ivIf still apneic or has a pulse rate of less than 100 beatsmin after 30

Ivif still apneic or has a pulse rate of less than

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iv.If still apneic or has a pulse rate of less than 100 beats/min after 30 seconds of drying, stimulation, and oxygen: (a)Begin positive-pressure ventilation (PPV) by a newborn-sized bag-mask device. (1)Be careful to not squeeze the bag too hard in order to avoid delivering too much volume. (2)If blended oxygen is not available, start with room air, then switch to 100% oxygen if needed. (3)If pulse rate is less than 50 beats/min, begin chest compressions in addition to PPV. 4.Fewer than 1% of deliveries result in bradycardia that requires chest compressions. a.Most common etiology is hypoxia, which is reversed by PPV. b.A less common etiology is tension pneumothorax, which is treated with needle decompression. c.If ventilation and chest compression do not improve the bradycardia, administer epinephrine via IV line or ET intubation. III. Specific Intervention and Resuscitation Steps A.Drying and stimulation 1.After ensuring airway patency, dry and stimulate the newborn. a.Nasal suctioning stimulates the newborn to breathe. i.Position on the back or side with the neck in the sniffing position. ii.If airway is not clear, suction with the head turned to the side. iii.Suction mouth before nose. b.Flick the soles of the feet and gently rub the back. B.Airway management 1.Free-flow oxygen a.If a newborn is cyanotic or pale, provide supplemental oxygen. i.Clinical cyanosis only becomes apparent when 5 g/dL of hemoglobin is deoxygenated. (a)Provide oxygen to a pale newborn until a pulse oximeter reading can give an accurate reading. b.If PPV is not indicated, oxygen can initially be delivered through: i.Oxygen mask ii.Oxygen tubing cupped and held close to the newborn’s nose and mouth. c.Oxygen flow rate should be 5 L/min. 2.Oral airways a.Rarely used on newborns. b.Conditions that may require oral airways: i.Bilateral choanal atresia ii.Pierre Robin sequence iii.Macroglossia (large tongue)
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iv.Craniofacial defects that affect the airway c.In all these cases (except bilateral choanal atresia), an ET tube is inserted down a nostril. i.Keep the mouth open to provide adequate ventilation. d.Bilateral choanal atresia: Bony or membranous obstruction of the back of the nose e.The Pierre Robin sequence: Series of developmental anomalies that include: i.Small chin ii.Posteriorly positioned tongue 3.Bag-mask ventilation a.Indicated when a newborn: i.Is apneic ii.Has inadequate respiratory effort iii.Has a pulse rate of less than 100 beats/min after: (a)Airway is cleared of secretions. (b)Tongue obstruction is relieved. (c)Newborn is dried and stimulated. b.Signs of respiratory distress suggesting need for bag-mask ventilation include: i.Periodic breathing ii.Intercostal retractions iii.Nasal flaring iv.Grunting on expiration c.Three devices to deliver bag-mask ventilation to newborns: i.Self-inflating bag with an oxygen reservoir—most likely to be found in the field ii.Flow-inflating bag—needs a gas source, more common in surgery iii.T-piece resuscitator—needs a gas source; usually found in neonatal intensive care units d.When using the self-inflating bag, always use the infant size (240 mL) when available.
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