Summary Final year MD notes - paediatric resuscitation
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Course
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Macquarie University (MQ
)
A collection suite of final paediatric MD notes to ace your penultimate and final year exams!
Look no further and save the stress of accessing multiple resources as this PDF collates and summarises information from several resources including but not limited to:
-Talley and O’Connor clinica...
NEONATE RESUSCITATION
PREPARE to resuscitate the newborn at every birth (Respiratory focused Resus)
30s for adequate stimulation (dry head) Key Notes:
Is baby dead? – if so were they dead in utero or post -delivery? *Minimise oxygen ® acts as
drug ® ROS production –
Assess HR/RR using pulsation of umbilical cord cytotoxic – brain/organ damage
NO HR > BAD RESUS = HIE = CP!
Crying HR present
Regular RR Irregular/ no RR
(GASPING/APNOEA) • Call code blue
• CPR 3:1
• High FiO2 (100% O2)
30 s ventilation (ROOM AIR) • Adrenaline 0.1mL/kg (1:10000)
Monitor • Airways positioned in for 1 min then 2nd cycle
(check BSL) NEUTRAL position • ADMINISTER VIA UMBO VEIN
Mother skin-skin • 30 bpm
HR > 60 HR < 60
SIGNS OF GOOD VENTILATION
1. CHEST Movement
2. Increase HR 30s ventilation Start CPR
3. Improved Sats + Reduced CONSIDER ANATOMICAL CAUSES:
WOB and RR (if ventilation + CPR given)
Crying & Regular RR Check equipment (from pt to wall)
If NOT improved?
• M: mask tightly fit? A/B:
Post resus care: • R: Reposition head into Ø Upper airway (obstruction,
sniffing position congenital airway anomalies)
• S: Safe care and sugar
• S: suction nares and pharynx Ø Lower airway (severe hMD,
• T: Temp. (plastic bag, overhead
heater) • O: Open mouth + oxygen pulm. Hypoplasia, PHTN)
• P: PPV – ensure adequate Ø External: PTX, pleural effusion,
• A: Airway
flow 8L/min ascites, CDH
• B: BP
• A: Alternate airway adjunct C – Congenital HB, cyanotic CHD
• L: Lab work (LMA, I+V)
• E: Emotional support (families & D - maternal meds, brain injury,
staff) encephalopathy, sepsis, NMD
Epidemiology Post-resus care: Physiology of ASPHYXIA (Brain Hypoperfusion)
Hypoglycaemia
• 85% ® initiate Ø
o 10% dextrose or glucogel
resp. spontaneously (0.5mL/kg)
• 10% ® initiate Ø Hypovolaemia
o 0.9% NS 10mL/kg
resp. while drying
Ø Infection
• 3% ® CPAP o BenPen (+)
o Gent (-)
• 2% ® vent. Support Ø Lung maturation
Artificial surfactant
• 0.1% ® CPR + o
o NGT (meconium aspirate)
adrenaline
Turn on Neopuff + prepare resus trolley è light and heater on è ensure ventilation working
• Check T-piece
• Check CPAP pressure – adjustable (lower for pre-term)
Check ante-natal notes:
Antepartum: Intrapartum: Important Q’s to ask: Before delivery:
Prep • Pre-eclampsia • Emergency LSCS Ø Meconium in liquor Ø Delivery method
• GDM • Prem labour Ø PV bleeding or blood-stained Ø GxPy + ABO (anti-D)
• Multiple pregnancy • Chorioamnionitis liquor Ø Infection status (BBV, TORCH, STI)
• Oligo/poly hydramnios • Placental abruption Ø Maternal issues Ø Abnormal ante-natal scans or tests
• Reduced fetal movement • Placental praevia Ø Foetal issues Ø Substance abuse
• Substance use Ø Vit K (IVH &haemorrhagic bleed of newborn)
• Check drips, sharps, remove furniture
D
• Provide stimulation + warmth + dry baby using plastic bag
