Presentation is loading. Please wait.

Presentation is loading. Please wait.

Physical Assessment and Newborn Stabilization: What You Can Do! Bette Johnson, CRNP, SCMC NICU Transport Coordinator Randa Bates, RN, NICU Transport Nurse.

Similar presentations


Presentation on theme: "Physical Assessment and Newborn Stabilization: What You Can Do! Bette Johnson, CRNP, SCMC NICU Transport Coordinator Randa Bates, RN, NICU Transport Nurse."— Presentation transcript:

1 Physical Assessment and Newborn Stabilization: What You Can Do! Bette Johnson, CRNP, SCMC NICU Transport Coordinator Randa Bates, RN, NICU Transport Nurse Doug Ferguson, RT, Airlink Respiratory Therapist

2 Questions to Consider How many staff have taken Neonatal Resuscitation(NRP)? How many staff have taken Neonatal Resuscitation(NRP)? Do you have a infant appropriate bags? Do you have a infant appropriate bags? Appropriate sized masks? Appropriate sized masks? Sat Probes? Sat Probes? Glucometer, or sticks? Glucometer, or sticks? Appropriate sized BP cuffs? Appropriate sized BP cuffs? Newborn Resuscitation Kit? Newborn Resuscitation Kit? Appropriate Sx equipment? Appropriate Sx equipment? Heat packs? Heat packs? Do you have monitors that can monitor an infant? Do you have monitors that can monitor an infant?

3 Provide Warmth, Position, Clear Airway, Dry, Stimulate to Breath CLINICAL ASSESSMENT Provide supplemental oxygen, as necessary Room air- 100% Assist Ventilation with Positive Pressure Ventilation MR SOPA Intubate the trachea Provide Chest compressions Administer Medications Neonatal Stabilization

4 MR SOPA If PPV not working M= mask, right size and fit M= mask, right size and fit R= reposition, neck and/or mask R= reposition, neck and/or mask S= suction, nose and mouth S= suction, nose and mouth O= open mouth while ventilating O= open mouth while ventilating P= increase pressure if no chest rise P= increase pressure if no chest rise A= consider alternative airway, intubate or LMA A= consider alternative airway, intubate or LMA

5 What to look for:

6 What You Can Do Continually assess- Five Apgar points Continually assess- Five Apgar points Maintain Warmth Maintain Warmth Maintain open and clear airway Maintain open and clear airway Provide supplemental oxygen Provide supplemental oxygen Call for help early Call for help early

7 Keypoints Initial steps of NRP are the most important Initial steps of NRP are the most important Most powerful tool initially is maintenance of airway- may prevent further decompensation Most powerful tool initially is maintenance of airway- may prevent further decompensation Oxygen is a powerful drug, start with room air, then go to 100% if no blender Oxygen is a powerful drug, start with room air, then go to 100% if no blender Know your equipment, maintain it and keep current on its use Know your equipment, maintain it and keep current on its use

8 Kit Lists Hat Hat Thermometer Thermometer Bulb Suction Bulb Suction Baby Booger Getter (BBG) Baby Booger Getter (BBG) Self-inflating bag and newborn mask Self-inflating bag and newborn mask Infant Sat Probes Infant Sat Probes Blankets Blankets Diapers Diapers Umbilical Tape Umbilical Tape Sucrose Sucrose 5 Fr. Feeding Tube 5 Fr. Feeding Tube Hat Hat Thermometer Thermometer Bulb Suction Bulb Suction Premie Mask Premie Mask Self-inflating Bag Self-inflating Bag Sat probe Sat probe Premie Diaper Premie Diaper Premie BP Cuff Premie BP Cuff Umbilical tape Umbilical tape Porta Warmer Porta Warmer Plastic bag/plastic wrap Plastic bag/plastic wrap Sucrose Sucrose 5 Fr. Feeding Tube 5 Fr. Feeding Tube Newborn Premature

