0071643192.pdf

Airway and breathing:

All basic CPR begins with opening the airway with a head tilt and chin lift

(jaw thrust alone if suspected trauma) and administration of two rescue

breaths.

Chest compressions:

Chest compressions may either push the blood out by direct compression

of the heart (cardiac pump theory) or produce blood flow via a pressure

gradient between the thorax and body (thoracic pump theory).

Factors that can worsen CPP:

■ Not allowing full recoil of chest (“push hard, push fast”)

■ Limits the “thoracic pump”

■ Interruptions in chest compression

■ Even brief interruption cause significant declines in CPP.

■ Overventilation

■ Decreases venous return and perfusion pressures

You are called to assess a newborn who just delivered on your ambulance

bay. He has been placed under a warmer and is being dried. On rapid

examination he has spontaneous respirations, poor tone, and an HR of

90 bpm. There was no meconium present on delivery. What is your first step in

the management of this neonate?

This neonate needs further resuscitation as his HR is < 100. The focus

should initially be on airway and breathing, beginning with (if no meconium

is present) positive pressure ventilation with 100% O 2 via BVM at a rate of 40–60

breaths/min. If the HR is not improved after 15–30 seconds, intubate, and provide

further positive pressure ventilation. A persistent low HR after this is indication for

chest compressions followed by cardiac drugs, glucose, and narcan if indicated.

NEONATALRESUSCITATION

Newborn resuscitation is unique compared to adult and pediatric resuscita-
tion in that the initial approach focuses almost entirely on management of the
airway and breathing. A primary cardiac etiology is uncommon.

Immediately after delivery the infant airway should be suctioned with a bulb
syringe (mouth, then nares); placed under warmer, dried, and positioned to
open airway (head tilt); stimulated; and assessed for respiratory effort and HR.

Indications for further neonatal resuscitation:

■ Apnea
■ HR< 100 bpm

TREATMENT

■ Airway
■ If meconium present→immediate intubation and endotracheal
suctioning.
■ Otherwise, provide positive pressure ventilationvia BVM (100% O 2 )
at 40–60 breaths/min.

RESUSCITATION

Factors that worsen CPP:

Interrupting chest

compressions

Overventilation

Improper CPR technique

Indications for neonatal

resuscitation:

Apnea

HR < 10 0