When using the self inflating bag always use the infant size 240 mL when

When using the self inflating bag always use the

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d.When using the self-inflating bag, always use the infant size (240 mL) when available. i.Only one tenth of the bag’s volume will be used for each breath. ii.If a neonatal bag is not available, use a bag designed for adults or larger children provided that: (a)The delivered breath size is appropriately small. (b)Chest rise is monitored for excessive volumes of delivered breaths. e.When administering bag-mask ventilation with 100% oxygen, the face mask should provide an airtight seal. i.Airway should be patent and head should be in the sniffing position. ii.The first few breaths after birth frequently need higher pressures (possibly 30 mm Hg). iii.Subsequent breaths should have enough pressure to deliver a visible but not excessive chest rise. f.The correct ventilation time (40 to 60 breaths/min) is important because a higher rate can cause: i.Hypocapnia ii.Air trapping iii.Pneumothorax g.Continue PPV as long as the pulse rate is less than 100 beats/min or the respiratory effort is ineffective.
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i.If more than 1 minute of PPV is needed, hook the system to a pressure manometer. h.Causes of ineffective bag-mask ventilation: i.Inadequate mask seal on the face ii.Incorrect head position iii.Copious secretions iv.Pneumothorax v.Equipment malfunction 4.Intubation a.Indicated when: i.Meconium-stained fluid is present and the newborn is not vigorous (tracheal suctioning is indicated). ii.Congenital diaphragmatic hernia is known and suspected, and respiratory support is necessary. (a)Abdominal organs herniate through an opening in the diaphragm into the chest cavity. iii.No response to bag-mask ventilation and chest compressions, necessitating ET administration of epinephrine iv.Prolonged PPV needed v.Craniofacial defects impede an adequate airway. b.The following equipment should be available: i.Suction equipment ii.Laryngoscope iii.Blades—straight iv.Shoulder roll v.Adhesive tape vi.ET tube vii. Stylet (used by some paramedics—must be secured at top of ET tube) c.To properly intubate a newborn, refer to Skill Drill 42-1. d.Complications of ET tube placement include: i.Oropharyngeal or tracheal perforation ii.Esophageal intubation with subsequent persistent hypoxia iii.Right mainstem intubation e.Risks can be minimized by: i.Ensuring optimal placement of laryngoscope blade ii.Noting how far the ET tube is advanced 5.Gastric decompression a.Indicated if: i.Prolonged bag-mask ventilation (more than 5 to 10 minutes) ii.Abdominal distention is impeding ventilation. iii.Diaphragmatic hernia or gastrointestinal congenital anomaly (a)Diaphragmatic hernias are suspected if: (1)Decreased breath sounds on left side (2)Scaphoid or concave abdomen (3)Increased work of breathing
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b.To properly insert an orogastric tube in the newborn, refer to Skill Drill 42-2.
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