9 Physical Assessment

10 VITAL SIGNS: Temp range: 97.8-98.6 VITAL SIGNS: Temp range: 97.8-98.6 Heart rate: 120s-160s, Resp rate: 40-60s Heart rate: 120s-160s, Resp rate: 40-60s Blood pressure: means approximate gestational age (i.e high 20s low 30s for preterms, high 30s low 40s for fullterm) Blood pressure: means approximate gestational age (i.e high 20s low 30s for preterms, high 30s low 40s for fullterm) SKIN: cyanosis vs acrocyanosis, perfusion, capillary refill, rashes, lesions, trauma SKIN: cyanosis vs acrocyanosis, perfusion, capillary refill, rashes, lesions, trauma HEENT: Head: scalp swellings, bruising, trauma Eyes: equal distance, lids open, pupils reactive HEENT: Head: scalp swellings, bruising, trauma Eyes: equal distance, lids open, pupils reactive Ears: in line with outer eye Nose: nares patent or not, Throat/Neck- no masses, clavicles intact or not Ears: in line with outer eye Nose: nares patent or not, Throat/Neck- no masses, clavicles intact or not

11 PHYSICAL ASSESSMENT CONTINUED CHEST: Tachypnea, Increased work of breathing: Barrel chest, retractions, grunting, breath sounds: clear and equal, coarse, diminished. Need for oxygen or assisted ventilation. Gasping or apnea CHEST: Tachypnea, Increased work of breathing: Barrel chest, retractions, grunting, breath sounds: clear and equal, coarse, diminished. Need for oxygen or assisted ventilation. Gasping or apnea HEART: rate, rhythm, murmur, pulses, blood pressure, perfusion (capillary refill >3secs) HEART: rate, rhythm, murmur, pulses, blood pressure, perfusion (capillary refill >3secs) ABDOMEN: full and soft, sunken, defect (omphalocele/gastroschisis), hard/firm/shiny, abnormal color ABDOMEN: full and soft, sunken, defect (omphalocele/gastroschisis), hard/firm/shiny, abnormal color

12 PHYSICAL ASSESSMENT CONTINUED EXTREMETIES: Number and placement of digits, movement equal, tone, trauma/bruising, lesions or marks EXTREMETIES: Number and placement of digits, movement equal, tone, trauma/bruising, lesions or marks NEUROLOGIC: tone, activity, able to focus on caregiver, response to painful stimuli, seizures NEUROLOGIC: tone, activity, able to focus on caregiver, response to painful stimuli, seizures GENITOURINARY: male vs female anatomy, can help tell gestation, anus present GENITOURINARY: male vs female anatomy, can help tell gestation, anus present

13 Premature vs Fullterm; Quick Assessment Preterm vs Fullterm: Weight - <5 lbs- full term babies who are small for gestational age can be under 5 lbs Weight - <5 lbs- full term babies who are small for gestational age can be under 5 lbs Gestational age- <37 weeks (35-37 weeks= late preterm infants) Gestational age- <37 weeks (35-37 weeks= late preterm infants) Physical exam: > lanugo, lanugo, { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/221354/1/slides/slide_12.jpg", "name": "Premature vs Fullterm; Quick Assessment Preterm vs Fullterm: Weight - <5 lbs- full term babies who are small for gestational age can be under 5 lbs Weight - <5 lbs- full term babies who are small for gestational age can be under 5 lbs Gestational age- <37 weeks (35-37 weeks= late preterm infants) Gestational age- <37 weeks (35-37 weeks= late preterm infants) Physical exam: > lanugo, lanugo, lanugo, lanugo,

14 Preterm vs Fullterm Infants

15 Why Does It Matter Preterm babies brains are vulnerable to pressure changes – fluids, ventilation, cold stress etc. affects brain- bleeding, apnea, seizures Preterm babies brains are vulnerable to pressure changes – fluids, ventilation, cold stress etc. affects brain- bleeding, apnea, seizures Preterm babies lungs are not fully formed in number of air sacs, capillaries and surfactant- respiratory distress, cyanosis Preterm babies lungs are not fully formed in number of air sacs, capillaries and surfactant- respiratory distress, cyanosis Preterm babies dont have good glucose stores- hypoglycemia Preterm babies dont have good glucose stores- hypoglycemia

