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Dr. Cooper
KEEP THE BABY WARM! – (Cold baby → hypoglycemia → seizures → death)
Make sure baby is not hypoglycemic. Neonates have non-shivering thermogenesis. They burn glucose to generate heat. They cannot shiver. (Brown fat)
Hypoxia → Bradycardia
Newborn – first 12-24 hours
Neonate – first month
6-10% of out of hospital births require ALS care
Maternal History
M – M – M – M
- Maturity
- Multiplicity
- Meconium
- Medications
Transition from fetus to newborn
- as a fetus lungs are collapsed and filled with fluid, most expelled during birth process
- must take first deep breath to inflate the lungs
- causes of delayed transition
- hypoxia
- meconium or blood aspiration
- acidosis
- hypothermia
- pneumonia
- hypotension
Anatomic Differences
- Airway
- shorter trachea
- delicate upper airway
- small soft epiglottis
- flexible tracheal rings
- obligate nose breathers
- Breathing
- fewer alveoli – less bronchial branches
- 30 m/kg lung fluid
- Preemies lack surfactant (<34 weeks)
- Circulation
- smaller blood volumes
- umbilical cord present
- Disability
- smaller glycogen stores
- delicate choroid plexuses (in brain – secrete CSF – can bleed profusely)
- larger TBSA/TBM – quicker hypothermia
- hypoxia and hypoglycemia poorly tolerated – leads to MR/DD – Death
- Family
- 97% babies are normal – scared family
- anger typically represents misdirected guilt
Cord clamping initiates the circulatory transition – closure of foramen ovale –Wait around 30 seconds to get most blood possible from placenta into baby.
maternal and fetal blood supply are separate and do not mix.
Problematic obstetrics conditions
- uterine/placental dysfunction
- placental disruptions
- ABO/D incompatibly – fetal hydrops
- fetal pelvic disproportions
- laryngeal webs
- nuchal cord
- prolapsed cord
Primary vs Secondary apnea (look up)
Prepare for delivery
4 ohs
- Ob kit
- Other hands
- Overheat ambulance
- Obstetric history
EMT ABC DEF
- Excretions, Meconium, Temp
- ABCs
- Dextrose, Epinephrine, Fluid
Suction secretions room nose first so as not to stimulate breathing, turn baby to side allow secretions to drain into cheek then suction mouth
When intubating for thick sticky meconium, the tube is the actual suction tube. use with a meconium adapter. pass a new tube up to three times then stop.
Dry thoroughly by patting , not rubbing
