Newborn Care:
http://www.emsworld.com/article/10318737/newborn-resuscitation
1. Protocol A2
2. After delivery of newborn
• Place newborn on mother’s chest/abdomen with minimal tension on umbilical cord
• Clamp and cut cord per skill 113.4
• If < 28 weeks gestation do not dry baby. Place newborn in polyurethane bag
with head exposed, wrap baby warmly
* Have a look at the start of this video for an example of the use of a bag to maintain normothermia in a premature newborn:
• If > 28 weeks gestation dry and wrap baby warmly
• Place newborn supine and perform APGAR score at 1 minute and 5 minutes
APGAR scoring
If baby is apnoeic or pulseless commence resuscitation immediately
24059553_ Controversies in neonatal resuscitation
3. Provide tactile stimulation and bag mask ventilation (room air) if any one or
more of the following signs are present:
• Heart rate < 100/min
• Apnoea or poor respiratory effort
• Hypotonia
23016614_ Oxygen administration for the resuscitation of term and preterm infants
4. Briefly suction mouth and pharynx under direct vision if secretions are present
5. CPR including airway management if heart rate <60/min, despite ≥30 seconds of
ventilation. Compressions should continue until heart rate >60/min and increasing
Ratio 3 compressions to 1 ventilation
(90 compressions: 30 inflations/min)
* A video from SMACC on resus of the newborn:
6. Repeat APGAR at 5 minutes, and every 5 minutes till APGAR >7
7. Adrenaline if HR <60/min despite effective CPR
8. Treat associated conditions if present:
– Hypoperfusion/hypotension
– Hypoglycaemia
9. Prevent Hypothermia
10. Urgent Transport if unresponsive to treatment
Adrenaline 10mcg/kg IV/IO every 4 minutes
– Indication: HR<60/min despite effective CPR
Hartmann‘s 10ml/kg IV/IO bolus
– Indication: Failure to respond to CPR and adrenaline
Glucose 10% 0.25ml/kg IV/IO bolus
– Indication: BGL <3mmol/L
A couple of videos on neonatal intubation and meconium suction:
The second one covers some basic stuff but has some great views of neonatal airways:
Placental Abruption:
This guys a bit annoying but this video is a good simple rundown of this time critical obstetric emergency:
And a simplistic rundown to help visualise the complications of Abruption, highlighting the need to be ready to treat for hypovolaemia and maintain endorgan perfusion
Placenta Praevia:
Sudden, bright red vaginal bleeding, most common at 29-32 weeks gestation. Usually painless.
Pre- eclampsia:
A longer video than I would normally put up but this is an excellent indepth discussion(I had a real light bulb moment in this one!):
Ectopic Pregnancy:
Any female of childbearing age with abdominal pain should raise an index of suspicion.
Uterine Inversion:
http://www.medscape.com/viewarticle/405770_1
Whilst usually occuring in the peri-delivery stage, inversion also occurs(very rarely) in chronic and acute settings due to fibroids or tumours.
Uterine Rupture:
http://reference.medscape.com/article/275854-overview
a very rare but catastrophic condition, only occurs in 0.07% of deliveries in developed countries.
Clinical Focus 