16 Why does it matter Preterm babies dont have fat stores- hypothermia, poor temp regulation Preterm babies dont have fat stores- hypothermia, poor temp regulation Preterm babies guts are not mature- dysmotility, aspiration, emesis, perforation Preterm babies guts are not mature- dysmotility, aspiration, emesis, perforation Preterm babies dont have mature immune function- vulnerable to infection Preterm babies dont have mature immune function- vulnerable to infection Preterm babies dont have good autoregulation of blood pressure- hypotension, bleeding Preterm babies dont have good autoregulation of blood pressure- hypotension, bleeding

17 What You Can Do… Estimate weight Estimate weight Estimate Gestational age Estimate Gestational age Have vital signs available for report Have vital signs available for report Give summary of most immediate reason for transport i.e. respiratory distress, seizures, trauma, unresponsive/floppy, cyanotic etc Give summary of most immediate reason for transport i.e. respiratory distress, seizures, trauma, unresponsive/floppy, cyanotic etc Call for specialty team early rather than later Call for specialty team early rather than later

18 Physical Assessment Key Points Approximate gestational age and weight are important pieces of information to pass on Approximate gestational age and weight are important pieces of information to pass on Neurologic changes are often the first sign that a baby is getting sick Neurologic changes are often the first sign that a baby is getting sick Comfortably tachypneic babies may have a primary congenital heart defect that may be getting worse- watch them closely Comfortably tachypneic babies may have a primary congenital heart defect that may be getting worse- watch them closely Preterm babies reach breaking points faster than fullterm babies Preterm babies reach breaking points faster than fullterm babies Babies in general jump off cliffs instead of rolling down a hill Babies in general jump off cliffs instead of rolling down a hill

19 S.T.A.B.L.E. Program Condensed Version Developed to help all types of providers stabilize sick babies no matter what type of facility they were born in or out of i.e home, car, field Developed to help all types of providers stabilize sick babies no matter what type of facility they were born in or out of i.e home, car, field Allows for consistency in care Allows for consistency in care Good communication tool to discuss Neonatal issues Good communication tool to discuss Neonatal issues Focus on safety and quality of care Focus on safety and quality of care Sugar, Temperature, Airway, Blood Pressure, Lab Work and Emotional Support Sugar, Temperature, Airway, Blood Pressure, Lab Work and Emotional Support

20 SUGAR Things that make you go MMM!!!

21 Causes of Hypoglycemia Decreased Glucose Stores: Small for gestational age/Premature/Intrauterine growth restriction Decreased Glucose Stores: Small for gestational age/Premature/Intrauterine growth restriction Hyperinsulinemia – Infants of Diabetic Moms/Large babies/Syndromes Hyperinsulinemia – Infants of Diabetic Moms/Large babies/Syndromes 2/3 maternal glucose 2/3 maternal glucose Stress/Increased Utilization- Depletion of stores Stress/Increased Utilization- Depletion of stores Cold stress Cold stress Traumatic deliveries Traumatic deliveries Cardio/pulmonary diseases Cardio/pulmonary diseases Infection Infection Shock Shock

22 Sugar BABY! Keys for aerobic metabolism Keys for aerobic metabolism Oxygen + Glucose = Oxygen + Glucose = ENERGY ENERGY Anaerobic Metabolism Anaerobic Metabolism Lack of 02 or Glucose Lactic acidosis = Lactic acidosis = IMPAIRED FUNCTION IMPAIRED FUNCTION Symptoms include: Symptoms include: Hypotonia Lethargy Poor feeds High pitched or weak cry Jittery/Irritable Seizures Increased RDS Apnea Bradycardia ?what part of body is responsible for all of these symptoms???

