OVERVIEW
Priorities:
- correction of hypoxia (most common cause of neonatal arrest)
- decreased risk of meconium aspiration
- support circulation
INITIAL ACTIONS
- Declare emergency
- Call for help (neonatal/paediatric registrar or consultant)
- Move baby to resuscitare
- Stimulate baby by drying
AIRWAY
- open airway and assess for patency (suction if required)
- if this baby doesn’t respond quickly will probably need intubation (appropriate size for term neonate = 3.5, intubate and place tip of ETT just beyond cords – ensure adequately ventilating both lungs, length @ lips should be 9cm)
- if meconium soiling airway intubate and suction down ETT before ventilating
BREATHING
- administer 100% O2 via bag-mask (5 effective breaths)
- provide PEEP
- watch for spontaneous breathing
- if no respiratory effort give IPPV until HR >100
CIRCULATION
- pulse = 60/min -> institute chest compression (3:1) @ rate of 100/min with thumbs around chest
- begin to obtain IV access by placing an IV cannula into the umbilical vein or interossous needle insertion
- administer adrenaline (0.1mL/kg o 1:10,000 – the average full term neonate = 3.5kg thus administer 0.35mL IV or 3.5mL into trachea)
- give an IV normal saline bolus of 70mL (20mL/kg)
- attach ECG if not responding ? shockable rhythm
DISABILITY
- send bloods for cord pH and ABG
- check glucose (dextrose 10% 5mL/kg)
- consider naloxone 200mcg IM
- consider NaHCO3 4.2% 1mmol/kg = 3.5mmoL
EXPOSURE/ ENVIRONMENT/ EVERYTHING ELSE
- keep warm and dry
- make sure wet towels are removed quickly and replaced with warm ones
- Constantly reassess airway, breathing, circulation, disability and exposure
- Transfer to neonatal unit for ongoing assessment and treatment
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