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So though neonatal resuscitation is not necessarily part of the normal BLS program, we think it's important that, for those of you who have an infant that's less than a month old, or for those of you who actually work with neonates, that you have an understanding of the differentiation between baby or infant CPR and neonatal resuscitation. So we're going to highlight some of the aspects of both the single and the two-rescuer CPR for the neonate. So we understand that a neonate is a baby that not necessarily falls into the category of premature, but is newborn up to 30 days. We're also going to understand that this baby, if they are in trouble, is in most cases going to be in trouble because of respiratory drive or a lack of oxygen, versus cardiac-driven cardiac arrest. So a lot of what you're going to see here is respiratory-driven respiratory response. And you'll see that reflected in how we give rescue breaths, but also in how we do CPR for a neonate that we do not suspect had cardiac arrest, and then that's why they're unresponsive. Now keep in mind that the rescue mask is very small. It's going to be important that you have it be the size appropriate for the neonate. They actually do have smaller face shields for preemies, and so it's important that if you're in a clinical setting, that you have the appropriate size equipment for the appropriate size patient. Now as we try to elicit a response from this baby, we find that they're not breathing normally, they're cyanotic, and they're not responsive. If we've not already called a code or called for 911 or EMS, we're now going to call for EMS. "You in the plaid shirt, go call 911, come back. I might need your help. And if you can find an AED bring it with you." If you're in a clinical setting, call a code and bring the cardiac resuscitation team in. Now I'm going to be checking for a brachial pulse for no more than 10 seconds. Now this baby in this situation has a pulse rate that is less than 100 beats per minute, but not less than 60. In this case I'm going to begin rescue breathing at a rate of 1 breath every 3 seconds. How much air do we put in, you say? Enough to get chest rise and fall. So 1 breath every 3 seconds. We're going to do this for 2 minutes. After 2 minutes I reassess for a brachial pulse, and now the brachial pulse is less than 60 beats per minute. I'm now going to go into neonatal resuscitation, which is going to be 3 chest compressions followed by 1 rescue breath, then followed by 3 more compressions and 1 rescue breath. And we keep that 3:1 ratio going for another 2 minutes. Landmarks are still the same, imaginary line across the nipples, 2 fingers down on the sternum. We're going to be compressing at the depth of 1/3 the chest of the baby, and we're going to be compressing no less than 100 times per minute, up to 120 times per minute. We're going to do this 3:1 for 2 minutes, reassess for a brachial pulse. If there is still a slow pulse, or no pulse, we're going to continue CPR, 3 compressions, 1 rescue breath, until EMS arrives, until the baby revives, or until an AED arrives. Now let's discuss the difference between single rescuer and two rescuer neonatal resuscitation. Now again, remember, there's a bit of a difference in how we resuscitate if we believe that the unresponsive neonate is due to a cardiac-related situation that led them to this versus a respiratory-driven problem. If it's respiratory-driven arrest, or bradycardia, meaning slow pulse, we're going to be doing 3 compressions to 1 rescue breath. If we believe though that there's a congenital heart defect or there was a cardiac arrest that led to their unresponsiveness and no breathing, we're going to do 15 compressions to 2 rescue breaths. So just a special note to keep in mind there. But when I have a second rescuer, this works extremely well, and it's usually going to be found more in a clinical or a professional healthcare provider related scenario. So with the second rescuer, we can incorporate things like high flow oxygen with bag valve mask, and we can also incorporate the circumferential thumb compression, which allows for a lot of efficiency when it comes to 3 compressions and 1 rescue breath. We're still going to do the setup the same way. We're still going to activate a code or EMS, but when we deliver the CPR, you'll see how we orchestrate two-rescuer into this. So we check for the baby's responsiveness and normal breathing. They are not breathing normally and they're not responding to my taps and shouts. I'm now going to activate EMS or call a code, and now we're going to assess the baby for a brachial pulse for no more than 10 seconds. If at that time I feel a pulse of 100 or less, but not less than 60, the rescue breather is going to give 1 rescue breath every 3 seconds. >> speaker 2: Breathe. >> speaker 1: 1 1000, 2 1000, 3 1000. >> speaker 2: Breathe. >> speaker 1: After 2 minutes of rescue breathing we're going to reassess a brachial pulse. If at that time the pulse rate is less than 60, we are now going to incorporate full neonatal CPR with 3 compressions followed by a rescue breath. 3 compressions, rescue breath. We're going to continue to do that until the patient begins to respond or an AED arrives. If the AED arrives, we're going to stop only to put the pads on, and then we'll move into the actual defibrillation mode. But we're going to continue to do this resuscitative effort until either the baby starts breathing normally or the next level of care comes to take over.
Neonates are newborns who are less than a month old. It's important to note that there are some significant differences between resuscitating neonates compared to infants.
As with infants, it's most common for the respiratory drive or lack of oxygen to contribute to the neonate's unresponsiveness versus a cardiac-driven event. This is important as it reflects how we perform rescue breaths and CPR. The following CPR instructions are for respiratory distress.
Pro Tip #1: The rescue mask for neonates is extremely small. It's important to have rescue masks to fit every size patient, as an adult mask could prove useless when trying to resuscitate a newborn.
After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin to assess whether or not the newborn is responsive.
If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the newborn's feet. If you still do not get a response, proceed with the following steps.
Pro Tip #2: If the newborn's pulse is 100 beats per minute or less but not less than 60, perform rescue breathing – one rescue breath every two to three seconds.
If the newborn's pulse is less than 60, begin to perform full neonatal CPR – three chest compressions followed by one rescue breath.
Pro Tip #3: Although most situations involving an unresponsive neonate will be due to a respiratory problem, remember that there is a difference in how we resuscitate an unresponsive newborn who has had a cardiac-related event that led to their current condition. If their condition was due to a congenital heart defect or cardiac arrest, perform 15 compressions to two rescue breaths and repeat.
This two-responder scenario is more likely to be found in a clinical or professional health setting. It allows the responders to incorporate things like high-flow oxygen with a bag valve mask and the use of circumferential thumb compressions. This is much more efficient when performing just three compressions to every breath, as one responder can handle the bag while the other performs the compressions.
Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations.
Pulse rate – 60 to 100 beats per minuteRespirations – 12 to 20 breaths per minute
Pulse rate – 80 to 100 beats per minuteRespirations – 15 to 30 breaths per minute
Pulse rate – 100 to 140 beats per minuteRespirations – 25 to 50 breaths per minute
Pulse rate – 120 to 160 beats per minuteRespirations – 40 to 60 breaths per minute