23 How to check glucose Pre-warm the heel Pre-warm the heel Warm water, chemical warmer, warm towel Warm water, chemical warmer, warm towel Cold foot = falsely low reading Cold foot = falsely low reading Do not over squeeze heel Do not over squeeze heel Causes clotting, bruising and pain

24 What You Can Do Be vigilent in assessment for hypoglycemia: Be vigilent in assessment for hypoglycemia: Ask mother or caregiver for risk factors; gestation diabetes, on insulin, symptoms of hypoglycemia herself Ask mother or caregiver for risk factors; gestation diabetes, on insulin, symptoms of hypoglycemia herself If infant has stable vital signs with no respiratory distress: Consider breastfeeding if mom able and willing or give If infant has stable vital signs with no respiratory distress: Consider breastfeeding if mom able and willing or give Oral Sucrose (D25W) – drops in cheek with syringe

25 Glucose Infusion Guidelines D50W Preparation Draw up 2 ml of D50 add to 10 mls of sterile water to make D10W solution Draw up 2 ml of D50 add to 10 mls of sterile water to make D10W solution Approximate infants weight (1 lb = 2.2 kgs) Approximate infants weight (1 lb = 2.2 kgs) Give via IV or IO Give via IV or IO 2ml/kg 2ml/kg May give bolus over a few minutes, slower if preterm May give bolus over a few minutes, slower if preterm D25W Preparation Draw up 5 mls of D25 and add to 5 mls sterile water to make D12.5 Draw up 5 mls of D25 and add to 5 mls sterile water to make D12.5 Approximate infants weight Approximate infants weight Give via IV or IO Give via IV or IO 1-1.5 ml/kg 1-1.5 ml/kg Give over a few minutes, slower if preterm Give over a few minutes, slower if preterm

26 Sugar Key Points Premature, SGA, LGA and stressed babies at highest risk Premature, SGA, LGA and stressed babies at highest risk Maintain glucose greater than 50mg/dl Maintain glucose greater than 50mg/dl No sugar = decline in status No sugar = decline in status Recheck 30 min after treatment and if baby is symptomatic Recheck 30 min after treatment and if baby is symptomatic If cant check glucose and baby is symptomatic – treat using guidelines If cant check glucose and baby is symptomatic – treat using guidelines

27 Thermoregulation: If youre hot youre hot, if youre not youre not!

28 Normal 36.5 – 37.5 C or 97.8 – 98.6 F HEAT LOSS: Conduction = loss to objects that are colder Convection = loss via air currents Evaporative = moisture turns to vapor Radiation = Loss to colder object not in contact with baby WHY?: Large surface area = greater heat loss Lack of shivering ability = no heat production Exposed Defects = increased surface area

29 Which babies are at risk? Premature/Low Birth Weight Premature/Low Birth Weight Small for gestational age (SGA) Small for gestational age (SGA) Prolonged Resuscitation Prolonged Resuscitation Acutely Ill (often accompanies sepsis) Acutely Ill (often accompanies sepsis) Abdominal or Spinal Defects Abdominal or Spinal Defects Any infant born in a compromised environment – i.e. birth center, home, car, outdoors Any infant born in a compromised environment – i.e. birth center, home, car, outdoors

30 Term vs. Preterm Term Response Vasoconstriction Peripherally Vasoconstriction Peripherally Increased tone and movement Increased tone and movement Normal glucose stores Normal glucose stores Brown Fat Metabolism Brown Fat Metabolism Preterm Response/SGA Poor vasoconstriction Poor vasoconstriction Weak muscle tone Weak muscle tone Limited glycogen stores Limited glycogen stores Minimal or No Brown Fat Minimal or No Brown Fat

31 Effects of Cold Stress Significantly increased metabolic rate Significantly increased metabolic rate Increased Oxygen consumption Increased Oxygen consumption Increased Glucose metabolism Increased Glucose metabolism At extreme risk for hypoxemia, hypoxia and hypoglycemiaAt extreme risk for hypoxemia, hypoxia and hypoglycemia ***Preventing hypothermia is much easier than overcoming the detrimental effects once hypothermia has occurred.***