Rs • Send for Help EARLY & Grab paeds resus trolley è “code-blue” + call “2222”
POSITION: Suction: Adjuncts
• Slightly extend neck • Aspiration meconium • Oropharyngeal Guedel (incisor to angle of jaw)
A • chin lift
è
• [NOT needed]
è
• Laryngeal mask (only for >34 wks GA or ETT
• jaw thrust unsuccessful)
• Check RR/HR • BEGIN PPV (bag-valve + Neopuff) Commence “oxygen” if:
• RESP: Apnoea > 30s o Set ROOM AIR + rate 40-60/min • Infant needs cardiac massage
WoB: o 25/6 cmH20 (IPPV, PEEP/CPAP) • No improvement after ventilation (i..e
• Chest wall movement o 30/6 (If HR < 100) bradycardic + intercostal recession + apnoea)
• Tracheal tug • ALL ABOUT BAGGING WELL • ETT (skill dependent) used ONLY if:
B • Grunting è • Correct paediatric mask fit (ensure you see
chest rise and fall)
è o
o
No heartbeat heard
Ineffective PPV
• Assisted ventilation of a baby’s lungs is the o To administer adrenaline
MOST effective action to resuscitating a o Suspected congenital
compromised infant diaphragmatic hernia
C
• Apply ECG & SaO2 (RIGHT HAND as pre-ductal) esp. if there is PDA HR Action Stop compressions +
• CPR è After 2 effective rescue breaths in lifeless infant No action Stop PPV ® APGAR score 1, 5
o Pulse check ® femoral + brachial ONLY for infants >100
(aim 120bpm) and 10 min
• Neonate 3:1 (3 compressions to 1 breath))
60-100 Continue PPV Continue PPV
• Infant 15:2 breaths (best = thumbs) è 100-120 bpm (1/3rd depth)
Start CPR + PPV + Intubate + adrenaline (via ETT
<60
FiO2 100% or UVC)
• Defibrillated (place pads + perform rhythm check) = if in shockable rhythm (VF, VT)
o COACHED ® deliver shock at 4J/kg
Defib o Recommence compressions after shock delivered
o When sinus rhythm returned or PEA® check for pulse
• Disarm machine = if non-shockable rhythm
Oxygen MoA INDICATION Route
Adrenaline (1:10000) • ↑ CO + HR = ↑ MAP • HR < 60 after effective CPR, PPV, FIO2 • Umbilical vein (best)
• Vasoconstrict = ↑TPR • Repeat dose every 3-5 mins @ 0.1-0.3 mL/kg
Vasodilators • ↑ vascular vol. • HR not increasing • Umbilical vein (best) 10mL/kg over
Drugs (Normal NaCl & O neg • ↓met acidosis by increasing • Blood loss suspected (pallor, weak pulse, 5-10 mins
blood) tissue perfusion poor perfusion)
*ADMINISTER MEDICATIONS VIA umbilical vein ® into umbilical vein (biggest collapsible thin walled vein)
Ø If UVC catheter wanted ® confirm position in IVC via AXR (should be at T10 level)
o Should not be in T12 (renal vein)
Debrief Document When to stop
• Parents • Tone, breathing, HR & HCW involved • Depends on infant E.g. In infants with an Apgar 0 after
• Delivery room staff (Nurses, • Time/details of intervention: 10mins of resuscitation, if the HR is undetectable, it may
obstetrician, anaesthetist) When Ventilation + CPR be reasonable to stop assisted ventilation.
After ―
• NICU staff (if baby going there for commenced • APGAR (1 after 1 min) = due to low HR ® signs of acidosis
math further management) ― Drugs given (route?) + ↑ lactate ® resp. compensation to blow out CO2
• NETS (if baby to be transferred) ― Vital signs (incl. post-resus Obs) • APGAR (8 after 5 mins) ® lost in activity and colour
*May need interpreter ― Agpar score
• Management plans
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