Page 84 - 2023 SMOG Digital

SPECIAL POPULATIONS

NEWBORN CARE & DISTRESS

Continued from: Meconium Staining of Amniotic Fluid? Targeted Preductal

• TACTICAL EVACUATION Guideline, • Suction mouth then nose until clear with bulb SpO2 After Birth
• CHILDBIRTH Guideline, or syringe. Deep suction is no longer advised.
• Pediatric RESPIRATORY DISTRESS Guideline 1 min: 60-65%
2 min: 65-70%
3 min: 70-75%
Maintain: 4 min: 75-80%
Universal Patient Care Guideline Post Resuscitation Care 5 min: 80-85%
(Mother and Newborn) • Clear Airway (bulb syringe mouth/nose) 10 min: 85-95%
• Dry Infant
• Keep Warm (wrap in blanket) Do NOT titrate O2 for
• Airway Open? (Breathing or Crying) o Avoid Hyper/Hypothermia SpO2 >95%
• Good Tone? YES • Determine APGAR Score
• Full Term Delivery? • Treat Hypoglycemia (Glucose <40) Signs of:
Dehydration
NO • Continuous Monitoring (with SpO2) • Tachycardia, ↓BP

• Clear Airway (Bulb syringe mouth/nose) • Sunken Fontanelles
• Dry Infant • HR <100? • No tears
• Stimulate (Foot Tap, Back Rub) • Apnea or Gasping? • Dry mouth, tongue, skin
• Keep Warm (wrap in dry blanket) • Labored Breathing? NO • ↓UOP
• SpO2 Monitor (if not already placed) • Persistent Cyanosis? Fluid Overload
• Determine APGAR Score • Shortness of Breath
YES • Ankle/Sacral Edema
Post Resuscitation Care • ↑Jugular venous pressure
• Clear Airway • Crackles in Lungs
• BVM (PPV): Titrate to 94-99% SpO 2 at
3 30–60 breaths/min APGAR SCORE
0
–
• SpO2 Monitoring • Determine by end of 1 st 60 seconds of care and repeat every 5 min.
• Score of 6 or less? Start Immediate Resuscitation.
(CPR: 90 compressions per 30 ventilations/min – provide supplemental O2 to
HR <100? NO APGAR titrate to 94-99% SpO2)

YES SCORING 0 POINTS 1 POINT 2 POINTS SCORE

Take Ventilation Corrective Steps Activity Absent Arms and Legs Active
(Intubate if NO Chest Rise) (Muscle Tone) Flex Movement
Pulse Absent Below 100 bpm Over 100 bpm
NO HR <60? Grimace Flaccid Some Extremity Active motion
(pull away,
YES (Reflex irritability) Flexion cough)

• Chest Compressions with PPV Appearance Blue, Pale Body Pink, Completely
(Skin color)
(120 events/min: 90 compressions Extremities blue Pink
interspersed with 30 ventilations) Respirations Absent Slow, irregular Vigorous cry
• Consider Intubation TOTAL
Epinephrine 1:10,000 APGAR:

0.01-0.03mg/kg push q3-5min
NO HR <60? YES (0.1-0.3mL of 1:10,000
10cc Cardiac Epi vial) Severely Depressed 0-3
Moderately Depressed 4-6
Excellent Condition 7-10
1. D12.5 1.0mL/kg IV (Dilute D50 to ¼ Consider:
strength (1mL D50 in 3mL NS) 1. Hypoglycemia (Treat Glucose <40)
2. IVF or Blood 10mL/kg IV 2. Shock
3. Intubation 3. Pneumothorax (Intubate)
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