32 Adapted from S.T.A.B.L.E Program 5 th Edition

33 What You Can Do

34 All Babies: Dry Dry Place Hat Place Hat Increase environmental temp Increase environmental temp Decrease Drafts Decrease Drafts Warm blankets Warm blankets IV bags from warmer IV bags from warmer Chemical Warmers Chemical Warmers Infant dependant: Skin to skin Skin to skin Saran Wrap Saran Wrap Swaddle Swaddle *** Never microwave blankets or other objects for heat Always cover warmers with cloth Always cover warmers with cloth

35 Key Points All infants are at varying risk for hypothermia All infants are at varying risk for hypothermia Check axillary temps frequently Check axillary temps frequently Increase environmental temp- you should be hot! Increase environmental temp- you should be hot! Keeping an infant normothermic can help PREVENT the need for further stabilization Keeping an infant normothermic can help PREVENT the need for further stabilization

36 Maternal Conditions Causing Infant Distress Diabetes: insulin dependent or gestational non-insulin dependent. A1c significance Diabetes: insulin dependent or gestational non-insulin dependent. A1c significance Hypertension: either pre-pregnancy or pregnancy induced Hypertension: either pre-pregnancy or pregnancy induced Placental/Uterine disruptions: placenta previa, abruption, uterine rupture, cord prolapse Placental/Uterine disruptions: placenta previa, abruption, uterine rupture, cord prolapse Infections: GBS, e.coli, MRSA, listeria Infections: GBS, e.coli, MRSA, listeria

37 Airway Management

38 RESPIRATORY DISTRESS IN FULLTERM INFANTS: MOST COMMON CAUSES TRANSIENT TACHYPNEA- retained interstitial lung fluid TRANSIENT TACHYPNEA- retained interstitial lung fluid ASPIRATION- meconium, amniotic fluid, blood, breast milk or formula, gastric contents ASPIRATION- meconium, amniotic fluid, blood, breast milk or formula, gastric contents AIR LEAK SYNDROMES: pneumothorax AIR LEAK SYNDROMES: pneumothorax PNEUMONIA PNEUMONIA CARDIAC LESIONS: duct dependent CARDIAC LESIONS: duct dependent

39 RESPIRATORY DISTRESS IN PRETERM INFANTS: MOST COMMON CAUSES RESPIRATORY DISTRESS SYNDROME: RESPIRATORY DISTRESS SYNDROME: Surfactant deficiency and immature anatomy ASPIRATION: same as full term babies ASPIRATION: same as full term babies AIRLEAKS: pneumothorax AIRLEAKS: pneumothorax PNEUMONIA: always have sepsis on differential with infant in respiratory distress- think SHOCK PNEUMONIA: always have sepsis on differential with infant in respiratory distress- think SHOCK

40 SIGNS/SYMPTOMS OF RESPIRATORY DISTRESS TACHYPNEA- 100 breaths per minute or more- comfortable or increased work of breathing TACHYPNEA- 100 breaths per minute or more- comfortable or increased work of breathing APNEA/GASPING – cessation of breathing >15 secs APNEA/GASPING – cessation of breathing >15 secs RETRACTIONS- intercostal, subcostal, suprasternal, supraclavicular RETRACTIONS- intercostal, subcostal, suprasternal, supraclavicular NASAL FLAIRING NASAL FLAIRING GRUNTING GRUNTING CYANOSIS CYANOSIS

41 What You Can Do KEEP THEM SWEET - normoglycemic KEEP THEM SWEET - normoglycemic KEEP THEM WARM – neutral thermal KEEP THEM WARM – neutral thermal KEEP AIRWAY CLEAR AND HEAD IN SNIFFING POSITION KEEP AIRWAY CLEAR AND HEAD IN SNIFFING POSITION PROVIDE SUPPLEMENTAL OXYGEN PROVIDE SUPPLEMENTAL OXYGEN PROVIDE BAG/MASK VENTILATION PROVIDE BAG/MASK VENTILATION PLACE AN ALTERNATIVE AIRWAY- INTUBATE OR USE LMA PLACE AN ALTERNATIVE AIRWAY- INTUBATE OR USE LMA KEEP THEM HYDRATED KEEP THEM HYDRATED

