0071643192.pdf

■ Reassess breathing and heart rate (HR)after 15–30 seconds.

■ If apnea or HR < 100 bpm (by umbilical pulse or auscultation of pre-

cordium) →intubateand ventilate.

■ Reassess HR after 15–30 seconds.

■ If HR < 60 bpm→beginchest compressions.

■ Thumbs just below nipple line with hands encircling the chest

■ Depth = 1/3–1/2 depth of chest

■ Rate = 120/min

■ Compression: ventilation ratio 3:1 (with pauses for ventilation)

■ Reassess HR after 15–30 seconds.

■ If HR < 60 bpm →begindrug therapy.

■ Epinephrine

■ Narcan (as indicated)

■ Glucose

■ Normal saline (NS) bolus

PULSELESSVENTRICULARTACHYCARDIA ANDVENTRICULARFIBRILLATION

TREATMENT

■ The goal of treatment is to rapidly provide defibrillation while minimizing

interruptions in CPR.

■ Provide O 2 via BVM when available, but do not delay CPR.

■ Immediate CPR AND rapid defibrillation.

■ Critical interventions in first minute.

■ 360J monophasic (120–200J biphasic) asynchronous.

■ Administer one shock onlyat this time.

■ Immediately resume CPR after defibrillation (don’t pause to check

rhythm).

■ After2 minutes of CPR →check rhythm.

■ Defibrillate again, if needed.

■ Administer epinephrine. Repeat every 3–5 minutes for three doses or

a single dose of vasopressin may be substituted for the first or second

epinephrine.

■ After2 minutes of CPR →check rhythm.

■ Defibrillate again, if needed.

■ Administer lidocaine or amiodarone as antidysrhythmic therapy.

■ Evaluate for shockable rhythm. If present, administer shock.

■ If any of the above is successful, check pulse and →postresuscitation

therapy.

■ Change of rhythm to pulseless electrical activity or asystole should initiate

those algorithms (see below).

Pulseless Electrical Activity (PEA)

PEA patients may be differentiated into two groups:

■ Those with electrical activity and echocardiographic evidence of cardiac

motion

■ Those with electrical activity in the absence of any cardiac motion

■ Patients in this group have a worse outcome than those with cardiac

motion.

PEA often results from reversible causes. These must be aggressively pursued

and managed if present:

RESUSCITATION

Drug therapy in neonatal

resuscitation:

Epinephrine

Narcan (as indicated)

Glucose

NS fluid bolus

A shorter time from onset of

VFib to defibrillation = single

best determinant of successful

outcome in cardiac arrest.