PALS - MUP 1
ABC of BirthEmergency delivery and newborn stabilization
PALS Paediatric Advanced Life Support – IRC Italian Resuscitation Council
SIMEUP Società Italiana di Medicina d'Emergenza e D'Urgenza
PALS - MUP 1
Guidelines for Physicians and Nurses inMATERNAL/FETAL TRANSPORTPrepared by the Maternal-Fetal Medicine Committee of theSociety of Obstetricians and Gynaecology of Canada, 1992
Pediatric education for prehospital professionals (PEEP)/ American Academy of Pediatrics., 2000
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Care and outcome of out-of-hospital deliveries
[Acad Emerg Med 2000]
Prospective study 1 NICU III1991-199491 birthMortality 10%
New Haven - Connetticut
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Testo
Objectives• Discuss triage of the laboring patient
• Outline the newborn resuscitation-oriented history
• Describe the steps for performing a vaginal
delivery and the steps performed immediately
post-delivery for every newborn
• Describe the steps in newborn resuscitation
TestoTesto
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Triage of the laboring patient
• 1. is this your first delivery?
• 2. Du you feel the urge to push?
• 3. Is the child’s head crowning?
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Risk factors = emergency transport w-out delay
• previous cesarean
• placenta previa
• severe maternal diseases
• known fetal malformations
• Loss of blood (> 2 cups)
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Mother’s care during transport
• offer to lie on the her left side
• assist during hyperventilation
• care in case of vomit
• obtain a peripherall venous access
Venentropf
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Triage of the laboring patient
• = imminent birth
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The newborn resuscitation-oriented history
3 questions
• 1. are they twins?
• 2. expected birth date?
• 3. coloured amniotic fluid?
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Equipment
• eye-wear and glove
• 5 dry towels
• 1 thermoblanket
• Betadine
• sterile scissors
• 2 Klemmer• 2 cord -clamp• 1 plastic bag to store the placenta • suction unit • Syntocinon 5U
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• prepar an area for
the baby
• Make sure that the
rooms is warm and
free from drafts
• Several acceptable
ways to position the
mother are available
Position the mother for vaginal delivery
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Points for vaginal delivery • allow the mother to push the head out
• refrain from pulling too hard
• keep the baby at level of the vaginal opening
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• Tie the cord in two
places and cut between
the ties
• Do not pull the cord
The cord care
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• 12-14% Newborns
• thin = of little
significance
• thick = potentially
dangerous
Special situation: Meconium
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• 1. Is the amniotic fluid clear of meconium?
• 2. is the baby breathing or crying?
• 3. is there good muscle tone?
• 4. is the color pink?
• 5. was the baby born at term?
At birth:
Visual Inspection
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the initial steps of the newborn resuscitation
• warm
• position
• suction
• drying
• stimulate
• oxigen (if necessary)
BreathingHeartrate
color
Check
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Seldom
Always
Airway Breathing Circulation
No often
Visual inspection with one look
To warm, positionate, keep free the airways, drying, stimulate, repositionate, O2
ventilationBMV
Intubation
Heartcompressions
Drugs
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the initial steps newborn resuscitation
Clear the airway : position
position the infant on her back and
slightly extend the head
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suction the
mouth and nose
the initial steps newborn resuscitation(30”):
Clear the airway: suction
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• have several pre-warmed towels available
• a new pre-warmed second towel should be use for continued drying and stimulation
• keep the head in the sniffing position
the initial steps newborn resuscitation(30”):
drying
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The act of drying the infant may supply stimulation to breathe.
Alternative methods: -massage of thye back -flickin the soles of the feeds
the initial steps newborn resuscitation(30”):
stimulate
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• Oxigen delivered
by tubing held in
cupped hand over
baby’s face
• at least 5L/min
the initial steps newborn resuscitation(30”):
oxigen
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No breathing or gasping
TestoTesto
BMV Ventilation+ O2 30 sec.
check Breathing
check HF
HR<60 s/min30”
Ventilation+
Heartcompressions
60 - 100
30”ventilation
>100stop ventilation
spontanous Breathingo
check HR< 100
check Color
Pink
CyanosisO2oxygen
Afterthe first steps (30”)
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bag and mask • 40 - 60 breaths pro Minute
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• stethoscope
• palpation of the pulse at
the base of the umbilical
cord
heart rate
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• central cyanosis. This is seen when the body and/or lips are blue, as opposed to just the extremities
assess color
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Chest compressions
• one ventilation
interposed after
every three
compressions 1:3 • total of 30 breathe and
90 compressions per minute
2 sec
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• Meconium suctioning
• bag and mask ventilation not
effective
• endotracheale drugs route
• Transport
Endotracheal Intubation
extreme Fruehgeburt
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• umbelical venous
• endotracheale
way
• Intraossea
Drugs route
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• effective for ventilating newly born full-term infants
• not been evaluated in small, preterm infants
Laryngeal mask
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Adrenaline
• Indication: heart rate<60 /Min. .
• Dose: 0.1 - 0.3 mL/kg of 1:10.000 IV, ET, IO (0.01 - 0.03 mg/kg).
• every 3-5 Minutes
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• prematurity
• congenital upper airway obstruction
• esophageal atresia
• congenital diaphragmatic hernia
• peumothorax
• pleural effusions/ascites (fetal hydrops)
• sepsis
• congenital heart disease
• multiple births
• maternofetal hemorrhage
Special resuscitation circumstances
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After birth
• Apgar score
• Transport
• Placenta
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• <500 mL
• Syntocinon 1A (3-4 mal)
Blood Loss
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Conclusion
• 2-3/1000 birth
• high morbidity
• “basic maternity skills”
• education