42 Airway Key Points Respiratory distress can present in babies due to hypoglycemia, hypo/hyperthermia, hypovolemia, sepsis, neurologic injury, cardiac disease, pulmonary disease- often first sign of distress Respiratory distress can present in babies due to hypoglycemia, hypo/hyperthermia, hypovolemia, sepsis, neurologic injury, cardiac disease, pulmonary disease- often first sign of distress Preterm babies present faster than full term babies- lack of compensatory mechanisms Preterm babies present faster than full term babies- lack of compensatory mechanisms **Clearing the airway and correct use of positive pressure ventilation should be the first course of action, not cardiac compressions **Clearing the airway and correct use of positive pressure ventilation should be the first course of action, not cardiac compressions Oxygen is a powerful drug, use it wisely Oxygen is a powerful drug, use it wisely

43 INFANT SHOCK !!!

44 Common Types of Shock Hypovolemic Hypovolemic Septic - Distributive Septic - Distributive Cardiogenic Cardiogenic

45 Hypovolemic Shock Most common cause of shock in the initial newborn period Most common cause of shock in the initial newborn periodCauses: Intrapartum blood loss Intrapartum blood loss -fetal-maternal hemorrhage -placental abruption/previa -umbilical vessel injury - cord prolapse - cord prolapse -twin to twin transfusion -organ laceration or injury

46 Hypovolemic Shock Postnatal hemorrhages: in babies Brain – intraventricular hemorrhage Brain – intraventricular hemorrhage Lung – pulmonary hemorrhage Lung – pulmonary hemorrhage Adrenal glands- trauma Adrenal glands- trauma Scalp – most serious subgaleal, loss of most of blood volume - trauma Scalp – most serious subgaleal, loss of most of blood volume - trauma

47 Septic or Distributive Shock May be either viral or bacterial in origin May be either viral or bacterial in origin May become critically ill rapidly May become critically ill rapidly Hypotension may be profound and respond poorly to fluid resuscitation Hypotension may be profound and respond poorly to fluid resuscitation *Be prepared to give volume; 10ml/kg may need multiple doses (normal saline or lactated ringers) *Be prepared to give volume; 10ml/kg may need multiple doses (normal saline or lactated ringers) *Push boluses over 2-3 mins full-term, 5-10 preterm *Push boluses over 2-3 mins full-term, 5-10 preterm Cultures and antibiotics at referral hospital Cultures and antibiotics at referral hospital *ALS only *ALS only

48 Cardiogenic Shock Heart Failure Causes: Intrapartum/postpartum asphyxia Intrapartum/postpartum asphyxia Hypoxia and/or prolonged metabolic acidosis Hypoxia and/or prolonged metabolic acidosis Bacterial or viral infection Bacterial or viral infection Respiratory failure Respiratory failure Severe hypoglycemia Severe hypoglycemia Severe metabolic and/or electrolyte disturbances Severe metabolic and/or electrolyte disturbances Arrhythmias Arrhythmias Congenital heart disease Congenital heart disease

49 Evaluation of Shock Physical Exam Neuro- tone and activity- floppy, lethargic, not able to open eyes and look at you, pupils not reactive or sluggish Neuro- tone and activity- floppy, lethargic, not able to open eyes and look at you, pupils not reactive or sluggish Respiratory- in distress, tachypneic- work of breathing will worsen with shock Respiratory- in distress, tachypneic- work of breathing will worsen with shock Cardiac- cyanosis – look at gums not lips, pallor, >cap refill time, weak or absent pulses- compare upper to lower and side to side Cardiac- cyanosis – look at gums not lips, pallor, >cap refill time, weak or absent pulses- compare upper to lower and side to side Blood pressure is the last to go- babies jump off cliffs not roll down hill Blood pressure is the last to go- babies jump off cliffs not roll down hill

50 Differential of Cyanosis Central 1) Lungs: No oxygen in the lungs, no oxygen in the blood Premie lungs, aspirations, pneumothorax Premie lungs, aspirations, pneumothorax 2) Heart: 2 types: a) no blood from heart to lungs (right sided problem or pulmonary hypertension) b) No blood from heart to rest of body (left sided problem) 3) Blood: No Oxygen in Blood, no oxygen to the tissues - anemia

