx during the first few minutes after birth can produce a
vagal response, causing severe bradycardia or apnea.*If no meconium
is present, simply suction the mouth, then nose, with a bulb
syringe. The mouth is suctioned before the nose to ensure that
there is nothing for the newborn to aspirate if he or she should
gasp when the nose is suctioned. If the newborn has copious
secretions coming from the mouth, turn the head to the side so that
secretions will collect in the cheek and be easily removed.
When you suction, particularly when using a catheter, be careful
ot to suction vigorously or deeply. Stimulation of the posterior
pharynx during the first few minutes after birth can produce a
vagal response, causing severe bradycardia or apnea.*If, after
drying and repositioning, the newborn does not have adequate
respirations, additional tactile stimulation may be provided
briefly to stimulate breathing. Safe and appropriate methods of
providing additional tactile stimulation include
Slapping or flicking the soles of the feet Gently rubbing the
back, trunk, or extremities
*Overly vigorous stimulation is not helpful and can cause
serious injury. The forms of stimulation listed in this slide may
cause bruising, fractures, tearing of internal organs, brain
damage, or other consequences.
If a baby is in primary apnea, almost any gentle stimulation
will initiate breathing. If a baby is in secondary apnea, no amount
of stimulation will work.
*Overly vigorous stimulation is not helpful and can cause
serious injury. The forms of stimulation listed in this slide may
cause bruising, fractures, tearing of internal organs, brain
damage, or other consequences.
If a baby is in primary apnea, almost any gentle stimulation
will initiate breathing. If a baby is in secondary apnea, no amount
of stimulation will work.
*Continuing to administer free-flow oxygen or providing tactile
stimulation to a nonbreathing or gasping newborn or baby whose
heart rate remains
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