empty sleep sack in plain bed – if baby was on stomach and nose was occluded they cant turn head and will stop breathing and die of sids SLEEP ON BACK ALONE Oral mucus secretions, cough/gag when clearing lung fluid and should never be left alone in the nursery—cant just leave bc they will che on secretions—puck up and throw kid over arm to handle secretions and fall on floor—if cant suction with blue balb syring in bed w kid COMPRESS first and mouth first then nose because mouths hold more than noses put in corner not straight back and get gag reflex and make it worse if still cant go to wall of nursery for mechanical suction to deeply suction that baby DECREASE IN HEART RATE r/t vagal nerve stimulation, so next to suction set up on wall is a set up for 100% O2 to help bring the heart rate back up again NEVER ALONE Silverman-Anderson Index don’t memorize, just concept on wall in nursery to know if a baby is doing well respiratory wise or not—if doing well synchronized movement of chest and abdomen as they start to get into respiratory distress there will be a lag on inspiration and eventually seesaw respirations where chest is down and belly is up. If well no chest retractions, but as they start to get into respiratory distress you can count ribs and eventually marked. If doing well they wont have xiphoid retractions but many have a xiphoid that sticks out, that isn’t what we are talking this is a sunken in chest so if retracted you can count ribs also. Babies tat are doing well don’t flare nostrils but as they get into respiratory distress they dilate nares and then marked to make a wider nasal passage (think breathe right nasal strips). A
baby doing well wont have n expiratory grunt but if they get into trouble first stethoscope then naked ear—expiratory grunt as an attempt to hold alveoli open at the end of expiration not a good thing. Sometimes you will have a late preterm baby (36 weeks) that doesn’t need the NICU but a regular nursery and for a few hours was doing fine and then a few hours later grunts with retraction and a lag with dilated nares—if born on the cusp of lung maturity have enough surfactant to get them through the first couple hours of life and then run out causing distress Retractions Xiphoid retractions—count ribs on baby with respiratory distress Airway, Breathing, Circulation
Nice open airway and establish breathing circulation will generally follow. Remember babies come with fetal circulation Fetal Circulation Purposes: 1. Decrease blood flow to fetal lungs this makes sense as a fetus your lungs are not your organ of respiration your placenta is so we need blood flow to placenta so we just need enough blood to your lungs to allow them to grow and mature but not enough to oxygenate the baby 2. Direct blood to the placenta organ of respiration 3. Increase blood flow to head & heart brain and heart are the two most important organs 1. Decrease Blood Flow to Fetal Lungs Fetal pulmonary BP > adult pulmonary BP want blood vessels to be clamped down
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- Fall '19