Resuscitation

Resuscitation

Revival after apparent death Risk factor for the need of resuscitation: In neonate: Twin gestation Prematurity Presence of meconium In child: Accidents or illnesses that compromise the respiration

Presentation: depends on the situation that leads to resuscitation Compromise of respiration system, cardiac system or both Physical examination: Cyanotic, pale or mottled appearance Drooling, if foreign body aspiration Apnea Tachycardia, bradycardia or asystole “Apnea is defined as a respiratory pause lasting more than 20 seconds—or any pause accompanied by cyanosis and bradycardia”

Heart rate

Diagnostic tests: vary according to the presentation; Apgar score needs to be determined Treatment: “A, B, C” A: Airway B: Breathing C: Circulation In neonate: Position, suction and tactile stimulation Oxygen Bag valve ventilation Chest compression Intubation (tube size 2.5 – 3.5, no cuff) Medication

Steps in the Resuscitation 1)Dry the infant well, and place him or her under the radiant heat source 2) Gently suction the mouth, then the nose 3) Quickly assess the infant's condition The best criteria are the infant's respiratory effort (apneic, gasping or, regular) and heart rate (> 100 or < 100 beats/min) A depressed heart rate—indicative of hypoxic myocardial depression—is the single most reliable indicator of the need for resuscitation.

4) Infants who are breathing and have heart rates over 100 beats/min usually require no further intervention Infants with heart rates less than 100 beats/min and apnea or irregular respiratory efforts should be stimulated vigorously The baby's back should be rubbed with a towel while oxygen is provided near the baby's face 5) If the baby fails to respond to tactile stimulation within a few seconds, begin bag and mask ventilation. Adequacy of ventilation is assessed by observing expansion of the infant's chest accompanied by an improvement in heart rate, perfusion, and color The rate of bagging should be 40–60 breaths/min.

6) If no respond to bag and mask ventilation, intubation is appropriate. Failure to respond to intubation and ventilation can result from (1) mechanical difficulties (2) profound asphyxia with myocardial depression, and (3) inadequate circulating blood volume. 7) If mechanical causes are ruled out and the heart rate remains below 60 beats/min after intubation and PPV for 30 seconds, cardiac compression should be initiated.

8) If drugs are needed, epinephrine 1:10,000 solution, 0.1–0.3 mL/kg given via the endotracheal tube or preferably through an umbilical venous line. Sodium bicarbonate, 1–2 mEq/kg of the neonatal dilution (0.5 mEq/mL), can be used in prolonged resuscitation efforts in which the response to other measures is poor If volume loss is suspected, 10 mL/kg of a volume expander (normal saline) should be administered through an umbilical vein line.

In children, Secure airway 100% Oxygen Start intravenous or intraosseous route of administration Check vital signs If severe cardiorespiratory compromise, follow standard algorithms Intubation (cuffed endotracheal tube if children >8

In aspiration of foreign body that is obstructing flow of air to the lungsChildren older than 1 year Heimlich maneuver: Wrapping the examiner’s arm around the victim’s waist from behind Placing a fist on the abdomen between the rib cage and navel Administering upward abdominal thrusts Maneuver should be performed until the foreign body dislodges

Children older than 1 year: Heimlich maneuver

Children younger than 1 year No Heimlich maneuver No any blind finger sweeps Perform back blows and chest thrusts Complications: Morbidity and mortality from attempts of resuscitation

Children younger than 1 year

Children younger than 1 year