51 Cyanosis: Pulmonary vs Cardiac Pulmonary- baby will be in respiratory distress, cyanosis will improve with adequate oxygenation and ventilation Pulmonary- baby will be in respiratory distress, cyanosis will improve with adequate oxygenation and ventilation Cardiac- babies are usually comfortably tachypneic - cyanosis may not improve or only slightly improve with oxygen and ventilation. May be pale, waxy and no urine output Cardiac- babies are usually comfortably tachypneic - cyanosis may not improve or only slightly improve with oxygen and ventilation. May be pale, waxy and no urine output

52 Treatment of Shock- What You Can Do……… Volume, Volume, Volume – 10 ml/kg Volume, Volume, Volume – 10 ml/kg Lactated ringers, normal saline,blood not dextrose *****keep them hydrated Maintain neutral thermal environment Maintain neutral thermal environment *****Keep warm and dry *****Keep warm and dry Give glucose at 2ml/kg to keep glucoses >50 (dont forget to dilute if you have D25 or D50) Make D10W or D12.5W *****Keep them sweet Give glucose at 2ml/kg to keep glucoses >50 (dont forget to dilute if you have D25 or D50) Make D10W or D12.5W *****Keep them sweet *****Keep oxygenated with bag/mask or if needed intubate/LMA *****Keep oxygenated with bag/mask or if needed intubate/LMA

53 Blood Pressure/Shock Key Points 3 Main types of shock in neonates 3 Main types of shock in neonates Overlap may occur giving a combined effect Overlap may occur giving a combined effect Keep babies warm, sweet, oxygenated and hydrated Keep babies warm, sweet, oxygenated and hydrated Older babies with cyanosis not responsive to oxygen may have CHD that is getting worse with impending shock Older babies with cyanosis not responsive to oxygen may have CHD that is getting worse with impending shock Always consider sepsis as a cause for shock Always consider sepsis as a cause for shock

54 Common Lab Work NICU Transports Glucoses- keep >50 Glucoses- keep >50 *Blood gases- capillary or venous *Blood gases- capillary or venous *CBC – looking for infection *CBC – looking for infection *Blood culture – looking for infection *Blood culture – looking for infection *Electrolytes- not necessary, reflective of Moms values for 12-24 hours *Electrolytes- not necessary, reflective of Moms values for 12-24 hours *would most likely never do on your leg of transport *would most likely never do on your leg of transport

55 What WE Can Do For You…. We would love to help with: We would love to help with: Education – S.T.A.B.L.E, NRP, PALS Education – S.T.A.B.L.E, NRP, PALS Simulation workshops Simulation workshops Offer routine competency seminars Offer routine competency seminars Offer to come out and review equipment, supplies etc. make recommendations Offer to come out and review equipment, supplies etc. make recommendations We are available for questions at anytime We are available for questions at anytime We are here to help you provide optimal care to your communities

56 Contacts Bette Johnson, MSN, CRNP – NICU Transport Coordinator,STABLE Lead Instructor Bette Johnson, MSN, CRNP – NICU Transport Coordinator,STABLE Lead Instructor Randa Bates, RN, - NICU Transport Team NRP Instructor, STABLE support instructor Randa Bates, RN, - NICU Transport Team NRP Instructor, STABLE support instructor Carol Craig,MSN, CRNP- Resuscitation Coordinator, NRP Instructor Carol Craig,MSN, CRNP- Resuscitation Coordinator, NRP Instructor For all of the above call NICU at 541-382- 4321 – SCMC Bend: then ask for x1630 or x3777 (at night only) For all of the above call NICU at 541-382- 4321 – SCMC Bend: then ask for x1630 or x3777 (at night only)


Download ppt "Physical Assessment and Newborn Stabilization: What You Can Do! Bette Johnson, CRNP, SCMC NICU Transport Coordinator Randa Bates, RN, NICU Transport Nurse."

Similar presentations


Ads by Google